title: Pediatric mood and anxiety syndromes in primary care: who gets identified?.
abstract: OBJECTIVE
  To seek clues to the enhancement of primary care management by (i) Determining how often and in whom primary care clinicians in the United States, Puerto Rico, and Canada identify pediatric mood or anxiety syndromes; (ii) Determining which clinical and demographic features predict higher rates of identification; (iii) Describing assessment methods used.
  
  
  METHODS
  This report uses the database of the multi-site Child Behavior Study. This cross-sectional study involved 206 primary care practices in the United States, Puerto Rico, and Canada; 395 clinicians and 20,861 primary care attenders aged 4-15 years. Clinicians completed a visit questionnaire addressing presence and type of psychosocial problems and how assessed. Parents completed a questionnaire addressing family demographics, child symptoms (Pediatric Symptom Checklist) and functioning, and child service use.
  
  
  RESULTS
  Clinicians identified psychosocial problems on 17.9% of visits, but mood or anxiety syndromes on only 3.3%, most commonly in children judged to have co-morbid behavioral syndromes, of whom the majority (66.7%) already had contact with specialized mental health. Neither parental concerns about mood and anxiety symptoms nor clinician familiarity with the patient were major predictors of identification. When making a diagnosis of a pure internalizing syndrome (i.e., without a co-morbid behavioral syndrome) clinicians rarely used standardized tools or school reports.
  
  
  CONCLUSIONS
  Neither screening for nor diagnosis of mood and anxiety syndromes is a routine part of primary care of children and adolescents. Efforts to improve care must include practical, validated screening procedures to enhance assessment for mood and anxiety syndromes, particularly among children in whom primary care clinicians identify psychosocial problems.
authors.affiliation: Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, California 94305-5719, USA. fwren@stanford.edu
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Wren
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Scholle
authors.forename: Jungeun
authors.initials: J
authors.lastname: Heo
authors.forename: Diane M
authors.initials: DM
authors.lastname: Comer
mesh_terms: D000293:Adolescent; D000296:Adolescent Psychiatry; D001008:Anxiety Disorders / Q000175:diagnosis*; D002170:Canada; D002648:Child; D002665:Child Psychiatry; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis*; D011320:Primary Health Care / Q000379:methods; D011581:Psychological Tests; D011647:Puerto Rico; D014481:United States