Trends in prevalence and management of childhood anxiety by Australian pediatricians

Objective: Rising anxiety rates and equity of care are ongoing concerns. Through 2 pediatric practice audits conducted 5 years apart, we aimed to determine the change in 1) anxiety diagnoses; 2) associated comorbid diagnoses; 3) variance in management by location; and 4) child, family, and pediatrician predictors of management. Methods: Members of the Australian Paediatric Research Network (APRN) were invited to participate in patient-level prospective national pediatric practice audits in 2008 and 2013. Pediatricians were asked to complete standardized forms for 100 consecutive patients or all patients seen over 2 weeks, whichever was completed first. Demographic data, diagnoses, medications, and referrals were collected. Logistic regressions were conducted, clustered at the pediatrician level. Results: Of eligible APRN pediatricians in 2013 and 2008, 48% and 66% participated and contributed 7102 and 8345 consultations, respectively. Anxiety diagnoses increased over the 5-year period (4.4% vs 7.6%; P <.001), as did proportions with comorbid autism spectrum disorder (18.4% vs 29.5%; P <.001) and sleep problems (5.1% vs 9.5%; P =.02). There was an increase in the prescription of core anxiety medications, with prescription of selective serotonin reuptake inhibitors increasing from 2.0% to 27.7% (P =.01). Children were more likely to be referred to a psychologist if they were seen in metropolitan practices (odds ratio = 2.0; 95% confidence interval, 1.1–3.9; P =.03) or had learning difficulties (odds ratio = 2.1; 95% confidence interval, 1.1–3.9; P =.03). Conclusions: Prevalence of anxiety among children and adolescents attending pediatricians nearly doubled over the 5-year period. Children in regional and remote locations are less likely to be referred to psychological services, prompting concerns about inequity in access to care.