Megan Cole Brahim, PhD, on addressing mental health concerns during pediatric primary care visits

Mental health concerns are being addressed with increasing frequency during pediatric primary care visits, according to a cohort study published in JAMA Network Open. Investigators found that visits involving mental health diagnoses rose steadily over the past decade, highlighting the growing role of pediatricians in identifying and managing behavioral health needs.¹

The study analyzed Massachusetts All-Payer Claims Database data from 2014 through 2023 and included 37.7 million person-quarters representing more than 1.8 million children aged 1 to 18 years. Researchers examined primary care visits that included a mental health diagnosis and evaluated trends across common conditions such as attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, autism spectrum disorder (ASD), and trauma-related disorders.

The rate of primary care visits involving any mental health diagnosis increased from 5.9 visits per 100 children in the first quarter of 2014 to 9.7 visits per 100 children in the first quarter of 2023. During the same period, overall primary care utilization declined slightly, suggesting that mental health concerns accounted for a growing share of pediatric visits.

Anxiety drives much of the increase

Among the mental health conditions studied, anxiety demonstrated the largest increase. Anxiety-related diagnoses accounted for 1.7% of primary care visits in 2014 and 6.1% in 2023, representing the largest absolute increase among all diagnostic categories.

Megan Cole Brahim, PhD, MPH, associate professor and division director in the Division of Health Policy and Insurance Research at Harvard Medical School, said the findings point to a sustained increase in mental health needs presenting within pediatric practices.

“Over a 10-year period from 2014 through 2023, we saw steady year-over-year increases in the extent to which mental health-related needs were presenting within pediatric primary care,” Cole Brahim said.

She noted that increases accelerated following the COVID-19 pandemic, but began before 2020.

“For anxiety specifically is where we really saw the largest absolute increases, nearly a 300% increase,” she said.

Although anxiety showed the largest growth, ADHD remained the most common mental health condition identified during pediatric primary care visits. The study found ADHD-related diagnoses increased from 5.0% of visits in 2014 to 6.7% in 2023.

Potential factors behind the trend

The study was not designed to identify causes of the increase, but Cole Brahim pointed to several factors that may be contributing to growing mental health needs among children and adolescents.

“I think a lot of other research has shown that things like exposure to social media, constant access to screens and digital technology, as well as some increasing academic pressures put on children and adolescents, are really driving some of these symptoms,” she said.

She also noted that the pandemic likely intensified existing challenges, particularly among adolescents.

“We also know that the COVID-19 pandemic exacerbated a lot of underlying mental health-related symptoms,” Cole Brahim said.

At the same time, improved screening may be contributing to increased detection. According to Cole Brahim, pediatric practices have become more effective at identifying anxiety and other behavioral health concerns over the past decade.

Expanding primary care capacity

The findings underscore the central role pediatric primary care plays in addressing behavioral health concerns. According to Cole Brahim, primary care is often the first—and sometimes only—point of contact children have with the health care system when mental health symptoms emerge.

She emphasized that screening alone is not sufficient and that practices need additional support to address growing demand.

“I think there's really a need to equip pediatric primary care practices with training, with staffing, with resources that really expand their capacity to effectively and really comprehensively address all of these needs,” she said.

Cole Brahim highlighted integrated behavioral health models as one potential approach, particularly because many children face barriers to accessing specialty mental health services.

“Most children have a very hard time accessing specialty mental health care,” she said. “Taken together with the fact that our data show that a lot of these mental issues, mental health issues are presenting frequently in primary care, it really motivates the need to increasingly integrate these services into pediatric primary care.”

The investigators concluded that additional training, staffing, and service capacity may be needed to help pediatric practices respond to increasing mental health needs, particularly for anxiety and ADHD.

Disclosure: Cole Brahim reports no relevant disclosures.

Reference

1. Gallagher KM, Burnett A, Kim J, et al. Pediatric primary care visits with mental health needs. JAMA Netw Open. 2026;9(5):e2613315. doi:10.1001/jamanetworkopen.2026.13315.