Primary care on the front lines of the youth mental health crisis

Youth mental health © Liubomir - stock.adobe.com

A new national study of more than one million children and teens diagnosed with major depressive disorder (MDD) revealed a notable trend: primary care physicians — not mental health specialists — are the first to diagnose nearly half of these cases.

The report, published by the Blue Cross Blue Shield Association as part of its Health of America series, shows that 41% of youth diagnosed with MDD between 2019 and 2023 were initially diagnosed in primary care screenings. In Washington state, specifically, that number climbs to 50%.

As rates of adolescent depression surge, particularly among teens ages 15 to 17, the findings highlight the central role of pediatricians and family practitioners in recognizing mental illness early, before symptoms escalate into a mental health crisis.

The findings were released in May, which is nationally recognized as Mental Health Awareness Month, a timely reminder of the urgent need for early detection and equitable access to behavioral health care for children and teens.

Depression rates doubled in older teens

Between 2019 and 2022, the prevalence of MDD in teens aged 15 to 17 doubled — from 3% to 6%. Among children ages 6 to 14, rates also rose, though less sharply. The increase coincided with the COVID-19 pandemic, which brought with it unprecedented levels of widespread isolation, trauma and stress, especially for youth in vulnerable populations.

The data comes from insurance claims filed by Blue Cross Blue Shield members nationwide. Researchers found that, while overall rates of diagnoses have increased, disparities persist.

Black, Hispanic and Asian/Pacific Islander youth were significantly less likely to be diagnosed with MDD than White youth — 30% lower for Black and Hispanic youth, and 50% lower for Asian youth. Children living in the most socially vulnerable communities were also less likely to be diagnosed than their peers in less vulnerable areas.

Researchers caution that these lower rates don’t necessarily mean those children are faring better. In fact, the opposite may be true.

Crisis as a first diagnosis

One of the report’s most troubling findings is how often vulnerable youth are diagnosed only after reaching a breaking point.

Black youth were 50% more likely than White youth to receive their first MDD diagnosis during a crisis event, like an emergency department visit or psychiatric hospitalization. Hispanic youth were 25% more likely. Children in the most socially vulnerable quartile were 40% more likely to be diagnosed during a crisis than those in the least vulnerable quartile.

Primary care plays an integral role in the early detection and management of youth depression. In rural and suburban areas, primary care physicians account for 44% of initial MDD diagnoses, compared to 39% in urban settings.

Considering the findings, the report advocates for additional measures to enhance early detection and treatment of MDD among youth, including:

• Enhanced training: Providing primary care physicians with specialized training to recognize early signs of depression and other mental health disorders.
• Integrated care models: Implementing collaborative care approaches that integrate mental health services within primary care settings.
• Community engagement: Partnering with community organizations to raise awareness and reduce stigma associated with mental health issues.
• Policy advocacy: Supporting policies that increase access to mental health services, particularly in underserved communities.

“Removing barriers to care is critical to addressing the youth mental health crisis,” said Romilla Batra, M.D., M.P.H., senior vice president and chief medical officer at Premera Blue Cross. “… For many young people, their first touchpoint for care is their primary care physician. Expanding primary care access, integrating mental health services, and supporting local partnerships are all essential to helping Washington’s youth thrive.”