The number of U.S. children and teens being treated for mental health issues has risen by about 50 percent in the past 20 years -- with most of those kids having relatively mild symptoms, a new study finds.
The research, published in the May 21 issue of the New England Journal of Medicine, comes at a time of growing concern over young people's mental health treatment.
In particular, some worry that kids with milder issues are being overtreated with antidepressants, stimulants (such as those used for attention deficit hyperactivity disorder) and antipsychotic drugs, said lead researcher Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University in New York City.
According to Olfson, his findings suggest that kids with less serious symptoms account for a large share of young people getting mental health care -- whether that means medication or "talk therapy."
"But we don't know if that's a positive or a negative development," said Olfson. "When you're looking at trends across the whole U.S., you can't tell who does or doesn't 'need' treatment."
And at the other end of the spectrum, he said, there are plenty of kids with more severe symptoms who are not getting treatment at all.
So, the story is more complicated than "U.S. kids are being overtreated," Olfson noted.
For the study, Olfson's team used a set of government surveys done between 1996 and 2012.
The researchers found that from 1996 to 1998, just over 9 percent of U.S. kids aged 6 to 17 received mental health treatment annually. By 2012, that figure had risen to over 13 percent.
Severity of problems
Next, they looked at the severity of kids' mental health issues, which they judged using parents' ratings on a standard scale.
It turned out that in terms of sheer numbers, kids with milder problems accounted for much of the increase in mental health treatment. By 2012, about 4.2 million were in treatment -- versus 2.7 million per year in the 1996-1998 period.
However, Olfson said, the relative increase in treatment was greater among kids with more severe problems: By 2012, about 44 percent were getting some kind of therapy, compared with only 26 percent in the late 1990s.
Brendan Saloner, an assistant professor of health policy and management at Johns Hopkins University in Baltimore, believes this is good news. "More kids with higher levels of impairment are getting treatment," he said.
However, there's still room for improvement, said Saloner, who was not involved in the study.
Olfson agreed. "Most kids with more severe impairment don't receive any treatment. Clearly, we need to do better."
What is "more severe impairment"? Basically, Olfson said, it means a child has significant problems at school, getting along with peers and getting along with family. It does not refer to any particular mental health disorder.
The question of whether kids with less serious issues are being overtreated is more complicated, according to Saloner. "Many of them might benefit from getting some help," he said.
"The real issue is, what is the quality of that care?" he added.
The main worry, Olfson said, is that those kids are receiving too many medications. Parents are usually open to counseling, he noted, and guidelines do recommend that kids try talk therapy before drugs.
Unfortunately, Olfson said, there are barriers to that.
"There are fewer than 10,000 child psychiatrists in the U.S.," he noted, "and they're concentrated in a few urban and more affluent areas."
And even if there are therapists nearby -- and insurance will pay -- it can be hard for working parents to get their child to regular appointments, Olfson said.
Still, his study found that both talk therapy and medication use increased over the years: By 2012, 26 percent of more seriously impaired kids were in counseling -- as were almost 4 percent of kids with less serious issues.
Medication was more popular, though. Almost one-third of kids with serious impairments were on a stimulant, antidepressant or other psychiatric medication. The same was true for 6 percent of less impaired kids.
Some of those medication trends are potentially worrying, according to Olfson. By 2012, more kids with less serious issues were on stimulants, antidepressants or antipsychotics.
Still, Olfson noted, the absolute numbers were fairly small. About 1.5 percent of those kids were on an antidepressant, for example.
There was also an unexpected positive finding, Olfson said: The number of kids with severe impairments actually went down over time -- from almost 13 percent in the 1990s, to just under 11 percent by 2012.
That stands in contrast to a recent government study that suggested mental health issues are increasing among U.S. kids.
The difference, Olfson said, is that the government study asked parents if their child had been diagnosed with a mental disorder. This study asked parents about their children's level of impairment.
"The decline we found in severe impairment paints a more hopeful picture," Olfson said. "In many ways, I think we're moving in the right direction."