Mental Health Diagnoses Among Children With and Without Complex and Chronic Conditions

OBJECTIVES Mental health (MH) diagnoses can complicate outcomes of underlying medical conditions. However, prevalence of MH diagnoses across the spectrum of complex and/or chronic conditions is poorly understood. We aimed to (1) compare prevalence of MH diagnoses across categories of complex and chronic conditions and (2) identify factors associated with MH diagnoses among children with noncomplex chronic conditions (NCCCs) and complex chronic conditions (CCCs). METHODS Retrospective cross-sectional study of 2.9 million children aged 5 to 17 years from MarketScan Medicaid Database representing 12 US states in 2022. The primary exposure was mutually exclusive categories of complex and chronic conditions: noncomplex nonchronic (NCNC) conditions, NCCCs, and CCCs. The outcome was presence of a mood or anxiety MH diagnosis (anxiety, depression, bipolar disorder, obsessive-compulsive disorders, trauma-related disorders, and suicide/self-injury) coded at 1 inpatient/emergency department or 2 outpatient encounters. RESULTS Prevalence of MH diagnoses increased with increasing medical complexity and chronicity: 7.6% in NCNC, 16.0% in NCCCs, and 20.0% in CCCs (P < .001). Among children with a CCC, categories with the greatest adjusted odds of MH diagnoses were cardiac (odds ratio [OR] 1.49; 95% CI, 1.44–1.54), neurologic (OR 1.18; 95% CI, 1.14–1.23), and renal (OR 1.13; 95% CI, 1.06–1.21). Among youth with NCCCs or CCCs, Black and Hispanic children had lower odds of MH diagnoses compared to non-Hispanic white children. CONCLUSIONS MH prevalence increased significantly with increasing medical complexity and chronicity. Differences in MH diagnoses were identified across individual NCCC and CCC categories and sociodemographic characteristics. These results may inform future screening, intervention, and health equity efforts among medically vulnerable populations.