States Differ on Rate of Untreated Youth Mental Illness

From so many online columns and posts, it’s easy to get the impression that everyone is being prescribed some kind of psychiatric medication to improve their mood or attention span. Concerns regarding children and adolescents are frequently mentioned with the implication that parents are too quickly moving to pills to give some kids the edge or to medicate very typically occurring behaviors. These are reasonable concerns, and they deserve real data to help us understand the scope of any problems that may exist.

Recently, a short study was published that tried to shed light on these questions, looking not only at the U.S as a whole but state-by-state. Using a nationally representative survey of 50,212 children between the ages of 0 and 17, the researchers looked at the answer to two yes-or-no questions that were posed to parents:

1. Does your child have current diagnosis of ADHD, depression, or an anxiety disorder?
2. Has that child had received treatment for this diagnosis of any kind in the past 12 months?

Responses were then weighted to provide estimates for state and national rates.

Looking at the U.S. overall, the prevalence of one of the three types of psychiatric disorders was 16.5%, or about 7.7 million children. This number isn’t that far from the “1 in 5” quote you often hear about the rate of having any psychiatric disorder — and remember that the survey only asked about three types of psychiatric disorders. More surprisingly, however, parents reported that almost half the time (49.4%), the child was receiving no treatment of any type for that condition.

At the state level, the answers to these same two questions varied quite a bit. With regard to the prevalence of one of these diagnoses, the rate ranged from a low of 7.6% in Hawaii to a high of 27.2% in Maine. Regarding lack of treatment, the percentage ranged even more widely from 29.5% in Washington, DC, to 72.2% in North Carolina. Four states — Alabama, Mississippi, Oklahoma, and Utah — were in the top quartile both for percentage of children with a diagnosis and percentage of untreated children. A map in the article shows where each state is (by quartile) with regard to both levels of disorders and lack of treatment. (If you want to know where your individual state stands in these two areas and can’t access the article, post a comment and I’ll try to respond.)

The authors of this study concluded that emotional-behavioral disorders in youth were common and often untreated, and the article generated a fair amount of news coverage for such a small report. Certainly, there are lots of places to criticize the methodology of the study, but some of these “flaws” might cause the true rates to be under reported rather than the other way around.

We’re also not given answers for why more than half of psychiatric disorders are left completely untreated. It might be for a lack of availability for therapists, psychiatrists, and other mental health professionals, or maybe some of it was due to parental choice and concern over stigma or the symptoms not being that severe in the first place. We also know nothing about the accuracy of the diagnoses that are given. Nonetheless, the lack of treatment is unexpected to many and counters some of the conventional sentiment we often encounter that parents are rushing out to get their children placed on medications without cause.

My main point is this: There is no reason that we need to think about treatment overuse OR underuse as though they are mutually exclusive categories; there’s data to support that both things are happening. As parents, physicians, or mental health professionals, there can be real negative consequences both when youth receive unnecessary treatment and when those with real struggles get overlooked.