Mental health in pediatric settings: distribution of disorders and factors related to service use.
OBJECTIVE
To examine child psychiatric disorders in pediatric settings and identify factors associated with parents' use of pediatricians as resources concerning emotional/behavioral issues and use of mental health services.


METHODS
The sample consists of 5- to 9-year-olds (mean = 7.17 years, SD = 1.41) from a representative sample (N = 1,060) of pediatric practices. Parent interviews included assessments of psychiatric disorders with the Diagnostic Interview Schedule for Children (DISC-R), parental depression/anxiety, possible child abuse, stress, support, and the use of mental health services.


RESULTS
The prevalence of any DISC disorder was 16.8%. Parental depression/anxiety and possible child abuse were associated independently with 2- to 3-times higher rates of disorder. Many parents (55%) who reported any disorder did not report discussing behavioral/emotional concerns with their pediatrician. Factors associated with discussing behavioral/emotional issues were the presence of any disorder and financial stress. Factors related to seeing a mental health professional were discussing behavioral/emotional issues with the pediatrician, single parenthood, and stressful life events.


CONCLUSIONS
The prevalence rates of disorders in this setting suggest that pediatricians are well-placed to identify and refer children with psychiatric disorders. However, most parents do not discuss behavioral/emotional issues with their pediatrician. Methods for improving rates of identification and referral (e.g., routine screening) are considered.
Briggs-Gowan
M J
MJ
Yale University Department of Psychology, New Haven, CT 06520, USA.
Horwitz
S M
SM
Schwab-Stone
M E
ME
Leventhal
J M
JM
Leaf
P J
PJ
D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003237:Connecticut / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008603:Mental Health; D010290:Parents / Q000523:psychology*; D010372:Pediatrics / Q000706:statistics & numerical data*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D012307:Risk Factors; D012494:Sampling Studies; D012959:Socioeconomic Factors