Screening to identify mental health problems in pediatric primary care: considerations for practice

Few pediatric primary care providers routinely use mental health screening tools, in part because they may have concerns about whether screening is useful and how it will affect their practice. This study examined the extent to which screening in primary care would increase the identification of mental health problems among a diverse population of children and youth.

Prior to the visit, the parents of 767 patients age 5 to 16 completed the Strengths and Difficulties Questionnaire to report their child's mental health symptoms and impairment. Without viewing the screening results, each child's provider (N = 53) completed a questionnaire to report whether the child or youth demonstrated a mental health problem.

Compared with providers, the screen identified twice as many patients with moderate symptoms and nearly 28% more patients with high symptoms. Among patients with high symptoms, providers failed to identify a problem among 78% of those who were Latino/Other and 55% of those who were African American compared with 27% of Caucasian patients (p < 0.001). Providers were not more likely to identify patients with externalizing versus internalizing symptoms but were more likely to identify patients who demonstrated symptoms across multiple domains of functioning.

Screening substantially increased the number of children and youth who would be identified as possibly having a mental health problem. Screening may have the most potential to increase the identification of problems among patients who have moderate mental health symptoms and those who are African American or Latino.