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Psychopathology and health care use among preschool children: a retrospective analysis
J V Lavigne1, H J Binns, R Arend
1Northwestern University Medical School, Chicago, IL, USA.
Insights
Preschool children with psychopathology, including internalizing and externalizing behaviors, show increased healthcare utilization. This includes more primary care, total visits, and emergency department (ED) use, highlighting an early link between mental health and healthcare needs.
Area of Science:
- Child psychology
- Pediatric healthcare utilization
- Mental health diagnostics
Background:
- Psychopathology in preschool children is a significant concern.
- Understanding early predictors of healthcare use is crucial for intervention.
- The link between mental health and healthcare needs emerges early in life.
Purpose of the Study:
- To investigate the association between psychopathology and healthcare utilization in preschool-aged children (2-5 years).
- To determine if specific diagnoses or behavioral problems predict primary care, total, or emergency department (ED) visits.
- To explore the role of functional impairment and overall health status in this relationship.
Main Methods:
- Five hundred ten preschool children were recruited from primary care settings.
- A comprehensive assessment battery, including the Child Behavior Checklist and developmental evaluations, was used for diagnoses.
- Consensus diagnoses (DSM-III-R) were established, and healthcare utilization was assessed via record review and maternal estimates of primary care, total, and ED visits.
Main Results:
- A diagnosed mental health condition was linked to increased emergency department (ED) use, but not primary care or total visits.
- Higher functional impairment correlated with fewer primary care visits but more ED visits.
- Internalizing and externalizing behavior problems were associated with increased primary care and total visits, while ED visits were linked to total and internalizing problems. Child's health status consistently correlated with utilization.
Conclusions:
- A clear and consistent relationship exists between healthcare utilization and psychopathology in preschool children.
- Early identification and management of mental health issues in young children may impact healthcare resource use.
- Findings underscore the importance of integrating mental health screening and services within pediatric primary care settings.
Objective:
To examine the relationship between psychopathology and health care utilization beginning in the preschool (ages 2 to 5) years.
Method:
Five hundred ten preschool children were enrolled through 68 primary care physicians. The test battery used for diagnoses included the Child Behavior Checklist, a developmental evaluation, the Rochester Adaptive Behavior Inventory, and a videotaped play session. Consensus DSM-III-R diagnoses were assigned using best-estimate procedures. Frequency of primary care visits was established through 1-year retrospective record review; mothers estimated total visits and emergency department (ED) use.
Results:
Logistic regression models showed that a DSM-III-R diagnosis was related to increased ED use but not primary care or total visits. Greater functional impairment was associated with fewer primary care visits and more ED visits. Total, internalizing, and externalizing behavior problem scores were associated with increased primary care and total visits; ED visits were associated with increased total and internalizing problems. Child's health status consistently correlated with utilization.
Conclusion:
There is a consistent relationship between health care use and child psychopathology beginning in the preschool years.