Behavioral and mental health diagnoses are on the
rise for adults and children, data analytics from BCBSA indicate.
March 28,
2019 - The nation’s behavioral and mental health patterns are
changing rapidly as patients and providers change their responses to issues
such as depression, ADHD, and pain management, reveals large-scale data
analytics from the Blue Cross Blue Shield Association (BCBSA).
In a series of data
briefs building off the 25th annual Health of America Report, BCBSA explored
critical population health trends such as opioid prescribing rates, the
treatment of major depression, and the management of attention disorders in
pediatric patients.
Major depression is
an increasingly common diagnosis among commercially insured adults, teens, and
children, the payer organization notes. More
than 9 million commercially insured people have been diagnosed with depression,
representing a 33 percent rise since 2013.
Diagnoses for younger
people, including teenagers and millennials, are rising faster than ever
before. The rates of diagnoses for teenagers has increased by 63 percent
and 47 percent for millennials.
While most Americans
consider depression a serious condition that requires treatment, not everyone
with a depression diagnoses is seeking out help.
More than two million
individuals are not receiving any type of treatment for the challenging mental
health condition, BCBSA says. Twenty percent of the teenagers and
millennials diagnosed with depression are not seeking care.
This is a significant
concern for healthcare providers and payers, especially since depression is
rarely found in isolation. Eighty-five percent of individuals with
depression also have another chronic disease, such as hypertension, diabetes,
or substance abuse disorders.
Depression can make
it much more difficult for patients to effectively manage their comorbidities,
and may decrease both the duration and quality of life for affected
individuals.
“As more Americans,
especially millennials and adolescents, are diagnosed with major depression
each year, it’s increasingly important that there’s continued research and
resources allocated towards new ways to treat depression,” said Vincent G.
Nelson, MD, vice president of medical affairs at BCBSA.
“The more options
there are, the greater the likelihood is that we can find the right course of
treatment for each person suffering from major depression.”
BCBSA suggests that providers explore
how to integrate mental healthcare into the primary care environment through
strategies such as colocation.
Adding mental health
counselors, psychiatrics, or other behavioral health experts to the medical
home environment can reduce emergency department visits and increase the number
of patients with standardized mental health management plans, the Association
says.
On the other hand,
some common behavioral health concerns may be overtreated, indicates a separate report based on the same
large-scale population health data.
The number of
children diagnosed with ADHD has also risen dramatically, nearly 2.4 million
pediatric patients now diagnosed with the disorder. That represents a 31
percent increase between 2010 and 2017, BCBSA says.
“Attention deficit
hyperactivity disorder is the second most impactful condition affecting
children’s health in the US,” said BCBSA. “It accounts for 16 percent of
the impact all health conditions have on Generation Z (0-19 years old) as
measured by the Blue Cross Blue Shield Health Index.”
Diagnoses are most
common among middle schoolers, with boys receiving the label almost twice as
often as girls.
“Through these
findings, we're seeing a change in what was traditionally understood amongst
the medical community, which is that ADHD diagnoses are actually more prevalent
among middle school children, not elementary school,” said Nelson in a separate
press release.
Diagnoses rates also
vary widely by geographic region, the analytics revealed. Children in the
south are more likely than those in the western states to be diagnosed, with
nearly a three-fold difference between the highest and lowest states.
Source: BCBSA
The data suggests
that providers may be in need of more standardized best practices for
diagnosing children with the behavioral health condition.
Many children are
still on medication-only treatment plans, for example, which is no longer
recommended practice. Experts now believe that a combination of
medication and behavioral therapy is more effective.
“The data also
revealed higher diagnosis rates in the south and that region of the US has a
larger portion of children treated with medication only,” said Nelson. “Knowing
this information, we're focused on ways we can provide greater access to
therapists and behavioral health experts to change this trend.”
ADHD and depression
are closely intertwined for many children. About 40 percent of children with
ADHD have also been diagnosed with another behavioral health disorder.
By high school, about
a quarter of children with an ADHD diagnosis will also be diagnosed with
depression. Thirty percent will also be diagnosed with anxiety.
As these children
become adults, they will continue to require behavioral health treatment,
especially if they develop any of the chronic diseases commonly found in
conjunction with mental health concerns.
Even without an ADHD
or depression diagnosis, teens and young adults are at high risk of developing
another major behavioral health concern: substance use disorder.
The opioid abuse
crisis continues to devastate communities across America, with scores of
overdose deaths reported every day.
Preventing the
development of dependence or abuse is a top concern for public health
advocates, including health insurance companies that are using their financial clout to
connect with patients and influence prescribing patterns among physicians.
Efforts to curb
prescribing rates appear to be paying off, BCBSA’s analytics show. The monthly
rate of first-time prescriptions dropped by 54 percent between July of 2012 and
December of 2017, due largely to intense national focus on the root causes of
the crisis.
Nearly 30 percent of
prescribers are refusing to write new prescriptions for brand new potential
opioid patients, the data found – yet others are still sticking to old habits.
Some of these
prescribers may feel uncomfortable restricting access to pain treatment for
patients with true needs, said study lead investigator Nicole Maestas, PhD,
professor of health care policy at Harvard Medical School.
“The challenge behind
the opioid crisis is finding the balance between providing those who need pain
relief with the necessary medicines, while also ensuring patients are not
prescribed potentially dangerous doses and durations of opioids,” she said.
“The data revealed
that while the health care community has made progress in curbing this
epidemic, there is still a lot that needs to be done.”
Maestas worked on a
collaborative team to use claims data from to better understand pain management
patterns across the US.
Untreated chronic
pain is also closely tied to depression, highlighting the complex interplay
between different behavioral health conditions and clinical factors.
With all three
conditions closely tied together, providers can use population health analytics
like these to better understand changing patterns in public health and develop
tailored strategies to address the unique needs of individuals.
“The research team’s
findings will provide the medical and health care community with a better understanding
of the impact of opioid prescriptions on first-time opioid users, providing
needed insight on how we can better fight this devastating epidemic,” says
Maureen Sullivan, chief strategy and innovation officer for the Blue Cross Blue
Shield Association.
“The ultimate goal is
to analyze and learn about critical health issues and find meaningful solutions
that improve care quality and affordability for all Americans.”
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