Barriers to health care research for children and youth with psychosocial problems.
BACKGROUND
The 1999 surgeon general's report on mental health concluded that insufficient attention to mental health disorders is being paid in children's primary medical care services. This lack of attention has occurred despite considerable attention to this issue in the planning documents of many federal agencies.


OBJECTIVE
To assess the extent to which federal agencies' portfolios of funded research grants were consistent with the directives for primary care-based mental health services for children and adolescents featured in their planning documents.


METHODS
A cross-sectional review of the 66 749 abstracts listed in the April 2001 Computer Retrieval of Information on Scientific Projects (CRISP) database of currently funded research grants supported by the US Department of Health and Human Services. Abstracts were rated by whether they targeted primary care, examined behavioral or emotional issues, and examined or modified a facet of primary care.


RESULTS
Of the 45 022 research abstracts in the CRISP database, 2720 (6%) contained the words children, adolescents, or youth. Sixty-three abstracts contained work on children, adolescents, or youth in primary care (0.14% of the portfolio). Of these 63 abstracts, only 21 (0.05% of the portfolio) addressed behavioral or emotional issues. Of the 21 projects, only 11 examined aspects of the primary care process. When the distribution of child and adult studies on the treatment of depression within primary care settings was examined, it was found that adults received 15 times the research attention compared with children.


CONCLUSIONS
Even though the importance of primary care as a system for identifying and treating behavioral and emotional problems in children has been recognized for more than 20 years, little attention is being paid to this topic in the research portfolios of the National Institutes of Health and other federal agencies that support research.
Horwitz
Sarah McCue
SM
Department of Epidemiology and Public Health, The Child Study Center, Yale University School of Medicine, 60 College St, Box 208034, New Haven, CT 06520-8034, USA. ronice.gilchrist@yale.edu
Kelleher
Kelly
K
Boyce
Thomas
T
Jensen
Peter
P
Murphy
Michael
M
Perrin
Ellen
E
Stein
Ruth E K
RE
Weitzman
Michael
M
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D016497:Adolescent Health Services; D002648:Child; D002652:Child Behavior / Q000523:psychology; D002662:Child Health Services; D019992:Databases as Topic; D005380:Financing, Government / Q000706:statistics & numerical data; D006302:Health Services Research / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services; D011320:Primary Health Care; D012109:Research Support as Topic / Q000706:statistics & numerical data; D014481:United States; D014483:United States Dept. of Health and Human Services