A Massachusetts claims study found rising pediatric primary care visits with mental health diagnoses, led by anxiety-related care.
A decade-long claims analysis from Massachusetts suggests that pediatric primary care clinicians are seeing a growing share of children’s
“Mental health needs affect about 1 in 5 children, but many families struggle to get specialty mental health care,” Megan Cole, senior author and associate professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, said in a press release. “Our findings show that primary care doctors are increasingly caring for children with mental health needs, especially anxiety.”2
The study, “Pediatric Primary Care Visits With Mental Health Needs,” used health insurance claims for nearly all insured children aged 1 to 18 years in Massachusetts from 2014 through 2023. The analysis included approximately 1.8 million children over 10 years and evaluated primary care visits that included a mental health diagnosis.1,2
Researchers reported that primary care visits with a mental health diagnosis increased from approximately 6 visits per 100 children in 2014 to nearly 10 visits per 100 children in 2023. Anxiety-related visits had the largest relative increase, rising by 300% over the study period.
The findings add to evidence that pediatric primary care is functioning as a front line for behavioral health detection and management. National surveillance data have shown that mental, behavioral, and developmental disorders are common among US children and adolescents, although prevalence estimates vary by condition, age, and data source.3 In clinical practice, access to child and adolescent mental health specialists remains uneven, often leaving pediatricians and family physicians to identify symptoms, initiate treatment, and coordinate referrals.
The clinical implications differ by condition. For
The Massachusetts study did not report treatment patterns, medication use, referral completion, or outcomes after identification in primary care. As a result, the data describe where mental health needs are appearing in the health system but do not establish whether children received guideline-concordant treatment or timely specialty follow-up.
Key Facts
The increase in anxiety-coded visits is clinically notable but should be interpreted cautiously. Claims-based increases may reflect higher symptom burden, greater clinician recognition, changes in coding practices, expanded screening, increased family help-seeking, or some combination of these factors. The study period also spans the COVID-19 pandemic, during which pediatric mental health concerns became more visible in schools, emergency departments, and outpatient practice; however, the release does not provide pandemic-era subgroup analyses.
Cole said the trend creates an opportunity for primary care, provided practices have adequate support. “Since nearly all children have access to primary care, this creates a major opportunity,” she 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 authors pointed to integrated behavioral health approaches, including the TEAM UP model, as one strategy for embedding mental health services within pediatric primary care. Such models may reduce referral barriers by colocating behavioral health clinicians, care coordination, and primary care teams, although the current study was not designed to evaluate the effectiveness of any specific model.1
Important limitations include the study’s restriction to insured children in Massachusetts, which may limit generalizability to uninsured populations, other states, or health systems with different access patterns. The analysis relied on insurance claims, which may miss symptoms that were discussed but not coded, as well as needs managed outside reimbursed medical care. According to the release, the study also did not examine variation by age, sex, or practice type.1
For clinicians, the findings underscore the need for workflows that can support screening, brief assessment, safety evaluation, family engagement, and referral tracking without assuming that specialty care will be rapidly available. The next questions are whether increased identification in primary care is translating into effective treatment, how practices can be resourced to manage common conditions such as anxiety and ADHD, and which integrated care models improve outcomes for children and families.
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