OBJECTIVES

This study was to compare pediatric mental disorder detection rates among screened and unscreened children in different racial/ethnic groups.

METHODS

Children and adolescents aged between 4 to 18 years old who enrolled in a Medicaid managed care plan from 2013 to 2016 were identified. A time-matched, nested case-control design was applied to examine the association between behavioral health screening provided by primary care providers (PCP) and the receipt of incident mental disorder diagnosis. For each case, two matched controls were selected by age, sex, and race/ethnicity from a pool of children who had a minimum of 12 months of continuous eligibility before the index mental disorder. Mental disorder screening was defined as having at least one CPT /HCPCS code of behavioral health screening during the measurement period by PCP, and mental disorder diagnosis was defined using ICD-9/10 code.

RESULTS

A total number of 403,451 individuals were identified after applying the inclusion and exclusion criteria. The most cohort was aged 7-12 (39%), male (51%), and Hispanics (62%). There were 42,982 (10.65%) who received screening for mental disorders. Significant racial/ethnic disparities in mental disorder diagnosis rates were observed in both screened and unscreened groups, with the highest diagnosis rates observed in Whites, followed by Blacks and Hispanics (Screened: 6.43%/5.30%/4.24%; Unscreened: 5.83%/4.69%/3.39%). A conditional logistic model was applied to 15, 941 cases, and 31,882 matched controls. The findings showed that screened individuals were 1.46 (OR: 1.46 95%CI: 1.36-1.55) times more likely than unscreened to receive a mental disorder diagnosis. Subgroup analysis suggested that the main finding was consistent across racial/ethnic, gender, and age groups.

CONCLUSIONS

PCP screening can improve early mental disorder detection among children. However, the overall mental disorder screening rate is low and minorities are less likely to be diagnosed compared to their white counterparts.