Why Pediatricians Need Training in Psychiatry

Key points

• Pediatricians have experienced a dramatic increase in patient visits for psychiatric conditions.

• This increase has occurred in both children (age 4 to 12) and adolescents (age 13 to 17).

• Much of this increase is attributed to an increase in anxiety disorders.

• It is critical that pediatric residents receive adequate exposure to child and adolescent psychiatry.

Much has been written recently about an increase in the number of American youths experiencing mental health conditions. In fact, several national medical associations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, declared an emergency in child and adolescent mental health in 2021. Considering the relatively small number of child and adolescent psychiatrists practicing in the U.S., pediatricians are increasingly seeing these patients.

A recent study published in Psychiatric Services by Alex Gertner and colleagues demonstrated a marked increase in the percentage of visits to primary care physicians by 4- to 17-year-old children and adolescents for psychiatric disorders. The researchers investigated which conditions are most responsible for this upsurge and whether demographic factors are associated with the increase.

The investigators analyzed data from the 2005-2019 waves of the National Medical Ambulatory Care Survey. Through a complex sampling design, this survey provides representative estimates of office-based physicians and outpatient visit characteristics.

Gertner and colleagues restricted their analyses to data from visits involving 4- to 17-year-old individuals. They counted a psychiatric diagnosis if it was listed by the treating physician in one of the top three diagnostic fields on forms that were filled out during each visit. Physicians utilized International Classification of Diseases (ICD)-9 (2005-2015) and ICD-10 (2016-2019) codes to classify psychiatric disorders. The research team grouped psychiatric disorders into the following categories: adjustment disorders, anxiety disorders, mood disorders, developmental disorders leading to mental impairment (including attention-deficit/hyperactivity disorder [ADHD]), conduct-related disorders, and other disorders (which included substance use disorders, psychotic disorders, eating disorders, personality disorders, and other less common disorders). They also collected information about psychiatric medications.

For the purposes of their study, the authors combined data from the 2005-2011 surveys and compared it to combined data from 2012-2019.

Key Findings

This study produced several key findings:

• Pediatric outpatient visits to primary care physicians for mental health conditions increased about 45 percent from 2005-2011 to 2012-2019. An increase was observed for both children aged 4 to 12 and adolescents aged 13 to 17.

• For 4- to 12-year-old children, the percentage of visits addressing psychiatric conditions increased from 8.7 to 11.4 percent. For adolescents aged 13 to 17 years, the percentage of mental health visits increased from 10.5 to 17.4 percent.

• The diagnosis most responsible for these increases was anxiety disorder. Among those with any mental health diagnosis, anxiety disorder diagnoses increased from 9 to 12.2 percent in the younger group and 14.8 to 26.4 percent in the older group.

• Among those with any mental health diagnosis, the percentage of visits for anxiety disorders increased from 16.7 to 26.9 percent in females and 8.5 to 13.6 percent in males.

• Statistically significant increases in pediatric mental health visits were seen for non-Hispanic White and Hispanic young people but not for Black youths.

• Psychiatric medications were prescribed at about 70 to 75 percent of pediatric mental health visits, and this percentage remained stable over time.

Our Thoughts

Primary care physicians, especially pediatricians, are responsible for treating an increasing number of children and adolescents suffering from anxiety disorders. Treatment typically involves medications and psychotherapy. However, treating a 4-year-old with anxiety is different from treating a 17-year-old.

Basic science and psychosocial science research are advancing our understanding of anxiety. These advances are informing treatment approaches. Because of the prevalence of psychiatric conditions now seen by pediatricians and the impact of advances in psychiatric research on treatment, it is imperative that pediatric residents gain meaningful experience in child and adolescent psychiatry. While such clinical training for pediatric residents is increasing, it must become part of all general pediatric residency programs. Collaborative care models with psychiatrists as consultants can also help pediatricians manage more complex patients.

The rise in youth mental health conditions is a national public health concern. There is a critical shortage of child and adolescent psychiatrists and, unfortunately, this will not change in the foreseeable future. Therefore, pediatricians will continue to play a central role in diagnosing children and adolescents with psychiatric conditions and coordinating their treatment.

Note: This article originally appeared on Psychology Today.