Mental Health Conditions and Health Care Payments for Children with Chronic Medical Conditions

Published:October 10, 2018DOI:



      To estimate additional payments associated with co-existing mental health or substance use disorders (MH/SUDs) among commercially insured children and youth with chronic medical conditions (CMCs) and to determine whether children's MH/SUDs have similar associations with parental health care payments.


      Cross-sectional analysis of a national database of paid commercial insurance claims for 2012–2013. Participants were children and youth ages 0 to 26 years covered as dependents on parents’ health insurance and categorized by the presence or absence of any of 11 chronic medical conditions and MH/SUDs. We determined the numbers of children and youth with CMCs and paid health care claims categorized as hospital, professional, and pharmacy services and as medical or behavioral. We compared paid claims for children and youth with CMCs with and without co-occurring MH/SUDs and for their parents.


      The sample included almost 6.6 million children and youth and 5.8 million parents. Compared to children without CMCs, children with CMCs had higher costs, even higher for children with CMCs who also had MH/SUDs. Children with CMCs and co-occurring MH/SUDs had 2.4 times the annual payments of those with chronic conditions alone, especially for medical expenses. Estimated additional annual payments associated with MH/SUDs in children with CMCs were $8.8 billion. Parents of children with CMCs and associated MH/SUDs had payments 59% higher than those for parents of children with CMCs alone.


      MH/SUDs in children and youth with CMCs are associated with higher total health care payments for both patients and their parents, suggesting potential benefits from preventing or reducing the impact of MH/SUDs among children and youth with CMCs.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Melek S, Norris DT, Paulus J. Economic impact of integrated medical-behavioral healthcare: implications for psychiatry. Available at: Accessed April 17, 2018.

        • Kessler RC
        • Heeriuga S
        • Lakoma MD
        • et al.
        Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication.
        Am J Psychiatry. 2004; 165: 703-711
        • Druss BG
        • Marcus SC
        • Olfson M
        • et al.
        The most expensive medical conditions in America.
        Health Aff (Millwood). 2002; 21: 105-111
        • Egede LE
        • Zheng D
        • Simpson K.
        Comorbid depression is associated with increased healthcare use and expenditures in individuals with diabetes.
        Diabetes Care. 2002; 25: 464-470
        • Suryavanshi MS
        • Yang Y
        Clinical and economic burden of mental disorders among children with chronic physical conditions, United States, 2008–2013.
        Prev Chronic Dis. 2016; 13: E71
        • Gray SH
        • Trudell EK
        • Emans SJ
        • et al.
        Total direct medical expenses and characteristics of privately insured adolescents who incur high costs.
        JAMA Pediatr. 2015; 169e152682
        • Van Cleave J
        • Gortmaker SL
        • Perrin JM.
        Dynamics of obesity and chronic health conditions among children and youth.
        JAMA. 2010; 303: 623-630
        • Houtrow AJ
        • Larson K
        • Olson LM
        • et al.
        Changing trends of childhood disability, 2001-2011.
        Pediatrics. 2014; 134: 530-538
        • Cadman D
        • Boyle M
        • Szatmari P
        • et al.
        Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study.
        Pediatrics. 1987; 79: 805-813
        • Lavelle TA
        • Weinstein MC
        • Newhouse JP
        • et al.
        Economic burden of childhood autism spectrum disorders.
        Pediatrics. 2014; 133: e520-e529
        • Bui AI
        • Dieleman JL
        • Hamavid H
        • et al.
        Spending on children's personal health care in the United States,1996-2013.
        JAMA Pediatr. 2017; 171: 181-189
        • Torio CM
        • Encinosa W
        • Berdahl T
        • et al.
        Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions.
        Acad Pediatr. 2015; 15: 19-35
        • Quittner AL
        • Pigriolamo AM.
        Family adaptation to childhood disability and illness.
        in: Ammerman RI Camo JV Handbook of Pediatric Psychology and Psychiatry. Allyn & Bacon, Boston, MA1998: 70-102
        • Cabizuca M
        • Marques-Portella C
        • Mendlowicz MV
        • et al.
        Posttraumatic stress disorder in parents of children with chronic illnesses: a meta-analysis.
        Health Psychol. 2009; 28: 379-388
        • Wiener L
        • Vasquez MJ
        • Battles H.
        Fathering a child living with HIV/AIDS: psychosocial adjustment and parenting stress.
        J Pediatr Psychol. 2001; 26: 353-358
        • Cousino MK
        • Hazen RA.
        Parenting stress among caregivers of children with chronic illness: a systematic review.
        J Pediatr Psychol. 2013; 38: 809-828
        • Cadman D
        • Rosenbaum P
        • Boyle M
        • et al.
        Children with chronic illness: family and parent demographic characteristics and psychological adjustment.
        Pediatrics. 1991; 87: 884-889
      2. IBM. IBM Watson Health. Available at: Accessed April 17, 2018.

        • Kuhlthau KA
        • Beal AC
        • Ferris TG
        • et al.
        Comparing a diagnosis list with a survey method to identify children with chronic conditions in an urban health center.
        Ambul Pediatr. 2002; 2: 58-62
      3. United States Census Bureau. Age and sex composition in the United States: 2013 (updated August 11, 2016). Available at: Accessed September 20, 2018.

        • Merikangas KR
        • Calkins ME
        • Burstein M
        • et al.
        Comorbidity of physical and mental disorders in the Neurodevelopmental Genomics Cohort Study.
        Pediatrics. 2015; 135: e927-e938
        • Canning EH
        • Hanser SB
        • Shade KA
        • et al.
        Mental disorders in chronically ill children: parent-child discrepancy and physician identification.
        Pediatrics. 1992; 90: 692-696
        • Ferro MA.
        Major depressive disorder, suicidal behaviour, bipolar disorder, and generalised anxiety disorder among emerging adults with and without chronic health conditions.
        Epidemiol Psychiatr Sci. 2016; 25: 462-474
        • Pinquart M
        • Shen Y.
        Behavior problems in children and adolescents with chronic physical illness: a meta-analysis.
        J Pediatr Psychol. 2011; 36: 1003-1016
        • Leininger LJ
        • Saloner B
        • Wherry LR.
        Predicting high cost pediatric patients: derivation and validation of a population-based model.
        Med Care. 2015; 53: 729-735
        • Olfson M
        • Druss BG
        • Marcus SC.
        Trends in mental health care among children and adolescents.
        N Engl J Med. 2015; 372: 2029-2038
        • Bethell CD
        • Kogan MD
        • Strickland BB
        • et al.
        A national and state profile of leading health care problems and health care quality for children: key insurance disparities and across-state variations.
        Acad Pediatr. 2011; 11: S22-S33
        • Katon W
        • Russo J
        • Lin EHB
        • et al.
        Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial.
        Arch Gen Psychiatry. 2012; 69: 506-514
        • Wright DR
        • Haaland WL
        • Ludman E
        • et al.
        The costs and cost-effectiveness of collaborative care for adolescents with depression in primary care settings: a randomized clinical trial.
        JAMA Pediatr. 2016; 170: 1048-1054
        • Katon WJ
        • Lin EH
        • VonKorff M
        • et al.
        Collaborative care for patients with depression and chronic illness.
        N Engl J Med. 2010; 363: 2611-2620