Mental Health Conditions Among Children — Trends and Demographic Disparities at National and State Levels
Alexia Málaga
2025 Council of State and Territorial Epidemiologists 2025 Annual Conference
Background
Early diagnosis of mental health conditions among children is vital to provide adequate care and support and reduce problems at home, school and socially. Understanding demographic trends and disparities can illuminate populations needing support for timely diagnosis and treatment.
Methods
Prevalence estimates, 95% confidence intervals and disparity ratios were calculated using 2-year estimates of National Survey of Children’s Health data. Mental health conditions (MHCs) is defined as the percentage of children ages 3-17 with a current, diagnosed mental or behavioral health condition such as ADHD, anxiety, behavioral problems or depression. Estimates were broken down by state, sex, race/ethnicity and caregiver educational attainment. All statistical analyses were performed using R-4.3.1.
Results
Nearly 12.1 million children in the U.S., or 1 in 5, had MHCs in 2022-2023, approximately 1.4 million more than in 2020-2021. The prevalence of MHCs significantly increased 12% since 2020-2021 and 28% since 2016-2017.
In 2022-2023, the most prevalent MHCs were anxiety (10.7%) and ADHD (10.5%) followed by behavioral problems (7.5%) and depression (4.4%). Since 2020-2021, anxiety significantly increased 18% and ADHD increased 12%. Since 2016-2017, depression, anxiety and ADHD significantly increased 47%, 45%, and 21%, respectively.
In 2022-2023, the prevalence of MHCs was 3.8 times higher among American Indian/Alaska Native (24.9%) than Hawaiian/Pacific Islander (6.6%) children, 2.1 times higher in Maine (28.9%) than Hawaii (14.0%), 1.6 times higher among children whose caregiver has some post-high school education (22.8%) than children whose caregiver has less than a high school education (14.2%), and 1.2 times higher among males (21.5%) than females (18.2%).
Between 2020-2021 and 2022-2023, the prevalence of MHCs significantly increased 16% among females, 10% among males, 15% among white children and 14% among children whose caregiver is a college graduate. These same populations experienced significant prevalence increases since 2016-2017, with the addition of children whose caregiver has some post-high school education or is a high school graduate, and Hispanic and multiracial children.
Conclusions
More children are being diagnosed with MHCs each year, and anxiety and ADHD are the most prevalent. ADHD increased the most since 2020-2021, while depression increased the most since 2016-2017. Children whose caregiver has less than a high school education had the highest prevalence of MHCs in 2016-2017 and lowest in 2022-2023. This group didn’t experience significant changes, rather prevalences among higher education groups have increased. While the prevalence of MHCs remains significantly higher among males than females, the disparity ratio has been narrowing.
Limitations
It is possible that the rise in diagnosed mental health conditions reflects an increase in diagnoses rather than the underlying conditions. NSCH data are reported by a parent or guardian. While a caregiver is likely to be aware of diagnoses, it is possible that the caregiver responding to the survey is unaware or unwilling to report a diagnosis. Anxiety, depression, and ADHD are as diagnosed by a doctor, while behavioral problems include those diagnosed by an educator.
