Prevalence of diagnosed mental health conditions among US children with public and commercial insurance.

BACKGROUND: Surveillance of diagnosed mental health conditions is essential for understanding geographic disparities in healthcare access and guiding public health policy. Previous studies provide national or state-level prevalence estimates with limited geographic granularity and few comparisons between insurance types. The aim of this study was to (1) estimate geographical-varying prevalence of diagnosed mental health conditions among Medicaid-insured and commercially-insured children; (2) examine geographic variations in prevalence across urban, suburban, and rural communities; (3) identify census tracts with significantly high and low prevalence; and (4) compare prevalence patterns between public and commercial insurance, and across geographic areas. METHODS: We evaluated the prevalence of MH diagnoses among children (3-17 years) using the 2018 Transformed Medicaid Analytic Files and 2018 claims database of a large commercial insurance provider. We applied spatial projection and smoothing to estimate census tract-level prevalence for overall MH conditions, ADHD, depression, and anxiety. RESULTS: The overall diagnosed-MH prevalence was 11.8% in the Medicaid-insured population compared to 5.5% in the commercially insured population. Suburban communities had higher prevalence rates (Medicaid: MH-15.8%, ADHD-7.7%, Depression-3.2%, Anxiety-0.9%; Commercial: MH-5.2%, ADHD-2.4%, Depression-1.1%, Anxiety-0.2%) than rural or urban communities in both the Medicaid-insured and commercially insured populations. Seven states had significantly lower diagnosed-MH prevalence than 30 or more other states. Most states had few to no tracts with low diagnosed-MH prevalence, but some states had high percentages (e.g., 10.0% in urban Florida for Medicaid, 8.7% in urban California for commercial insurance). Conversely, few states had approximately zero tracts with high diagnosed-MH prevalence, with the highest percentages being 8.9% in urban Montana for Medicaid, 9.3% in urban Minnesota for commercial insurance, 7.0% in rural Maine for Medicaid, and 4.8% in rural Massachusetts for commercial insurance. CONCLUSION: Variations in prevalence differed widely across states and by communities' rurality-urbanity. Medicaid-insured children had consistently higher prevalence than commercially insured children throughout all states. Suburban communities demonstrated the highest prevalence rates for both insurance types, with geographic clustering of high-prevalence areas observed particularly in eastern states for Medicaid-insured children and primarily in urban areas for commercially insured children.