JAMA Netw Open
Anxiety visits in pediatric primary care up 300% in a decade
Clinical Takeaway: Anxiety and ADHD now drive most mental health visits in pediatric primary care. Screening, brief intervention, and warm handoffs to integrated behavioral health are increasingly part of the job.
Children's mental health needs are landing in pediatric primary care at rising rates, and the shift is most pronounced for anxiety. The setting matters because nearly all children have a primary care provider, while specialty mental health access remains constrained.
Primary care visits with any mental health diagnosis rose from 5.9 per 100 children in early 2014 to 9.7 per 100 children in early 2023 across Massachusetts. Over the same period, all-cause primary care visits drifted slightly down, from 58.9 to 54.8 per 100 children. Mental health work is growing inside a visit base that is not growing.
Anxiety accounted for the largest absolute shift. The share of primary care visits carrying an anxiety diagnosis rose from 1.7% to 6.1%, a roughly 300% relative increase over the decade. ADHD remained the most common mental health diagnosis at these visits, climbing from 5.0% to 6.7%. Smaller increases were seen for autism spectrum disorder (0.5% to 2.0%), trauma and stressor-related disorders (0.8% to 1.6%), and depression (1.2% to 1.6%).
The cohort study drew on the Massachusetts All-Payer Claims Database from 2014 through 2023, covering nearly all insured children ages 1 to 18 in the state. Whether the trend reflects rising underlying prevalence, expanded screening, better recognition, or some mix is not resolved here.
The authors flag all three as plausible contributors. Either way, the practical implication points the same direction: primary care is increasingly where these children are first identified and, often, where their care begins. The authors point to integrated models, including the TEAM UP program that embeds behavioral health into pediatric primary care, as one route to match capacity to demand.
"Mental health needs affect about 1 in 5 children, but many families struggle to get specialty mental health care," said Megan Cole, PhD, MPH, senior author and associate professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute. "Our findings show that primary care doctors are increasingly caring for children with mental health needs, especially anxiety."
Source: Gallagher KM. JAMA Netw Open. 2026 May 18. Pediatric Primary Care Visits With Mental Health Needs