Children & Mental Health: Part One

HOST:  May is Mental Health Month in the United States.  In recent years, mental health awareness has grown as a major public health issue, with suicide being one of the leading causes of death in the country.  The arrival of the COVID-19 pandemic in 2020 placed even more of a spotlight on the subject, and NCHS collects data on topics such as anxiety and depression as well as mental health treatment in the U.S. during the pandemic, all part of the new national Household Pulse Survey.  During the period April 14-26, Pulse data showed that over 27 percent of adults suffered from anxiety in the past week, and that almost 23 percent suffered from depression.  A third, or 32 percent of adults, suffered from both.

These numbers are the lowest in over a year, but still pose a significant impact on American society and on the American health care system.  21 percent of adults used prescription drugs for mental health problems in the past four weeks, and nearly 10 percent received mental health counseling.  However, the number of suicides and the rate of suicide in the U.S. declined in 2019 and appeared to also decline in 2020, which runs somewhat counter to the fact that 1 in 4 adults either used prescription drugs or received counseling for mental health issues, while another 10 percent needed mental health treatment but did not receive it.

Mental health concerns are also significant among children, and last week the country observed “Children’s Mental Health Awareness Week.”  Suicide is the 2^nd leading cause of death among children between ages 10 and 14, and there is a great deal of concern about the impact of the pandemic on children’s mental health.

NCHS has several measures that provide insight into children’s mental health in the U.S.  And joining us today is Benjamin Zablotsky, a health statistician for the Division of Health Interview Statistics at NCHS.

HOST: What did the data tell us about the scope of mental health concerns among children in the U.S.?

BEN ZABLOTSKY: Sure, I think when we are talking about mental health concerns, we can break that down into two separate things – two different bins if you will.  The first would be the prevalence of mental health disorders in the United States.  And this includes developmental disabilities like autism spectrum disorder and intellectual disabilities, but it also includes behavioral and mental disorders like ADHD, anxiety, and depression.  And when we look at the prevalence of conditions we see about one in five or one in six, depending on what you look at, that seems to be about the prevalence of mental health concerns.  But I think we need to look beyond just the prevalence of these disorders.  The other “bin” I would talk about as it relates to mental health concerns is also what percentage of children are receiving treatment for mental health.  And when we’re talking about mental health treatment, we talk about whether a child is on a pharmaceutical medication or receiving counseling or therapy – and we look at those two things to get a sense of what percentage of the child population is on mental health treatment.  And the report I wrote in 2019 found that about 14% of children have received either a therapy or a mental health-related medication in the past 12 months.

HOST:  So there’s a lot of information out there.  Now, are teenagers at particular risk of mental health problems compared to adults, given all the changes they’re going through?

BEN ZABLOTSKY: I would say that older children are more likely to be diagnosed with anxiety and depression, and they’re typically along the same lines in terms of prevalence as adults.  And a lot of this just has to do with the stresses of being a teenager – it’s a challenging time.  Teenagers tend to experience a lot of transitions during that time period as it relates to school and their own development. So yeah, I would say certainly teenagers are more likely to experience the mental health conditions than their younger peers, and sometimes comparable to those of adults.

HOST:  Is there any sense that these issues have worsened or become more prevalent over time?

BEN ZABLOTSKY:  You know, people have looked at things like the prevalence of developmental disabilities over time and we have seen an increase in the prevalence of some of those disorders.  As it relates to teenagers and mental health, as it relates to both anxiety and depression, I believe there are some findings that have found higher rates of those two conditions – depression and anxiety – and some of it might be tied to the introduction of social media and the prevalence of bullying generally, including the kind of the more present cyber-bullying that wasn’t something that necessarily existed, you know, a few decades ago.

HOST:  So the social media and the cyber-bullying – is that something you’ve done any research on yourself?

BEN ZABLOTSKY: I haven’t looked at that personally but we actually are now including some questions on the National Health Interview Survey on bullying to get a sense of that from the parent perspective, and interestingly enough later this year as part of a CDC data modernization initiative, the Division of Health Interview Statistics is going to be launching a survey of adolescents.  These are actually people who were the subjects at the National Health Interview Survey, and we are going to be including some questions on cyber-bullying and bullying in general. This should be really great to look at to get a sense of that from the adolescent perspective.

HOST: You mentioned some of your research – could you talk a little bit more about some of the studies you’ve been involved in and what you found?

BEN ZABLOTSKY: Sure.  So as I was mentioning I kind of think of two different domains that my research lies in.  The first part is looking at the prevalence of mental health conditions generally, and most of that work has been focused around developmental disabilities.  And using the NHIS we explored how there might have been changes in the prevalence over time in children in the United States between (ages) 3 and 17.  And we actually did find a significant increase in the prevalence of developmental disabilities over time, with the current prevalence being about one in six children in the United States.  And then some of the other work that I do which focuses on the treatment side of things – which I think is really important just to make the point that even though we’re talking about the prevalence of these disorders, we’re really only talking for the most part about the prevalence “diagnosed” disorders.  And so it’s quite possible that children could be receiving treatment for their mental health that’s not affiliated or to a specific disorder.  So that mental health treatment side, we are finding in a report that used data from 2019 that about 14% of children are receiving mental health treatment, either in the form of taking a medication for their mental health or receiving counseling or therapy from a mental health professional in the past 12 months.

HOST:  So often times mental health is something that’s viewed as kind of a silent problem, and therefore it’s assumed that people who need treatment aren’t getting it.  Would you say that your data support that or does it show that on contrary kids are actually getting treatment for some of these problems?

BEN ZABLOTSKY: Right.  So there are situations where if you were to kind of do a crosstab of children who have a diagnosed condition and a child who has received mental health treatment, it’s not a one-to-one match.  So there are certainly situations where children who don’t have a diagnosis are still receiving mental health treatment, and a lot of times it might be a situation where the child doesn’t have access to services to get a diagnosis but they certainly can find resources in the community to get treatment of some sort to help in the treatment of the diagnosis that just might be not actually diagnosed by a professional.

HOST:  Next week we will continue our discussion with Ben Zablotsky about his research on mental health issues facing children in the U.S.

This week, NCHS released the latest quarterly data on infant mortality in the U.S., showing a rate of an estimated 5.50 infant deaths per 1,000 live births in the one-year period ending in mid-year 2020, the lowest rate on record.

NCHS also released the latest monthly data on drug overdose deaths in the country, for the one-year period ending in October 2020.  Over 91,000 Americans died from drug overdoses during this period, a 30% increase from the same period a year ago.

Finally, NCHS released an analysis of total fertility rates by educational attainment, which showed that women with no high school diploma are giving birth at above-replacement levels whereas women with the highest educational attainment are giving birth at levels considerably below replacement.