Complex Medical Conditions Drive Children’s Mental Health

The odds of a mental health diagnosis in children with chronic medical conditions increased stepwise based on the severity of their illness, according to data from nearly 3 million children presented at the Pediatric Hospital Medicine (PHM) 2025 in Anaheim, California.

Mental health diagnoses are known to complicate outcomes of underlying medical conditions in children, but the prevalence of mental health diagnoses across multiple complex, chronic conditions and the factors associated with them have not been well studied, wrote Maria Newmaster, MD, of Children’s Mercy Hospital, Kansas City, Missouri, and colleagues.

“Understanding mental health trends across the array of medical complexity and chronicity in pediatrics is important for informing intervention efforts, which may ultimately aid with disease trajectory and healthcare use and spending,” Newmaster said in an interview.

In a retrospective study, the researchers examined data from children aged 5-17 years with at least 11 months of continuous Medicaid enrollment in 2022 based on the Merative MarketScan Medicaid Database. The study population included 2.9 million children, categorized into noncomplex nonchronic (NCNC) conditions, noncomplex chronic (NCC) conditions, and complex chronic conditions (CCC).

The primary outcome was diagnosis of a mood disorder or affective mental health condition including anxiety, depression, bipolar disorder, obsessive-compulsive disorders, trauma-related disorders, and suicide/self-injury.

Overall, 310,000 (10.6%) of the children had a mental health diagnosis, and the rates increased stepwise with increasing severity and chronicity of disease: 7.6%, 16.0%, and 20% for the NCNC, NCC, and CCC groups, respectively. The most common mental health diagnoses were trauma/stressor disorders, anxiety disorders, and depressive disorders, accounting for 5.3%, 4.6%, and 4.3%, respectively.

In the CCC group, the prevalence of any mental health diagnosis varied across disease category. The disease categories with the greatest odds of a mental health diagnosis were cardiovascular, neurologic, and metabolic.

When stratified by race, Black non-Hispanic and Hispanic children were less likely to have a mental health diagnosis than non-Hispanic White children (adjusted odds ratios [aORs], 0.56 and 0.57, respectively).

However, foster care, female sex, and older age (13-17 years) were independently associated with increased odds of a mental health diagnosis (aORs, 3.37, 1.51, and 3.89, respectively).

The findings were limited by several factors including the retrospective design, the researchers noted. However, the variability in mental health diagnoses across medical conditions as well as race/ethnicity and foster care status may reflect true differences in prevalence vs inequities in diagnosis or access, they said.

The results can guide clinicians to increase attention on mental health screening and treatment in this patient population, Newmaster told Medscape Medical News.

Future studies may be aimed at identifying the proportion of children receiving mental health care intervention, as well as identifying specific risk factors among the complex chronic categories with the greatest odds of mental health diagnoses, she added.

Chronic Conditions May Drive Teen Isolation

The current study highlights the increased rates of mental health diagnoses that clinicians are seeing every day, said Margaret Thew, DNP, FNP-BC, a nurse practitioner and specialist in adolescent medicine at the Medical College of Wisconsin, Milwaukee, in an interview.

The increased numbers of children and adolescents presenting with mental health concerns cross all socioeconomic, acute, and chronic medical conditions, said Thew, who was not involved in the study.

“What has been a surprise is the positive mental health screenings we are seeing in primary and specialty clinics,” she said. These conditions have always been present, but more are being identified and treated, she said. Thew has been working with children and teens with disordered eating for the past 10 years and has never had a patient with cerebral palsy, but in the past year, she has had three who also have had some form of anxiety and anorexia nervosa.

“Developmentally, children compare themselves to others during preteen and early teen years, so I would image [imagine] the children who are developmentally appropriate but also deal with chronic conditions would compare themselves to peers; these comparisons spotlight their differences, and they may have increased isolation,” she said.

The implications of the current study for clinical practice include persistent screening of all children and teens, regardless of chronic conditions, Thew told Medscape Medical News. The study also shows the need for psychologists and practitioners with the knowledge and clinical skills to support the unique medical and mental health needs of children with chronic and complex health conditions, she said.

The study was limited by the use of insurance coverage to identify the population, as it may be missing a population not covered by Medicaid, Thew noted.

“This study may also have some reporting bias given the higher Caucasian population, female, and foster care status,” she said. “Although children in the foster care system may have higher rates of trauma and [mental and behavioral health], they may also be screened at a higher rate, resulting in sampling bias,” she explained.

The study received no outside funding. The researchers had no financial conflicts to disclose. Thew had no financial conflicts to disclose.