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Mental Disorders and Disabilities Among Low-Income Children (2015)

Chapter: 17 Prevalence of Mood Disorders

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Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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17

Prevalence of Mood Disorders

Within the Social Security Administration (SSA) Listing of Impairments, mood disorders are recognized as an individual diagnostic category. In 2013 mood disorders represented the fourth largest group of Supplemental Security Income (SSI) recipients, after attention deficit hyperactivity disorder, autistic disorder, and intellectual disability. The medical criteria listed within the mood disorder listing include criteria for major depressive syndrome, manic syndrome, and bipolar or cyclothymic syndrome; however, as previously explained, current diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, treat depression and bipolar as separate categories.

This chapter includes separate reviews of estimates of the prevalence of pediatric depression and of pediatric bipolar disorder in the United States. Individual epidemiologic studies using structured diagnostic interviews provide the best prevalence estimates; these exist for depression and have been done over time, thus yielding data on trends (Angold et al., 2012). National survey data that do not use structured diagnostic interviews exist for depression, but these estimates vary widely and should be interpreted cautiously. With respect to pediatric bipolar disorder, no individual epidemiologic studies using structured diagnostic interviews exist, and only one national survey exists. However, this targeted adolescents only (not children). Thus, estimates of the prevalence of pediatric bipolar disorder must be interpreted cautiously.

These reviews are followed by a discussion of trends in the rates of depression and bipolar disorder observed in the Medicaid Analytic eXtract (MAX) study. The chapter concludes with a discussion comparing these

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

estimates with trends in the rate of allowances and recipients of SSI benefits for children with mood disorders.

ESTIMATES OF DEPRESSION PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION

Findings from epidemiologic studies of depression among children and youth vary widely, but the overall prevalence rate has remained relatively constant over four decades. The prevalence estimates from various individual epidemiologic studies ranged from 0.3 to 18 percent of children, and the predominant variation in these estimates was by the period of time examined (e.g., 1 month, 3 months, 6 months, and lifetime) and by the instrument used to detect depression (Angold et al., 2012). A meta-analysis of 51 published studies of children born during various periods between 1954 and 2005 found an overall prevalence rate of 3.8 percent with no appreciable change over time (Angold et al., 2012). Figure 17-1 shows the estimated prevalence rates by approximate assessment date, with a linear trend line. When the meta-analysis was updated to include the 18 most recent studies published since 2004, a somewhat lower estimate (2.7 percent) was found,

images

FIGURE 17-1 Prevalence of depression or dysthymia.
SOURCE: Angold et al., 2012.

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

but these findings further support a conclusion that the prevalence rates of child and youth depression has not increased over time (Angold et al., 2012). In addition, findings from a meta-analysis of more than 50 community surveys between 1994 and 2009 found that the estimated prevalence of depression in children and adolescents had remained relatively constant, at 5.2 percent (confidence interval 4–7 percent) (NRC and IOM, 2009).

Prevalence estimates of pediatric mood disorders based on national surveys should be interpreted with caution. The national surveys that have included questions about the symptoms or diagnosis of depression are the National Health Interview Survey (NHIS), the National Survey of Children’s Health (NSCH), the National Survey on Drug Use and Health (NSDUH), the National Comorbidity Survey-Adolescent Supplement (NCS-A), and the National Health and Nutrition Examination Survey (NHANES) (NCHS, 2012; NHANES and CDC, 2010; NHIS and NCHS, 2007; NSDUH, 2002). However, the data available to estimate changes in the prevalence of depression from 2004 to 2013 are very limited because the surveys use different methods and are administered in different years. In addition, survey items, even when they are the same from year to year, often assess changes in parental awareness of a child receiving a diagnosis of depression or changes in primary care provider detection of depressive symptoms in children. Within a survey, the language used to assess depression often varies across years. For example, the NSCH included questions for parents about their children receiving diagnoses for depression in 2003 and in 2007, but the questions varied slightly. The results of these recent estimates of child and youth depression are summarized in Table 17-1.

ESTIMATES OF BIPOLAR DISORDER PREVALENCE AND PREVALENCE TRENDS FROM THE GENERAL POPULATION

Although there is a general consensus that pediatric bipolar disorder is an uncommon and serious mental illness, it is sufficiently rare to go unmeasured in most epidemiologic surveys. The 12-month prevalence for bipolar disorder I or II among adolescents, as reported in the NCS-A, was 2.1 percent, and the 30-day prevalence 0.7 percent (Kessler et al., 2012). A meta-analysis that included studies reporting rates for mania or hypomania in community epidemiologic samples with participants up to 21 years of age found the overall prevalence of bipolar disorder to be 1.8 percent (Van Meter et al., 2011).

According to medical data, the rates of bipolar diagnoses among youth have risen dramatically. According to the National Ambulatory Medical Care Survey, the estimated annual number of office-based visits for youth with a diagnosis of bipolar disorder increased from 25 (1994–1995) to 1,003 (2002–2003) visits per 100,000 population, representing a 40-fold

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

TABLE 17-1 Prevalence Estimates of Depression Based on Household Surveys

Source Year Question Estimate Age Range
NSCH (2003) 2003 Parent report Has a doctor or health professional ever told you that (child’s name) has depression or anxiety problems? 4.2% 2–17
NSCH (2007a) 2007 Parent report In the 2007 NSCH parents are asked whether they have ever been told that their child has a specific condition, from a list of 16 conditions. If they answer “yes,” they are then asked if the child currently has the condition. Current depression 2.0% 2–17
NSCH (2007a) 2007 In the 2007 NSCH parents are asked whether they have ever been told that their child has a specific condition, from a list of 16 conditions. If they answer “yes,” they are then asked if the child currently has the condition. Had depression at some point, but not currently 1.7% 2–17
NSCH (2012) 2011/2012 Parent report Same as 2007 Current depression 2.2% 2–17
NSCH (2012) 2011/2012 Parent report Same as 2007 Had depression at some point, but not currently 1.6% 2–17
NHIS (Perou et al., 2013) 2007 Parent report Received a diagnosis of depression during past 12 months 3.0% 4–17
NHANES (Perou et al., 2013) 2007–2010 Child report Current depression during past 2 weeks (child report, score of ≥10 on PHQ-9) 6.7% 12–17
NSDUH (Perou et al., 2013) 2010–2011 Child report Major depressive episode during past 12 months 8.1% 12–17

NOTE: PHQ-9 = Patient Health Questionnaire 9.
SOURCES: NSCH, 2003, 2007a, 2012; Perou et al., 2013.

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

increase over 10 years (Moreno et al., 2007). These findings should be interpreted with caution. However, claims-based diagnoses may differ from clinical diagnoses (Youngstrom et al., 2015).

The reported rates of pediatric bipolar disorder have also varied between the United States and Europe. Using hospital discharge data from the English National Health Service Hospital Episode Statistics data set and the U.S. National Hospital Discharge Survey from 2000 to 2010, James and colleagues found a 72.1-fold difference in discharge rates for pediatric bipolar disorder between the United States and England (James et al., 2014). After controlling for cross-national differences in the length of stay, pediatric bipolar disorder discharges remained 12.5 times higher in the United States than in England (James et al., 2014). These findings are directionally consistent with an earlier study that examined the incidence of childhood-onset bipolar illness among a cohort of 500 adult outpatients with bipolar illness. In that study, more than 60 percent of U.S. patients reported onset of symptoms during childhood or adolescence versus only 30 percent in the Netherlands or Germany (Post et al., 2010). Although some of this variation has been attributed to differences in diagnostic criteria (Dougherty et al., 2014), substantive questions have been raised about the validity of this diagnosis in children (Demeter et al., 2008; Duffy et al., 2007; Horst, 2009).

TRENDS IN THE RATES OF MOOD DISORDERS AMONG SSI AND MEDICAID POPULATIONS

This section presents data on trends in the rates of mood disorders in the SSI program for children from 2004 to 2013 and among child Medicaid enrollees from 2001 to 2010. The Medicaid data are presented as a rough approximation of the population living in poverty from which SSI recipients are drawn. Comparisons across these data sources as well as comparisons with earlier findings from epidemiologic studies should be made with caution because of their methodological differences. National prevalence estimates from epidemiologic studies for mood disorders vary because they are influenced by differences in study methods, such as how the children were selected, how the presence of the diagnosis was identified, the time period over which data were taken concerning symptoms (i.e., lifetime, past 6 months), and the respondent (i.e., parent, youth). The diagnoses listed for SSI determinations are those that most strongly support eligibility for benefits, and they may be influenced by the extent to which documentation is available to the evaluator and may be prioritized according to which symptoms contribute most to a child’s disability. The prevalence estimates of children with mood disorders based on Medicaid data are based on encounter coding and billing which can reflect efforts to

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

optimize reimbursement rather than accuracy of clinical diagnosis. With these caveats, findings from these data sources are described by source. The proportion of children with mood disorders identified in the SSI administrative data is described within the context of national poverty trends among U.S. children. Findings from the Medicaid data are stratified to compare the proportion of children with mood disorders who are receiving SSI with all children receiving Medicaid.

SSI

Table 17-2 examines the SSI administrative data on mood disorders in children. Column 1 shows the number of child allowances made on the basis of mood disorders at the initial level for each year. Column 2 shows the number of child recipients who received SSI benefits on the basis of

TABLE 17-2 SSI Child Initial Allowances and Recipient Numbers for Mood Disorders

Year 1 2 3 4 5
# of Child SSI Allowances for Mood Disorders # of Child SSI Recipients for Mood Disorders # of Children in Households Under 200% FPL % of Children Under 200% FPL Allowed SSI Benefits for Mood Disorders % of Children Under 200% FPL Who Are Recipients of SSI Benefits for Mood Disorders
2004   9,760 32,078 28,753,000 0.034% 0.11%
2005   9,835 35,184 28,539,000 0.034% 0.12%
2006   9,084 37,112 28,757,000 0.032% 0.13%
2007   8,907 38,280 28,999,000 0.031% 0.13%
2008   9,199 39,164 30,064,000 0.031% 0.13%
2009   9,869 40,444 31,505,000 0.031% 0.13%
2010 10,588 41,932 32,254,000 0.033% 0.13%
2011 10,339 42,936 32,678,000 0.032% 0.13%
2012   9,331 43,508 32,269,000 0.029% 0.13%
2013   8,400 42,826 31,364,000 0.027% 0.14%

NOTE: The Current Population Survey table creator was used to generate numbers of children below 200 percent of the federal poverty level. Parameters used to generate the numbers include get count of: persons in poverty universe (everyone except unrelated individuals under 15); years: 2004 to 2013; Census 2010 weights; row variable: age; column variable: income-to-poverty ratio; and customized formatting: income-to-poverty ratio percent cutoff of 200 percent.
SOURCES: U.S. Census Bureau, 2015; unpublished data set provided by the SSA.

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

images

FIGURE 17-2 Percentages of SSI child initial allowances and recipients for mood disorders under 200 percent FPL.
NOTE: The Current Population Survey table creator was used to generate numbers of children below 200 percent of the federal poverty level. Parameters used to generate the numbers include get count of: persons in poverty universe (everyone except unrelated individuals under 15); years: 2004 to 2013; Census 2010 weights; row variable: age; column variable: income-to-poverty ratio; and customized formatting: income-to-poverty ratio percent cutoff of 200 percent.
SOURCES: U.S. Census Bureau, 2015; unpublished data set provided by the SSA.

mood disorders in December of each year. Column 3 shows the estimated number of children in households with incomes under 200 percent of the federal poverty level (FPL) for each year. Columns 4 and 5 show the rate of allowances and recipients based on all mood disorders as a percentage of the number of children in households under 200 percent FPL for each year. Figure 17-2 plots the average of the percentages of allowances and recipients for mood disorders from columns 4 and 5 and illustrates deviations from the 10-year average for each.

As shown in Chapter 3, between 2004 and 2013, approximately 10 percent of SSI allowances for children were on the basis of mood disorders, and, of these, the allowance rate decreased from 47 to 36 percent. The decreasing allowance rate corresponds to a slight decrease in the number

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

of allowances; however, the absolute number of recipients for mood disorders has gradually risen. Between 2004 and 2013, allowances decreased from 9,760 to 8,400, while the number of recipients rose from 32,078 to 42,826. Among children in households under 200 percent FPL in the same time period, the rate of child mood disorder allowances decreased by approximately −21 percent, from 0.034 to 0.027 percent. Between 2004 and 2013 the rate of child mood disorder recipients increased by approximately 22 percent, from 0.11 to 0.14 percent.

Medicaid

Table 17-3 shows the percentage of children who were diagnosed with depression in two different groups of Medicaid enrollees from 2001 to 2010. Column 1 shows the percentage of depression diagnoses among all Medicaid enrollees for each year. Column 2 shows the percentage of depression diagnoses among the smaller subpopulation of Medicaid enrollees who are eligible to be enrolled in Medicaid based on their eligibility to receive SSI benefits. Figure 17-3 visually displays the upward trends for each set of percentages.

Overall, during this time period the proportion of children receiving Medicaid-funded services for depression among all child Medicaid beneficiaries was roughly one-half the proportion of children who received care

TABLE 17-3 Percentage of Child Medicaid Enrollees and SSI Medicaid Enrollees Diagnosed with Depression

Year 1 2
% of All Child Medicaid Enrollees with a Depression Diagnosis % of Child SSI Medicaid Enrollee Subpopulation with a Depression Diagnosis
2001 1.70% 4.00%
2002 1.70% 4.30%
2003 1.90% 4.50%
2004 2.00% 4.60%
2005 1.90% 4.50%
2006 1.90% 4.40%
2007 2.00% 4.40%
2008 2.10% 4.80%
2009 2.20% 5.40%
2010 2.20% 5.50%

SOURCE: MAX data.

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

images

FIGURE 17-3 Percentage of child Medicaid enrollees and SSI Medicaid enrollees diagnosed with depression.
SOURCE: MAX data.

for depression among all children eligible for Medicaid through SSI. It is worth noting that between 2001 and 2010 the proportion of children with depression diagnoses in these two groups increased. In the SSI subpopulation, starting in 2008, a relatively large increase in the proportion of children with depression diagnoses was observed, likely corresponding to the onset of the economic recession. Between 2001 and 2010 the proportion of children with depression diagnoses among all Medicaid enrollees increased by 29.4 percent, from 1.7 to 2.2 percent. The proportion of children with depression diagnoses among the SSI-eligible subpopulation of Medicaid enrollees increased by 37.5 percent, from 4 to 5.5 percent.

Table 17-4 and Figure 17-4 summarize the Medicaid data for children receiving care that is linked to the diagnosis of bipolar disorder. Overall, the annual proportion of children receiving Medicaid-funded services for bipolar disorder among all child Medicaid beneficiaries was roughly 20 percent of the proportion of children who received care for depression among children eligible for Medicaid through SSI. In addition, the proportion of children with a bipolar diagnosis among these two increased between 2001 and 2009, although it plateaued for the entire Medicaid population from 2006 to 2010 and decreased in 2010 for the Medicaid SSI subgroup. From 2001 to 2010 the proportion of children with a bipolar diagnosis among all Medicaid enrollees increased by 100 percent, from 0.3 to 0.6 percent.

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

TABLE 17-4 Percentage of Child Medicaid Enrollees and SSI Medicaid Enrollees Diagnosed with Bipolar Disorder

Year 1 2
% of All Child Medicaid Enrollees with a Bipolar Diagnosis % of Child SSI Medicaid Enrollee Subpopulation with a Bipolar Diagnosis
2001 0.3% 1.4%
2002 0.3% 1.7%
2003 0.4% 1.9%
2004 0.5% 2.3%
2005 0.5% 2.4%
2006 0.6% 2.5%
2007 0.6% 2.7%
2008 0.6% 2.8%
2009 0.6% 3.0%
2010 0.6% 2.8%

SOURCE: MAX data.

images

FIGURE 17-4 Percentage of child Medicaid enrollees and SSI Medicaid enrollees diagnosed with bipolar disorder.
SOURCE: MAX data.

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

TABLE 17-5 Percent Increases of Depression, Bipolar Disorder, and Mood Disorder for Medicaid Enrollees, Medicaid SSI Enrollees, and SSI Disability Recipients

  Medicaid All Enrollees Medicaid SSI Enrollees SSI Disability Recipients
Depression Bipolar disorder Depression Bipolar disorder Mood disorders
Percent increase from 2004 to 2010 10% 25% 19.6% 25% 27.3%

SOURCE: MAX and unpublished data set provided by the SSA.

The proportion of children with a bipolar diagnosis among the SSI eligible subpopulation of Medicaid enrollees also increased by 100 percent, from 1.4 to 2.8 percent.

Table 17-5 compares percent increases from 2004 to 2010 in the proportions of children in the two Medicaid populations and the SSI disability population who were identified as having depression or bipolar disorder—or both in the case of SSI disability children. This is the time period—from 2004 to 2010—for which the available Medicaid and SSI data overlapped. Among children receiving Medicaid because they were eligible through SSI, the percentage increase in the proportion of children with depression was roughly twice the percentage increase in the proportion of all children receiving Medicaid. The increase for the SSI combined mood disorders recipient population was similar to that for the Medicaid SSI group. The percent increase in the proportion of children with bipolar disorder diagnosis was similar between the two groups, but this finding should be interpreted with caution because smaller numbers of children received this diagnosis. The limitations in comparing percentage increases across these two different data sources were detailed earlier in this chapter. Diagnoses in the Medicaid data are based on billing, whereas SSI disability data are based upon the evaluator’s determination following SSA disability guidelines and agency final decisions related to receipt.

DISCUSSION

The task order directed the committee to compare trends observed in the SSI disability program for children with mental disorders with trends in the prevalence of mental disorders among children in the general population. This chapter focused on trends in the percentage of children who are recipients of the SSI disability benefits on the basis of the mood disorder

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

diagnostic category, which includes major depressive syndrome, manic syndrome, and bipolar or cyclothymic syndrome. The SSI mood disorders diagnostic category thus presents challenges for comparing prevalence estimates with findings from national epidemiologic studies and Medicaid data because depression and bipolar disorder are distinct diagnostic groups in these data sources. Comparisons between the SSI trend data by disorder to either the general population data or Medicaid data are also problematic because the data sources differ starkly in their main purpose and in how a disorder is identified. To satisfy the task order while safeguarding against erroneous interpretation of the data, the committee chose to present available data and point out apparent differences and trends while also noting caveats to their interpretation.

Prevalence estimates of depression in the general population between 2004 and 2013 indicate that there was no increase in depression among children. In addition, pediatric bipolar disorder is relatively rare, and there are few data available with which to estimate population-level trends for this disorder. Within this 10-year period, a small increase was observed in the proportion of the child SSI recipients for mood disorders, while a slight decrease was observed in allowances. From 2001 to 2010 a slight increase was observed in the proportion of children receiving care for depression and bipolar disorder among all children enrolled in Medicaid, which was similar to that among children eligible for Medicaid through SSI.

Overall, trends in the proportion of children receiving SSI on the basis of mood disorders are consistent with trends in depression observed in the general and Medicaid population. When the poverty level is taken into account, the proportion of children allowed SSI and receiving SSI for mood disorders is relatively constant, with a 2-year increase that corresponds with the onset of an economic recession.

Depression may be underdiagnosed in children living in poverty, and the pool of children potentially eligible for SSI benefits based on mood disorders is estimated to be large. The NSCH prevalence estimates of children and adolescents (ages 2–17) with moderate or severe depression for 2007, as reported by parents, was 1.0 percent (NSCH, 2007b). The estimated number of children under 200 percent FPL in 2007 was 28,999,000. Therefore, the estimated number of children with moderate or severe depression (not including bipolar) under 200 percent FPL would be expected to be 289,990. In contrast, in 2007 there were 8,907 child recipients of SSI benefits for mood disorders. Figure 17-5 illustrates these relationships. A final consideration relates to questions about bipolar disorder diagnoses in children. Until widespread adoption of standardized diagnostic criteria is achieved, questions will remain about the prevalence and its trends for this disorder. However, this concern does not mitigate the possibility that, even

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

images

FIGURE 17-5 Children potentially eligible for SSI for depression versus children receiving SSI for mood disorders in 2007, according to the NSCH.
NOTE: The Current Population Survey table creator was used to generate numbers of children below 200 percent of the federal poverty level. Parameters used to generate the numbers include get count of: persons in poverty universe (everyone except unrelated individuals under 15); years: 2004 to 2013; Census 2010 weights; row variable: age; column variable: income-to-poverty ratio; and customized formatting: income-to-poverty ratio percent cutoff of 200 percent.
SOURCES: NSCH, 2007b; U.S. Census Bureau, 2014, 2015; unpublished data set provided by the SSA.

Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

if misdiagnosed, many children currently labeled with bipolar disorder are likely to qualify for SSI based on moderate or severe disability.

FINDINGS

  • Prevalence estimates for child and adolescent depression in the general population range from 2 to 8 percent. Because pediatric bipolar disorder is uncommon, additional research is needed to more robustly estimate the prevalence rates using standardized diagnostic criteria among children in nationally representative samples.
  • The prevalence of depression among children and adolescents in the general population does not appear to be increasing. The trends in the prevalence of pediatric bipolar disorder remain unknown.
  • From 2004 to 2013 the allowance rates for SSI benefits for mood disorders decreased, while the percentage of children in low-income households who were recipients of SSI benefits for mood disorders increased modestly.
  • The trend for SSI mood disorder recipients is upward among both the SSI and Medicaid enrollees.

CONCLUSION

  • Conservative estimates of the prevalence of moderate to severe depression among children and adolescents (i.e., 1 percent) applied to the population of these children and adolescents who are below 200 percent FPL suggest that only a small proportion, approximately 3 percent, of those who are potentially eligible for SSI benefits on the basis of mood disorders are actually recipients.

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Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

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Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

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Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"17 Prevalence of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Children living in poverty are more likely to have mental health problems, and their conditions are more likely to be severe. Of the approximately 1.3 million children who were recipients of Supplemental Security Income (SSI) disability benefits in 2013, about 50% were disabled primarily due to a mental disorder. An increase in the number of children who are recipients of SSI benefits due to mental disorders has been observed through several decades of the program beginning in 1985 and continuing through 2010. Nevertheless, less than 1% of children in the United States are recipients of SSI disability benefits for a mental disorder.

At the request of the Social Security Administration, Mental Disorders and Disability Among Low-Income Children compares national trends in the number of children with mental disorders with the trends in the number of children receiving benefits from the SSI program, and describes the possible factors that may contribute to any differences between the two groups. This report provides an overview of the current status of the diagnosis and treatment of mental disorders, and the levels of impairment in the U.S. population under age 18. The report focuses on 6 mental disorders, chosen due to their prevalence and the severity of disability attributed to those disorders within the SSI disability program: attention-deficit/hyperactivity disorder, oppositional defiant disorder/conduct disorder, autism spectrum disorder, intellectual disability, learning disabilities, and mood disorders. While this report is not a comprehensive discussion of these disorders, Mental Disorders and Disability Among Low-Income Children provides the best currently available information regarding demographics, diagnosis, treatment, and expectations for the disorder time course - both the natural course and under treatment.

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