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Identification of psychosocial problems in pediatric primary care: do family attitudes make a difference?
S M Horwitz1, P J Leaf, J M Leventhal
1Department of Epidemiology and Public Health, Child Study Center, Yale University School of Medicine, New Haven, Conn 06520-8034, USA.
Insights
Parents often believe discussing psychosocial issues with pediatricians is appropriate but rarely do so. Pediatricians identify these problems based on observation, not parental reports, highlighting communication gaps.
Area of Science:
- Pediatric healthcare
- Child psychology
- Family medicine
Background:
- Psychosocial problems in children are common.
- Effective identification and management are crucial for child well-being.
- Pediatric providers play a key role in early detection.
Purpose of the Study:
- To examine how parents' attitudes toward discussing psychosocial concerns influence pediatric providers' identification of these issues.
- To explore the discrepancy between parental intent and action regarding psychosocial problem disclosure.
Main Methods:
- Prospective cohort study involving families of children aged 4-8 years.
- Recruitment from a stratified random sample of primary care practices.
- Data collected on parental attitudes and physician identification of psychosocial problems.
Main Results:
- A significant gap exists between parents' perceived appropriateness of discussing psychosocial problems and their actual disclosure to physicians.
- Parents with higher education, income, and insurance were more likely to intend discussion, suggesting potential social desirability bias.
- Physician identification of psychosocial problems was not associated with parents' reported discussions.
Conclusions:
- Pediatricians' assessments of psychosocial problems rely more on their own observations than parental reports.
- Enhancing physician-parent communication regarding psychosocial concerns is vital for effective healthcare referrals.
- Primary care physicians are essential gatekeepers for accessing specialized mental health services.
Objective:
To evaluate the affect of families' attitudes about the appropriateness of discussing psychosocial concerns on pediatric providers' identification of psychosocial problems.
Design:
These data were collected as part of the Greater New Haven Child Health Study, New Haven, Conn. The study design was a prospective cohort.
Setting:
Families were recruited from a stratified random sample of all primary care practices in the greater New Haven area. Nineteen of 23 invited practices agreed to participate including 2 prepaid practices, 2 neighborhood health centers, and 7 fee-for-service group and 8 fee-for-service solo practices.
Participants:
All families of children aged 4 to 8 years who attended these practices during 2 separate 3-week periods (1 in fall 1987 and 1 in spring 1988) were invited to participate in the study. Families were invited to participate only once, on the first contact with any eligible child, using approved procedures. Of 2006 eligible families, 1886 (94%) chose to participate.
Main Outcome Measure:
The outcome variable for these analyses is the identification of any behavioral, emotional, or developmental problem by the pediatrician on the 13-category checklist. Overall, pediatric clinicians identified 27.5% of children with 1 or more psychosocial problems.
Results:
Our data suggest that there is a great deal of discrepancy between what parents report is appropriate to do when their children have psychosocial problems and what they actually do when they recognize such problems in their children. Most (81.1%) believed it was appropriate to discuss 4 or more of the 6 hypothetical situations with their children's physician, while only 40.9% actually did discuss any of these problems with a physician when a problem occurred. Given the correlates of parents who intended to discuss such problems (higher education, older age, Euro-American ethnicity, higher income, married, availability of medical insurance) the possibility that parents are providing socially acceptable responses to such questions seems likely. Further, our data indicate that parents' actual reports of discussions of psychosocial problems is unrelated to whether physicians identified those problems in children.
Conclusions:
Pediatricians'judgments about the presence of psychosocial problems in their young patients seem to be based on their own observations rather than on what parents report. Physician-parent communication about psychosocial problems will be increasingly important as primary care physicians assume their role as gatekeepers to more expensive services such as mental health interventions.