More kids are anxious but fewer are getting the right help, study shows

CNN  — 

More kids, teens and young adults are experiencing anxiety — but fewer are getting the appropriate treatment, according to the latest research.

A new study looked at data from the National Ambulatory Medical Care Survey from 2006 to 2018 and assessed office-based physician visits to see how many included an anxiety disorder diagnosis and what treatment, if any, was given. The patients observed ranged in age from 4 to 24 years old.

While visits for anxiety increased from 1.4% in the 2006 to 2009 period to 4.2% in the period from 2014 to 2018, the proportion of visits with therapy decreased, according to the study published Monday in the American Academy of Pediatrics’ journal Pediatrics.

The likelihood of a patient receiving medication alone to treat the anxiety with no therapy increased significantly in the later years of the data analyzed in this survey, which continues to be administered by the US National Center for Health Statistics.

The research showed what mental health care providers have reported: Anxiety in young people is getting worse in the United States, said lead study author Dr. Laura Chavez, a principal investigator in the Center for Child Health Equity and Outcomes Research at Nationwide Children’s Hospital in Columbus, Ohio.

“The burden for treating mental health conditions among young kids is growing,” Chavez said. “Even when patients are able to navigate the health care system and attended visits with a physician, it may still leave without (the patient) getting the treatment that they need.”

A weakness of the study is that it likely only covers part of the problem, said Dr. Lata McGinn, a professor of psychology at Yeshiva University in New York City who did not work on the study.

While the study includes people who are coming in for treatment, there are many people who never come to the doctor’s office, said McGinn, who is also cofounder of Cognitive & Behavioral Consultants in White Plains, New York. “There are lots and lots of people who are not even getting anything.”

The data around treatment is troubling, because existing evidence has shown that for most people, therapy is the best way to treat anxiety, McGinn said.

But the bulk of young people were not receiving any kind of therapy, even though treatment like cognitive behavioral therapy, or CBT, is a frontline defense against anxiety, she added.

For severe conditions that do benefit from medication, best practices say those patients should have both pharmaceutical and psychotherapy interventions, McGinn said.

Taking medication as the only form of treatment could mean being on it for a long time, she said.

“The fact that they’re not receiving therapy suggests that they’re basically not learning tools to cope with anxiety on their own,” McGinn said, adding that’s especially concerning for young people who are still developing biologically and socially.

Living with conditions such as anxiety and depression can feel like being in an ocean, said Dr. Ariana Hoet, executive clinical director of On Our Sleeves, an initiative created by Nationwide Children’s Hospital that advocates for children’s mental health. Hoet was not involved in the research.

Therapy is meant to teach you to swim, but sometimes you are sinking with exhaustion from navigating the currents and need floats to help, she added.

“That’s what the medication can be,” Hoet said. “You can have these floaties, and it gives you that breather. It takes away the intensity of the symptoms, but then you still want to go into therapy to learn the tools to still learn how to cope with it and live with it and live through it.”

More effective treatment including therapy might help with the growing mental health challenges in young people, Chavez said.

“We would hope that patients can have access to both and then we wouldn’t see sort of these changes over time that we were observing where actually more patients are receiving medications only,” she added.

While there is a larger problem of resources and availability when it comes to mental health care, there are things families can do to get help.

“Unfortunately, the way our system is designed, it’s a lot of the burden for advocating and navigating this falls to the patient and to the family,” Chavez said.

One of the first steps is learning to recognize anxiety in children early, McGinn added. This type of behavior usually manifests in avoidance — such as being afraid to sleep alone or trying to stay home from school.

As much as the drive to nurture and protect may push adults to enable the avoidance to ease the anxiety in the immediate term, McGinn advised not caving to the anxiety while still supporting your child.

That approach might mean not letting your child stay home when they are feeling anxious. Don’t write off chronically anxious behavior as shyness and instead seek out a mental health professional for an evaluation, she said.

And though pharmaceutical companies have more money to market their solutions, be sure to find the providers who can work with your family through therapy programs based in evidence like CBT, she said.

There can be barriers to navigating insurance and finding available providers, so Hoet recommends families contact their child’s school or their workplace to see if help is available there.

Families can also find help getting care and resources in the meantime at onoursleeves.org, she added.

What’s in the 2023 health and human services package

Minnesota Democrats this session passed a behemoth health and human services budget on the last day of the legislative session, arguing that the nearly $1.1 billion in new general fund spending over the next two years will give more Minnesotans access to the health care and social services they need.

Democrats said the health and human services budget addresses longstanding inequities in Minnesota health and wellness outcomes.

“This bill is truly born of a commitment to our shared humanity,” said Rep. Tina Liebling, DFL-Rochester, on the House floor.

The bill, which according to the Senate spends $6.2 billion from the state’s general fund in the next two years, passed both chambers on party line votes. 

Here are some of the significant provisions from the health and human services bill:

Over 40,000 Minnesotans are eligible to enroll in the state’s publicly subsidized insurance program for low-income residents, known as MinnesotaCare. 

Minnesota is now the second state to allow all low-income residents to enroll in public insurance, regardless of immigration status. The state aims to begin enrolling undocumented residents in 2025. 

About 17% of Minnesota’s uninsured are undocumented, and the expansion is estimated to cost Minnesota about $8 million in the first two years and will jump to $100 million in the following two years as enrollment increases. 

Immigrant rights advocates heralded the expansion of MinnesotaCare.

“Workers without status have made enormous sacrifices to our state, paying the highest toll to keep our state running during COVID-19. All people deserve access to health insurance,” said Emilia Gonzalez, executive director of Unidos Minnesota, in a statement.

Lawmakers originally proposed expanding MinnesotaCare eligibility to residents above the income cap to buy into the program, but legislators ultimately delayed the expansion by at least one year to study its impact. The state must conduct an actuarial analysis to determine state costs, premiums, and projected enrollment, among other details. 

Minnesota could be the first state to offer a government-run public option health care, but the earliest Minnesotans might be able to enroll is 2027. 

The bill repealed most of the state’s restrictions on abortion, many of which were already ruled unconstitutional by a district court judge. Those included requirements that women wait 24 hours before having an abortion, that abortions after the first trimester be performed in a hospital, and that doctors recite a list of medically dubious claims about the risks of abortion. Lawmakers also repealed the state’s restrictions on abortion after viability, which existed in a legal gray area because of a 1970s ruling that found it was more restrictive than the since-overturned Roe v. Wade decision allowed.

Progressive democrats aimed to strike virtually all abortion regulations off the books, but were forced to leave some in place. Abortion providers will still be required to collect and report data on abortions to the Department of Health, albeit with far fewer details. Health care providers will have to record how the abortion was performed, the approximate gestational age and the age of the woman. They won’t have to record if the woman’s physical or emotional health was at stake, the number of previous abortions the woman had or if the pregnancy was the result of rape or incest.

Lawmakers also left in place a version of the “Born Alive Act,” but changed the mandate that doctors “preserve the life” of babies to “care” for babies “consistent with good medical practice.” Proponents say the change is compassionate to parents who have to induce pregnancy early because of severe complications. Those parents will be able to spend time with their babies for whom no medical interventions will save their lives. 

The requirement that both parents be notified if a minor seeks an abortion was also left in place, even though that law is not in effect because it was ruled unconstitutional by a Ramsey County judge last year.

Lawmakers also eliminated the “Positive Alternatives” program, which funded so-called crisis pregnancy centers that encourage women to carry pregnancies to term and provide resources to them. Under Minnesota law, grant recipients under the program were explicitly prohibited from counseling clients on abortion or referring them to organizations that provide abortions.

The health bill instead funds a new initiative called “Healthy Beginnings, Healthy Families,” which supports nonprofits that implement data-driven, culturally relevant activities to improve infant health.

Democrats sought to tackle skyrocketing health care costs. Then Minnesota’s big hospital systems stepped in.

As originally proposed, the health care affordability board would have set health care spending targets for health care entities in the state. The board would have been able to fine hospitals and insurance companies for growth that went beyond the spending targets created by the board.

The Minnesota Hospital Association was opposed to the fines.

“Creating a new body to analyze health care spending in Minnesota may be necessary to better understand the shared goal of sustaining access to care, but it does not require establishing punitive regulatory power and severe civil penalties,” MHA said in an April letter to lawmakers.

Weeks after the MHA’s letter, Mayo Clinic sent a letter to Walz threatening to pull billions in investments from the state in part over the creation of the affordability board.

Lawmakers appeared to acquiesce to Mayo’s demand, and the affordability board was ultimately replaced by a center within the Department of Health that will analyze escalating costs, but does not have the power to fine or penalize hospitals or insurers.

On top of a slew of tax increases passed in other budget bills, lawmakers approved a law in the health bill that will add up to 25 cents per month onto monthly phone bills to fund the state’s 988 suicide prevention lifeline.

Beginning January 2024, the state will impose a monthly fee on each subscriber of a landline, wireless or IP-enabled voice service to fund the 988 lifeline.

People may call or text the number 24 hours, seven days a week to receive help from one of the Department of Health’s lifeline centers, which offer assistance from professionals to people in crisis or aid people concerned about someone potentially in crisis.

The lifeline isn’t new, but the state says it needs funding to help keep up with an influx of calls.

The state will annually recommend a fee amount to the state’s Public Utilities Commission, but it cannot exceed 25 cents per month.

According to estimates, the telecommunications fee is expected to generate nearly $15 million in the next two years. States already implement a telecommunications fee to fund 911 services, with Minnesota’s fee currently sitting at 95 cents.

Throughout the 845-page bill, lawmakers allocated about $98 million in the next two years for mental health services, according to the National Alliance on Mental Illness — Minnesota.

Going into final negotiations, the House had nearly $130 million for mental health funding for fiscal years 2024 and 2025 and the Senate about $108 million. Walz had proposed in his budget about $123 million for mental health.

Lawmakers came to an agreement for $98 million in mental health funding behind closed doors in the conference committee, with lawmakers from both chambers appointed to iron out a compromise. Sue Abderholden, NAMI Minnesota executive director, said it was less than mental health advocates were expecting.

“We were a little disappointed knowing what we all know — that there is a mental health crisis,” Abderholden said.

Lawmakers allocated about $14 million in the next two years for school-linked behavioral health programs. These include community mental health providers partnering with their local schools to provide mental health services for students. The $14 million funds grants to the providers, who are then in a better position to aid uninsured and low-income students.

In addition, legislators allocated about $6 million for the next two years on grants for mental health facilities serving a cultural or ethnic minority population. The facility can use the funds for workforce development and outreach and expand their services into greater Minnesota, among other initiatives.

The bill also spends $18 million for mobile mental health crisis grants, which fund teams to respond to people suffering from mental health emergencies. 

Lawmakers allocated a chunk of funding — $316 million — for Minnesota’s Great Start compensation support payment program. This initiative sends money to eligible child care and early learning programs, to improve access to the programs and boost child care worker pay.

The state’s education budget also has millions for child care and early education, including more than $250 million for the state’s early learning scholarships program, which is targeted at 3 and 4 year olds.

In addition, the state allocated $100 million for emergency shelter grants and over $30 million in extra funding for the Homeless Youth Act, which was established in 2006. The Homeless Youth Act provides grants for community outreach, drop-in programs and emergency shelters to reduce the number of Minnesota children experiencing homelessness.

According to estimates, about 5,800 children under 18 experience homelessness over the course of a year.

The so-called Keeping Nurses at the Bedside Act aimed to give nurses some say over hospital staffing, but lawmakers wound up passing a watered down version that will have no immediate impact on nurse staffing levels. It passed separately from the health and human services budget.

Lawmakers were concerned over the proposed carve out for Mayo Clinic, which the hospital won after it threatened to pull billions in investments from Minnesota.

“I’m very concerned by the Mayo carve out. It’s bad public policy. Everyone should play by the same rules and the same laws,” Sen. Kelly Morrison, DFL-Deephaven, told the Reformer.

The bill was made into a study after supporters capitulated to the demands of hospitals, which were fiercely opposed to the bill. The legislation will support violence prevention — another key concern of nurses, who suffer high rates of workplace abuse — and bolster nursing recruitment, but will be without the signature goal of giving nurses some say in how hospitals are staffed.

“Because of the power and influence of corporate health care executives, that bill has died,” said Mary Turner, the president of the Minnesota Nurses’ Association.

Legislators said they will attempt to pass the full Keeping Nurses at the Bedside Act next year.

The Legislature passed a bill that bans anti-competitive health care mergers, which could kill the proposed marriage of Minneapolis-based Fairview Health Services and Sioux Falls-based Sanford Health. The bill passed separately from the health and human services budget.

The bill also prohibits out-of-state entities from owning in whole or part University of Minnesota health care entities, as would be the case were Sanford to complete its merger with Fairview, which owns the university’s teaching hospital.

But Fairview and Sanford said they intend to continue with the merger — which has already been delayed — despite the legislation.

The legislation prohibits health care transactions that “substantially lessen competition or tend to create a monopoly.” Attorney General Keith Ellison is already investigating the proposed Fairview-Sanford merger for potentially running afoul of antitrust and charity laws, but the new law gives the Attorney General’s Office greater latitude in bringing a case in state court if the merger is deemed not in the public interest. 

Democrats in the Legislature have criticized the proposed Fairview-Sanford merger. They say that it would create a health care monopoly in greater Minnesota and likely lead to clinic closures and higher costs for patients.

In a statement, Fairview said the legislation will not deter the health care nonprofit from merging with Sanford, and that the proposed merger meets the legislation’s requirements.

“This new law does not change our desire to combine with Sanford Health, and while it creates new regulatory processes, we strongly believe that the merger is in the public interest and that we can comply with the new requirements,” Fairview said.

Reformer reporter Max Nesterak contributed to this report.

Cooking Pasta Al Dente Could Help You Lose Weight, Study Finds

The way you prepare your food could be making you fat.

A study from Wageningen University in the Netherlands found that the texture of your food can greatly affect eating speed, which in turn might increase or decrease your overall calorie consumption.

One of the first things we are told on any weight loss journey is to eat more slowly. This is largely because it takes time for your brain to register that you have had enough food.

When we eat, our stomachs begin to stretch, sending a signal to our brain that says we are full. But this physical stretching is not the only factor involved in satiety. Our bodies also release a complex cocktail of hormones that help us feel satisfied after our meals and control our hunger levels throughout the day.

The hormones act more slowly than physical feelings of fullness, with many taking between 10 and 20 minutes to reach their maximum level. Therefore, it is important to give your body the time it needs to process these signals.

Fast eating might also affect digestion and long-term blood sugar control, potentially increasing your risk of diabetes.

But trying to eat more slowly is easier said than done. We are often told to practice mindful eating, concentrating on every bite and pausing between each mouthful, but there might also be more practical ways to slow your eating.

In the Wageningen University study, which was published in the journal of Food Quality and Preference, 54 healthy participants were given 12 different meals with a range of textures and toppings. These comprised penne pasta and/or carrots that were either served al dente (just cooked) or well boiled. The participants also received the same dishes with the addition of a simple tomato sauce.

The researchers found that the softer dishes were eaten with larger bite sizes and fewer chews than the harder dishes, and the addition of sauce made the food more swallowable by moistening its texture and sticking it together.

In total, the soft penne was consumed 42 percent faster than hard penne, while soft carrots were eaten roughly 94 percent faster than hard ones. The addition of the tomato sauce also increased eating speed, by a further 30 percent.

The researchers did not directly measure the impact of eating speed on energy consumption, but previous research has demonstrated that energy intake can increase by roughly 26 percent for an increased eating speed of 35 percent.

So simply by opting for harder or raw foods and cutting back on sauces, you can passively reduce your calorie intake without having to make any drastic dietary changes.