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Background: Mental health (MH) diagnoses are known to complicate outcomes of underlying medical conditions in pediatrics, but the prevalence of MH diagnoses across the array of medically complex and/or chronic conditions are not well known. Objective: To compare prevalence of MH diagnoses across levels of medical complexity and chronicity, and identify factors associated with MH diagnoses among children with complex chronic conditions (CCC). Methods: This retrospective cross-sectional study included children ages 5-17 years with at least 11 months of continuous Medicaid enrollment in 2022 from the Merative Marketscan Medicaid Database which collects data from all children with Medicaid in the US. The primary exposures were three mutually exclusive levels of medical complexity/chronicity: non-complex/non-chronic (NCNC), non-complex chronic (NCC), and CCC. The primary outcome was presence of a mood or affective mental health diagnosis, including anxiety, depression, bipolar, obsessive-compulsive disorders, trauma-related disorders, and suicide/self-injury; coded in one inpatient/ED or two outpatient visits. Chi-square tests compared frequencies and multivariable logistic regression tested associations and estimated adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Included were 2.9 million children, of which 1.9 million (66.5%) were NCNC, 820,000 (28.1%) had a NCC, and 159,000 (5.5%) had a CCC (table 1). There were 310,000 (10.6%) children with a MH diagnosis. Rates of any MH diagnosis increased with increasing medical complexity and chronicity, with 7.6% in NCNC, 16.0% in NCC, and 20.0% in CCC (p< 0.001); similar stepwise increases were observed for all types of MH diagnoses (p< 0.001 for all; table 1). The prevalence of any MH diagnosis varied across the CCC categories (Figure). The CCC categories with the greatest adjusted odds of MH diagnosis were cardiac (OR 1.49 [95% CI 1.44-1.54]), neurologic (OR 1.18 [95% CI 1.14-1.23]), and renal (OR 1.13 [95% CI 1.06-1.21]; table 2). Among those with CCC, Black and Hispanic children had lower odds of MH diagnoses compared to non-Hispanic white, and foster care was associated with greater odds of MH diagnoses compared to other sources of Medicaid eligibility (table 2). Discussion: Prevalence of MH diagnoses increased with increasing medical complexity and chronicity. Variability in MH diagnoses across medical conditions, race and ethnicity, and foster care status may represent true differences in prevalence versus inequities in access to diagnosis. These populations may benefit from greater attention to MH diagnosis and treatment.

Publication Date

4-2025

Disciplines

Pediatrics

When and Where Presented

Presented at the 2025 Pediatric Academic Societies (PAS) Annual Meeting; Honolulu, HI; April 24-28, 2025.

Mental health diagnoses amongst children with complex chronic medical conditions

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Pediatrics Commons

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