Clinical depression is on the rise among Vermont’s kids and teens, according to a recent study.
Every time a health care provider treats a medical issue, such as depression, during a patient visit at a doctor’s office or hospital, they enter a certain code to bill insurance companies. Researchers from Johns Hopkins School of Public Health used that billing data to track changes in depression rates for Vermont youth, and published their findings this summer in the Journal of Rural Mental Health.
Looking at what are known as all-payer claims from nearly 100,000 young people in Vermont between 2016 and 2022, researchers found the amount of kids under the age of 18 who received depression diagnoses nearly doubled over that time — from about 4% to nearly 7%.
It's a problem that's not unique to Vermont. Youth mental health disorders are on the rise globally.
“We also know why this is happening,” said Professor Ramesh Raghavan, who studies mental health at New York University and lives in Dorset.
Rising rates of depression are linked to a variety of factors, he said, including social disconnection, bullying, school challenges, financial problems and heightened expectations for young people. Social media use can also play a role, though the research is somewhat mixed about its link with depression.
Kids from low-income families may be more at risk
In Vermont, researchers also found a discrepancy between depression rates of kids covered by commercial insurance and kids covered by Medicaid, a public program that insures people with low-incomes and people with disabilities. Kids who get insurance through Medicaid had a more than 50% chance of having a depression diagnosis, even though they weren’t screened more — they actually had fewer routine visits to the doctor’s office.
“Medicaid can be a proxy for economic status,” said Dr. Greta Spottswood, a child psychiatrist in Vermont. “We know that when there's less economic opportunity, as we're seeing in the study, there's less access to health care, maybe less access to healthy foods, less autonomy over a family's time.”
All of those factors can be linked to an increase in mental health disorders.
“It's unfortunate to say that it's not surprising,” added Kyle Moon, a public health researcher at Johns Hopkins who led the claims data study. “We see these disparities even early in life.”
The findings complement state surveys tracking mental health symptoms in the state. The most recent survey from 2023 found about one-third of high school students and one-quarter of middle school students say their mental health is not good most of the time or always. The number of students who report self harm and make a suicide plan has also steadily increased over the past decade.
More from Vermont Public: Survey shows Vermont youth mental health stuck in pandemic trough
“Clinicians are not surprised by the survey data, because I think they see it on the ground before it comes out in the surveys,” said Spottswood, who works for a hotline for pediatricians and primary care providers in the state who have questions about working with patients with complex mental health issues.
Spottswood speaks with hundreds of providers a year, and she said when it came to people calling in, they did not see these same discrepancies in depression rates between kids covered by commercial insurance and Medicaid.
Medical billing practices may have something to do with that, she said. Since Medicaid reimbursement rates are often low, Spottswood said providers who serve those patients might bill for more diagnoses to pay their bills.
Clinicians calling her line for help also might not capture the same disparities because, while their patients may be experiencing mental health challenges, their medical diagnosis is different.
“Sometimes in primary care, depression itself is a proxy for something like sleep apnea or something like trauma,” Spottswood said. “So depression might not tell the whole story.”
Solutions go beyond treatment
Combating the rise in mental health issues among kids cannot purely be solved by medical treatment, according to Raghavan, at New York University. He said it has to include social changes too.
A lot of those interventions should start early on in life, he said. Examples include universal home visiting programs that provide in-person support to pregnant people and families with young children, or implementing programs in schools to teach kids how to regulate their emotions.
“At the same time as we treat individual kids and try and manage their disease burdens, we ought to also be focusing on making these investments,” Raghavan said. “That is, I think, the fundamental problem that we haven't quite grasped in the youth mental health space.”
Another part of promoting child well being is just letting kids be kids, he said.
“What that means is children have to react with gaiety, spontaneity, curiosity,” said Raghavan. “Those things that we think of as intrinsically child-like, we have to preserve.”
Vermont presents some unique opportunities to do that, he said.
“We should be taking advantage of the spectacular natural resources that our state provides our children.”
