Pediatric mental health treatment rises above prepandemic levels

Pediatric mental health treatment remained above prepandemic levels after schools reopened and COVID-19 restrictions eased, with increases driven largely by children entering care and particularly pronounced antidepressant increases among girls, according to a nationwide study published in JAACAP Open.^1,2

The retrospective study included 13,302,511 children and adolescents aged 3 to 18 years with health care encounters from October 2018 through December 2022. Investigators examined psychiatric diagnoses, psychotropic medication initiation, and psychotherapy before, during, and after the pandemic.

How did pediatric mental health treatment change after the pandemic?

Rates initially declined during early pandemic lockdowns before rebounding by March 2021. During the postpandemic period, incidence of new psychiatric diagnoses was 23.9% higher than prepandemic levels, while psychotropic medication initiation increased 35.2% and psychotherapy increased 26.0%.

Raman Baweja, MD, MS, professor of psychiatry and public health sciences at Penn State College of Medicine and first author of the study, said the findings should be considered within a longer-running pediatric mental health problem.

"This is not a new phenomenon. Unfortunately, we are in a public health crisis, especially of our youth mental health," Baweja said.

Baweja noted that pandemic-related isolation, disrupted social interaction, and changes in schooling may have affected children differently depending on their developmental stage.

Which children experienced the largest increases?

Antidepressants showed the largest medication-specific increase, with initiation rising from 147 per 100,000 children accessing health care prepandemic to 229 per 100,000 postpandemic.

Differences were particularly pronounced among girls. Antidepressant initiation increased 136.8% among girls aged 6 to 12 years and 65.3% among girls aged 13 to 18 years compared with prepandemic levels.

"It did not impact everyone the same," Baweja said, adding that adolescent girls and girls aged 6 to 12 years received more antidepressants following the pandemic.

Why did stimulant initiation rise among preschoolers?

Another notable finding involved children aged 3 to 5 years. Central nervous system stimulant initiation increased from 32 per 100,000 prepandemic to 79 per 100,000 postpandemic, a 146.9% increase.

Baweja said difficulty accessing behavioral health services may help explain the increase. Parent training in behavior management is recommended as initial treatment for young children with attention-deficit/hyperactivity disorder, but therapy and parent training can be difficult to obtain.

"Accessing those services, unfortunately, is the challenge," Baweja said. "So, that may be pulling towards, “Okay, we need to do some alternative treatment,” which is not the ideal, but sometimes that's the only option they have."

Did telehealth eliminate disparities in mental health care?

Racial and ethnic disparities persisted across the study period. Hispanic youth had lower rates of psychiatric diagnoses, medication initiation, and psychotherapy than non-Hispanic youth, while substantial differences were also observed across racial groups.

Although telehealth expanded during the pandemic, Baweja said availability of virtual care alone does not ensure access. Barriers can include internet connectivity, technology access and literacy, stigma, and mistrust of the health care system.

"Just having that tele access from the healthcare system is not going to resolve everything," he said.

What should pediatricians take from the findings?

The study measured documented diagnoses and treatment among children accessing health care rather than population-level prevalence of mental health conditions, an important distinction when interpreting the increases.

For pediatricians, Baweja emphasized routine identification of mental health concerns and connecting families with evidence-based services. When local services are limited, he pointed to telephonic psychiatric access programs that can provide consultation and care coordination.

References

1. Baweja R, Waschbusch DA, Matos Padilla F, Mattison RE, Waxmonsky JG. Post-pandemic trends in pediatric mental health treatment: a nationwide study. JAACAP Open. 2026;4(4):625-637. doi:10.1016/j.jaacop.2026.04.006.
2. Penn State. Kids received mental health treatment in record numbers after pandemic. Eurekalert. July 9, 2026. Accessed August 21, 2026. https://www.eurekalert.org/news-releases/1135555