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Use of the Pediatric Symptom Checklist to screen for psychosocial problems in pediatric primary care: a national
M S Jellinek1, J M Murphy, M Little
1Child Psychiatry Service, Massachusetts General Hospital, Boston 02114, USA. mjellinek@partners.org
Insights
The Pediatric Symptom Checklist (PSC) effectively identifies psychosocial dysfunction in children across diverse pediatric settings. Its consistent results and high completion rates support routine use for improved child mental health recognition and care.
Area of Science:
- Pediatric mental health
- Primary care screening
- Child psychology
Background:
- Brief psychosocial screening aims to improve recognition, management, and referral of children's psychosocial morbidity in primary care.
- The Pediatric Symptom Checklist (PSC) is a tool for assessing psychosocial issues in children.
Purpose of the Study:
- To evaluate the feasibility of routine psychosocial screening using a brief version of the PSC in a large, representative sample of pediatric practice settings in the US and Canada.
- To assess the PSC's performance in detecting psychosocial problems by examining prevalence consistency, subgroup variations, and completion rates.
Main Methods:
- A large-scale study involving 21,065 children aged 4-15 years across primary care networks in the US and Canada.
- Parents completed demographic information, mental health history, the 35-item PSC, and a visit history questionnaire.
- Data were collected from 395 clinicians in 44 states, Puerto Rico, and 4 Canadian provinces.
Main Results:
- Overall prevalence of psychosocial dysfunction (13% school-aged, 10% preschool-aged) matched previous smaller samples.
- Children from low-income, single-parent, or those with prior mental health services showed higher dysfunction risk.
- Male children had a 50% increased risk of impairment; form completion rates were high (97% overall, ≥94% across subgroups).
Conclusions:
- The PSC is a consistent and widely acceptable tool for recognizing psychosocial dysfunction in pediatric outpatient settings.
- Its utility supports integration into comprehensive pediatric care and future research on cost-effective interventions.
- The PSC's performance across diverse groups and settings supports its role in advancing pediatric mental health services research.
Background:
Routine use of a brief psychosocial screening instrument has been proposed as a means of improving recognition, management, and referral of children's psychosocial morbidity in primary care.
Objective:
To assess the feasibility of routine psychosocial screening using the Pediatric Symptom Checklist (PSC) in pediatrics by using a brief version of the checklist in a large sample representative of the full range of pediatric practice settings in the United States and Canada. We evaluated large-scale screening and the performance of the PSC in detecting psychosocial problems by (1) determining whether the prevalence of psychosocial dysfunction identified by the PSC was consistent with findings in previous, smaller samples; (2) assessing whether the prevalence of positive PSC screening scores varied by population subgroups; and (3) determining whether the PSC was completed by a significant proportion of parents from all subgroups and settings.
Patients And Methods:
Twenty-one thousand sixty-five children between the ages of 4 and 15 years were seen in 2 large primary care networks: the Ambulatory Sentinel Practice Network and the Pediatric Research in Office Settings network, involving 395 pediatric and family practice clinicians in 44 states, Puerto Rico, and 4 Canadian provinces. Parents were asked to complete a brief questionnaire that included demographic information, history of mental health services, the 35-item PSC, and the number of pediatric visits within the past 6 months.
Results:
The overall prevalence rates of psychosocial dysfunction as measured by the PSC in school-aged and preschool-aged pediatric outpatients (13% and 10%, respectively) were nearly identical to the rates that had been reported in several smaller samples (12%-14% among school-aged children and 7%-14% among preschoolers). Consistent with previous findings, children from low-income families were twice as likely to be scored as dysfunctional on the PSC than were children from higher-income families. Similarly, children from single-parent as opposed to those from 2-parent families and children with a past history of mental health services showed an elevated risk of psychosocial impairment. The current study was the first to demonstrate a 50% increase in risk of impairment for male children. The overall rate of completed forms was 97%, well within an acceptable range, and at least 94% of the parents in each sociodemographic subgroup completed the PSC form.
Conclusions:
Use of the PSC offers an approach to the recognition of psychosocial dysfunction that is sufficiently consistent across groups and locales to become part of comprehensive pediatric care in virtually all outpatient settings. In addition to its clinical utility, the consistency and widespread acceptability of the PSC make it well suited for the next generation of pediatric mental health services research, which can address whether earlier recognition of and intervention for psychosocial problems in pediatrics will lead to cost-effective outcomes.
