Primary care is seeing more children's mental health needs, led by a surge in anxiety

by Harvard Pilgrim Health Care Institute

edited by Lisa Lock, reviewed by Robert Egan

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A new study led by researchers at the Harvard Pilgrim Health Care Institute, Boston University, Boston Medical Center, UMass Chan Medical School, and Brown University finds that children's mental health concerns are appearing more often during routine visits with primary care doctors. Published in JAMA Network Open, the study shows a steady rise over the past decade, with especially large increases in visits related to anxiety.

Researchers studied health insurance claims for nearly all insured children ages 1 to 18 in Massachusetts between 2014 and 2023. This included data on about 1.8 million children over 10 years.

The study found that primary care visits that included a mental health diagnosis increased from about 6 visits per 100 children in 2014 to nearly 10 visits per 100 children in 2023. Visits related to anxiety saw the biggest change, rising by 300% over the decade. Attention-deficit/hyperactivity disorder (ADHD) remained the most common mental health condition addressed in primary care visits.

"Mental health needs affect about 1 in 5 children, but many families struggle to get specialty mental health care," said Megan Cole, senior author and Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute. "Our findings show that primary care doctors are increasingly caring for children with mental health needs, especially anxiety."

Most children can easily get an appointment with a primary care provider. Yet, many children with mental health needs cannot get an appointment with a mental health specialist.

Children often see their primary care provider more regularly than a mental health specialist. Because of this, primary care settings may play a key role in identifying and addressing mental health concerns early.

"Since nearly all children have access to primary care, this creates a major opportunity," Cole said. "With the right training and support, primary care practices can help screen, diagnose, and treat mental health conditions or connect families to care."

The researchers say their findings point to a growing need for more mental health training and resources in pediatric primary care. This includes support for managing common conditions like anxiety and ADHD and models that integrate mental health services directly into primary care practices.

One such approach is the TEAM UP model, which brings mental health care into pediatric primary care settings. Integrated care models like this may help reduce barriers to mental health services for children and families.

The authors note that the study only looked at children in Massachusetts and relied on insurance claims data, which may not capture every mental health concern. The study also did not examine differences by age, sex, or type of medical practice.

Still, the researchers say the results highlight a clear trend: children's mental health needs are increasingly being addressed in primary care, and the health system must be ready to support that shift.

Publication details

Pediatric Primary Care Visits With Mental Health Needs, JAMA Network Open (2026). DOI: 10.1001/jamanetworkopen.2026.13315

Journal information: JAMA Network Open

Key medical concepts

Anxiety DisordersMental DisordersAttention Deficit Hyperactivity Disorder

Clinical categories

PediatricsChildren's healthPsychology & Mental healthPsychiatry Provided by Harvard Pilgrim Health Care Institute Who's behind this story?

Lisa Lock

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