Comorbidities of Anxiety Disorders in Children and Adolescents in Germany: A Nationwide Representative Claims Data Analysis
Author(s)
Lisa Wandschneider, PhD, MPH (MSc)1, Lena Hasemann, MPH (MSc)1, Jana Diekmannshemke, DS (MSc)1, Julian Witte, DrPH, MPH, MSc1, Malte Klee, M.D.2, Matthias Linhardt, M.D.3, Chantal Wallau, M.D.4.
1VANDAGE, Bielefeld, Germany, 2DAK-Gesundheit, Hamburg, Germany, 3Uniklinikum Würzburg, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Würzburg, Germany, 4Julius-Maximilians-Universität Würzburg, Department of Psychology I, Psychotherapy and Intervention Psychology Würzburg, Germany, Würzburg, Germany.
1VANDAGE, Bielefeld, Germany, 2DAK-Gesundheit, Hamburg, Germany, 3Uniklinikum Würzburg, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Würzburg, Germany, 4Julius-Maximilians-Universität Würzburg, Department of Psychology I, Psychotherapy and Intervention Psychology Würzburg, Germany, Würzburg, Germany.
OBJECTIVES: Anxiety disorders are the most prevalent mental health issue in young ages with high levels of comorbidity. In Germany, the prevalence of anxiety disorders ranges between 5-10% among children and adolescents and has increased compared to pre-pandemic years. This study aims to estimate associations between anxiety disorders and particular comorbidities, incl. depression, pain and chronic diseases, in children and adolescents in Germany.
METHODS: This retrospective analysis uses German nationwide representative social health insurance claims data covering January 2019 to December 2023. We include children and adolescents aged 5-17 years, equating to approximately 550,000 individuals per year of observation. We calculate odds ratios for anxiety disorders and depression, chronic diseases (asthma, diabetes and obesity) or pain, stratified by age and sex.
RESULTS: The chance of being diagnosed with depression in children and adolescents with anxiety disorders is higher for girls and boys across all age groups, compared to those without anxiety disorders. In 2023, the chance was 26 times higher (95%CI: 25,2; 27,7) and has increased since 2019 (OR: 18,2 [95%CI 17,2; 19,3]). Though less pronounced, children with anxiety disorders also have a higher chance of being diagnosed with a chronic disease (e.g. obesity in 2023: OR 2,0 [95%CI 1,9; 2,1]) or pain diagnosis (2023: OR 2,3 [95%CI 2,2; 2,4]). Across all comorbidities assessed, we observe higher chances in older children and adolescents for both sexes, except for adolescent girls where chances remain elevated but decrease compared to younger age groups.
CONCLUSIONS: Children with anxiety disorders frequently present with comorbid depression, chronic somatic conditions, and pain, indicating a substantial burden. The clustering of mental and somatic conditions points to the need for comprehensive, patient-centered approaches that account for both psychological and physical symptoms. Strengthening early detection—especially in children with somatic complaints—may improve care coordination and enhance long-term outcomes.
METHODS: This retrospective analysis uses German nationwide representative social health insurance claims data covering January 2019 to December 2023. We include children and adolescents aged 5-17 years, equating to approximately 550,000 individuals per year of observation. We calculate odds ratios for anxiety disorders and depression, chronic diseases (asthma, diabetes and obesity) or pain, stratified by age and sex.
RESULTS: The chance of being diagnosed with depression in children and adolescents with anxiety disorders is higher for girls and boys across all age groups, compared to those without anxiety disorders. In 2023, the chance was 26 times higher (95%CI: 25,2; 27,7) and has increased since 2019 (OR: 18,2 [95%CI 17,2; 19,3]). Though less pronounced, children with anxiety disorders also have a higher chance of being diagnosed with a chronic disease (e.g. obesity in 2023: OR 2,0 [95%CI 1,9; 2,1]) or pain diagnosis (2023: OR 2,3 [95%CI 2,2; 2,4]). Across all comorbidities assessed, we observe higher chances in older children and adolescents for both sexes, except for adolescent girls where chances remain elevated but decrease compared to younger age groups.
CONCLUSIONS: Children with anxiety disorders frequently present with comorbid depression, chronic somatic conditions, and pain, indicating a substantial burden. The clustering of mental and somatic conditions points to the need for comprehensive, patient-centered approaches that account for both psychological and physical symptoms. Strengthening early detection—especially in children with somatic complaints—may improve care coordination and enhance long-term outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH49
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Public Health
Disease
Mental Health (including addition), Pediatrics