Mental Disorders Treatment Rates Remain Low Among Children and Adolescents

Treatment rates for depression, anxiety, ADHD, and behavior disorders among children and adolescents are low—and rates differ by age, income level, and region, according to a new international study.

Investigators, led by Sifan Wang, BM, of the school of public health at Kunming Medical University in Yunnan, China, noted that prior research suggests low treatment rates for pediatric and adolescent mental disorders may be linked to multiple determinants.

“The coverage of mental health services is inadequate,” the team wrote. “Fewer approved drug therapies for treating mental disorders among children and adolescents limit possible treatment options.”

The prevalence of mental disorders among children and adolescents has been growing for a few decades now. Anxiety, depression, ADHD, and behavior disorders such as oppositional-defiant disorder and conduct disorders are the most common mental disorders among youth. According to a 2015 study, there was a mental disorder worldwide prevalence of 13.4%, with the prevalence of specific common mental disorders was as followed: anxiety (6.5%); depression (2.6%); ADHD (3.4%); and behavior disorders (5.7%).2

In 2019, 1 in every 8 people globally lived with a mental disorder. In 2020, the prevalence of anxiety and depression disorders rose 26% and 28% respectively.3

Depending on the region where people live, mental disorder prevalence varies. For example, 20% of people in North America have a mental disorder, whereas 12% do in Europe and Asia, and 8% do in Africa. As for gender, boys are more likely than girls to receive an ADHD diagnosis. Age also plays an important part; adolescents are more likely to have an affective disorder or behavior disorder than children.

While age can affect the prevalence of mental disorders, a prior study found that about 75% of mental disorders diagnosed at adult age also had undetected psychiatric symptoms in childhood or adolescence.

For Wang and colleagues’ analysis, the team examined 40 studies, published between 1988 – 2021, that conducted diagnostic interviews. The mental disorders included were depressive disorders like major depressive disorder, destructive mood disorder, and dysthymia; anxiety disorders like generalized anxiety disorder, panic disorder, and PTSD; and behavior disorders like oppositional defiant disorder and conduct disorder.

The team only stuck to the common mental disorders and therefore did not include bipolar disorder, borderline personality disorder, and autism spectrum disorder for the study.

The investigators found there was no significant differences in treatment rates for any mental disorder, depressive disorder, anxiety disorder, or behavior disorder. However, the subgroup differences for ADHD were statistically significant.

For depressive disorders, the data suggested that America had significantly 40% more treatment rates (40%; 95% CI, 30 – 51) than the 28% in Europe (28%; 95% CI, 13 – 43) and the Western Pacific region(6%; 95% CI, 1- 16) (P <.001).

“This discrepancy may be caused by social norms and the stigma associated with psychological disorders, for negative biases against people with mental illnesses have been found to be common in Western European countries,” the investigators wrote. “Compared with US adults (23%), a much higher proportion of European adults (41 - 45%) reported unwillingness to see a professional when experiencing emotional distress.”

The investigators found no significant differences between children (<12 years old) and adolescents (13 – 17 years old) in treatment rates of any of the mental disorders, ADHD, and behavior disorders. Though there was a difference with anxiety and depression. Adolescents (36%; 95% CI, 25 – 46)had a higher treatment rate for depressive disorders than children (11%; 95% CI, 0 – 25) (P <.001).

“The onset of childhood depression can be subtle: children may express irritability and frustration through tantrums and behavioral problems rather than verbally expressing their feelings,” the investigators wrote. “Meanwhile, compared with adolescents, children with a diagnosis of depressive disorder are less prone to exhibit suicidal behavior,70 which may account for their lower treatment rates.”

As for anxiety disorders, treatment higher was higher for children (64%; 95% CI, 52 – 75) than adolescents (20%; 95% CI, 9 – 30) (P <.001).

“The treatment rate of anxiety disorders among adolescents was lower than among children, probably because, compared with adolescents, children with anxiety disorders are more prone to experiencing physical symptoms such as shortness of breath, headaches, stomach pain, and heart palpitations, which may prompt parents to seek assistance,” the team wrote.

Then, for income comparisons, high-income countries had a higher treatment rate of any mental disorder (43%; 95% CI, 35 - 52) while upper-middle income countries were only 24% (95% CI, 2 – 47), and lower-middle income countries was 6% (95% CI, 2 – 14). The same is the same for anxiety treatments; for anxiety there was a 31% treatment rate (95% CI, 16 – 46) for upper-middle income countries and 34% treatment rate (95% CI, 18 – 49) in high-income countries.

The investigated noted incongruity in treatment rates as parents reported higher treatment rates for anxiety (48%; 95% CI, 21 – 76) than their children (24%; 95% CI, 13 – 35).

As for internalizing disorders and externalizing disorders, the combined treatment was 34% (95% CI, 26 – 43) and 54% (95% CI, 39 – 70), respectively.

Overall, the investigators found consistently low treatment rates among children and adolescents.

“Lack of knowledge about mental health and available help, perceived social stigma and embarrassment, therapeutic relationships with professionals, financial costs associated with mental health services, and logistical concerns were also frequently cited barriers,” the investigators wrote. “Lower treatment rates were found for depressive disorders and anxiety disorders, probably because children and adolescents are reluctant to disclose their emotional difficulties to other people for support, owing to fears of negative social consequences.”

References

1. ^{Wang, S, Li, Q, Lu, J, et. Al. Treatment Rates for Mental Disorders Among Children and Adolescents. JAMA Network Open. 2023. doi:10.1001/jamanetworkopen.2023.38174.}
2. ^{Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: ameta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345-365. doi:10.1111/jcpp.12381}
3. ^{Mental Disorders. World Health Organization. June 8, 2022. https://www.who.int/news-room/fact-sheets/detail/mental-disorders. Accessed October 20, 2023.}