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Mental health problems among children seen in pediatric practice: prevalence and management
Insights
Pediatricians identified mental health problems in 5.09% of child visits, with higher rates in boys and those with chronic conditions. Most common issues included adaptation reactions and speech disorders, often requiring supportive therapy.
Area of Science:
- Child and Adolescent Psychiatry
- Pediatric Mental Health
- Public Health
Background:
- Pediatricians are often the first point of contact for children's health concerns.
- Estimating the prevalence of mental health problems in pediatric primary care is crucial for resource allocation and early intervention.
Purpose of the Study:
- To estimate the point prevalence of mental health problems among children seen in ambulatory pediatric care.
- To identify demographic and clinical factors associated with these problems.
- To describe the nature of the problems and the interventions provided by pediatricians.
Main Methods:
- A survey of 30 pediatricians in Monroe County, NY, representing a 40% probability sample of practices.
- Data collected over a 2-month period for each pediatrician, covering all child visits.
- Detailed recording of identified mental health problems, their impact, and pediatrician-initiated actions.
Main Results:
- A point prevalence of 5.09% for mental health problems was observed at the time of first visit.
- Prevalence varied by practice type, with health center pediatricians reporting higher rates (7.33%).
- Higher rates were found in older children (7-14 years), boys, children on Medicaid, those with chronic physical disorders, and children from one-parent families.
Conclusions:
- Mental health problems are common in pediatric primary care settings.
- Specific subgroups of children are at higher risk, highlighting the need for targeted screening and support.
- Pediatricians primarily utilize supportive therapy and counseling, with medication use being less frequent.
Abstract:
An ambulatory care survey involving 40% of all pediatricians in Monroe County, NY, was conducted between January and December 1979 to obtain an estimate of the prevalence of mental health problems among children seen by pediatricians. If a child with such a problem was identified, the pediatrician described the problem in detail, its impact on the family and the patient, and the action taken to handle the problem. The weighted 40% probability sample was representative of all pediatric practices in the county. During the 2 months for which each of the 30 pediatricians reported on all visits, there were 21,575 visits made by 18,351 children. There were 935 children detected at their first visit as having a problem, and another 48 children at a repeat visit during the reporting period. This is equivalent to a point prevalence at time of first visit of 5.09%. There was considerable variation between pediatricians: group practitioners reported a point prevalence of 4.06%, solo practitioners reported 5.06%, and health center pediatricians reported 7.33%. High rates were reported among children 7 to 14 years old (8.0%), boys (6.2%) compared with girls (3.9%), those on Medicaid (8.3%), and those whose presenting complaint was a chronic physical disorder (13.1%). The slightly higher rate among blacks than whites appeared to be related to the generally lower socioeconomic status among blacks. The rate among children in one-parent families was twice as high as in two-parent families. With regard to the mental health problem, most frequent diagnoses (primary or secondary) were adaptation reaction (31.5% of "problem" children), speech and language disorder (18.4%), other specific learning disorder (17.1%), hyperkinetic disorder (16.8%), and conduct disorder (14.7%). Functional impairment was moderate or severe in more than half the affected children; most frequent treatment provided by the pediatricians was supportive therapy or counseling (81.4%); drugs were prescribed for 11.3% of the affected children, amphetamines for 4.7%.