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Association between child behavior problems and frequent physician visits
B Zuckerman1, K A Moore, D Glei
1Department of Pediatrics, Boston University School of Medicine, Mass., USA.
Insights
Children with behavior problems visit the doctor more often, especially those who are physically healthy. This study highlights the link between behavioral health and healthcare utilization in children.
Area of Science:
- Pediatric Health Services Research
- Child Psychology and Psychiatry
- Public Health and Epidemiology
Background:
- Parent-reported behavior problems are common in children.
- Understanding factors influencing healthcare utilization is crucial for resource allocation and intervention planning.
- The relationship between behavioral issues and healthcare access, particularly in seemingly healthy children, requires further investigation.
Purpose of the Study:
- To examine the association between parent-reported behavior problems and healthcare utilization among children.
- To specifically investigate this association in physically healthy children.
- To determine if specific behavior syndromes (antisocial, anxious/depressed) are linked to frequent physician visits.
Main Methods:
- Utilized data from the 1988 National Health Interviews Survey--Child Health Supplement.
- Analyzed a sample of 11,840 children aged 5 to 17 years.
- Employed bivariate and multivariate analyses using the Behavior Problems Index, comparing children in the highest quartile of behavior problems with others.
Main Results:
- Children in the top quartile for behavior problems were significantly more likely to have four or more physician visits annually.
- This association was particularly pronounced among physically healthy children.
- Both anxious/depressed and antisocial behavior subscales showed independent significant links to increased physician visits.
Conclusions:
- Parent-reported behavior problems are a significant predictor of increased physician visits in children.
- This association persists even after controlling for sociodemographic and health status variables.
- The findings underscore the importance of considering behavioral health in pediatric healthcare utilization, especially for healthy children.
Objective:
To determine the association between parent-reported behavior problems and health care utilization, especially among physically healthy children.
Design:
Analysis of data from the 1988 National Health Interviews Survey--Child Health Supplement. The sample for analysis consisted of 11,840 children aged 5 to 17 years. The independent measure of primary interest are behavior problems as measured by the Behavior Problems Index. For the bivariate analysis, children in the lowest quartile, highest quartile and middle half were compared. For the multivariate analysis, children in the highest quartile with behavior problems were compared with all other children.
Main Outcome Measures:
The number of reported physician visits in the past year and the past 2 weeks, Two common behavior syndromes--antisocial and depressed or anxious--were analyzed separately to determine whether a specific type of behavior problem was associated with frequent health care utilization.
Results:
Eighteen percent of the children aged 5 to 17 years had four or more health visits during the past year, and 2% had two or more visits during the past 2 weeks. Children in the top quartile for parent-reported behavior problems were more likely to have four or more physician visits than children in the middle half and bottom quartile. Children reported to be in "excellent," "very good," or "good" health who were in the top quartile of behavior problems were more likely to report four or more physician visits during the past year, but no statistically significant differences were seen among children reported to be in "fair" or "poor" health. Controlling for confounding variables, children in the top quartile of the Behavior Problems Index are significantly more likely to report four or more visits during the past year and two or more visits during the past 2 weeks compared with other children. Anxious or depressed and antisocial subscales of the Behavior Problems Index showed independent and significant associations with four or more physician visits in the past year.
Conclusion:
Children with parent-reported behavior problems are likely to have more frequent physician visits compared with children without behavior problems, even when confounding sociodemographic and health status variables are controlled. The association is concentrated among physically healthy children.