ImportanceDespite a federal declaration of a national child and adolescent mental health crisis in 2021, little is known about recent national trends in mental health impairment and outpatient mental health treatment of US children and adolescents.ObjectiveTo characterize trends in mental health impairment and outpatient mental health care among US children and adolescents from 2019 to 2021 across demographic groups and levels of impairment.Design, Setting, and ParticipantsSurvey study with a repeated cross-sectional analysis of mental health impairment and outpatient mental health care use among youth (ages 6-17 years) within the 2019 and 2021 Medical Expenditure Panel Surveys, nationally representative surveys of US households. Race and ethnicity were parent reported separately from 15 racial categories and 8 ethnic categories that were aggregated into Black, non-Hispanic; Hispanic; Other, non-Hispanic; and White, non-Hispanic.ExposureTime period from 2019 to 2021.Main Outcomes and MeasuresAge- and sex-adjusted differences between 2019 and 2021 in mental health impairment measured with the Columbia Impairment Scale (a score ≥16 indicates severe; 1-15, less severe; and 0, no impairment) and age-, sex-, and Columbia Impairment Scale strata–adjusted differences in the use of any outpatient mental health care in 2019 and 2021.ResultsThe analysis involved 8331 participants, including 4031 girls and 4300 boys; among them, 1248 were Black and 3385 were White. The overall mean (SE) age was 11.6 (3.4) years. The percentage of children and adolescents with severe mental health impairment was 9.7% in 2019 and 9.4% in 2021 (adjusted difference, −0.3%; 95% CI, −1.9% to 1.2%). Between 2019 and 2021, there was also no significant difference in the percentage of children and adolescents with less severe impairment and no impairment. The overall annual percentages of children with any outpatient mental health care showed little change: 11.9% in 2019 and 13.0% in 2021 (adjusted difference, 1.3%; 95% CI, −0.4% to 3.0%); however, this masked widening differences by race. Outpatient mental health care decreased for Black youth from 9.2% in 2019 to 4.0% in 2021 (adjusted difference, −4.3%; 95% CI, −7.3% to −1.4%) and increased for White youth from 15.1% to 18.4% (adjusted difference, 3.0%; 95% CI, 0.0% to 6.0%).Conclusions and RelevanceBetween 2019 and 2021, there was little change in the overall percentage of US children and adolescents with severe mental health impairment. During this period, however, there was a significant increase in the gap separating outpatient mental health care of Black and White youth.

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美国儿童和青少年的心理健康损害和门诊心理保健

重要性尽管联邦宣布 2021 年将发生全国儿童和青少年心理健康危机，但人们对美国儿童和青少年心理健康损伤和门诊心理健康治疗的最新全国趋势知之甚少。目的描述心理健康损伤和门诊心理健康护理的趋势2019 年至 2021 年美国儿童和青少年的不同人口群体和障碍程度。设计、设置和参与者调查研究，对青少年（6-17 岁）的心理健康障碍和门诊心理保健使用情况进行重复横断面分析2019 年和 2021 年医疗支出小组调查，即对美国家庭进行的全国代表性调查。种族和族裔是父母分别报告的 15 个种族类别和 8 个民族类别，这些类别汇总为黑人、非西班牙裔；西班牙裔；其他，非西班牙裔；暴露时间段为 2019 年至 2021 年。主要结果和衡量指标 2019 年至 2021 年，用哥伦比亚损伤量表测量的心理健康损伤存在年龄和性别调整后的差异（得分 ≥16 表示严重；1-15，严重程度较轻；0，无损伤）以及年龄、性别和哥伦比亚损伤量表分层调整后的 2019 年和 2021 年门诊精神卫生保健使用差异。结果分析涉及 8331 名参与者，其中包括 4031 名女孩和 4300 名男孩; 其中，黑人1248人，白人3385人。总体平均 (SE) 年龄为 11.6 (3.4) 岁。2019年，患有严重心理健康障碍的儿童和青少年比例为9.7%，2021年为9.4%（调整后差异，-0.3%；95% CI，-1.9%至1.2%）。2019年至2021年间，轻度障碍和无障碍儿童和青少年的比例也没有显着差异。接受任何门诊心理健康护理的儿童的年度总体百分比变化不大：2019 年为 11.9%，2021 年为 13.0%（调整后差异，1.3%；95% CI，-0.4% 至 3.0%）；然而，这掩盖了种族之间日益扩大的差异。黑人青少年的门诊心理健康护理从 2019 年的 9.2% 下降至 2021 年的 4.0%（调整后差异，-4.3%；95% CI，-7.3% 至 -1.4%），白人青少年的门诊心理健康护理从 15.1% 增加至 18.4%（调整后差异，3.0%；95% CI，0.0% 至 6.0%）。 结论和相关性 2019 年至 2021 年，美国患有严重心理健康障碍的儿童和青少年的总体比例几乎没有变化。然而，在此期间，黑人和白人青少年的门诊心理健康护理之间的差距显着扩大。