Primary care clinicians' use of standardized psychiatric diagnoses.
OBJECTIVE
Treatment of child mental health (MH) problems should be informed by psychiatric diagnosis. Whether primary care clinicians (PCCs) use standardized psychiatric diagnostic criteria to direct the treatment of child MH problems is unknown. This study investigated PCCs' use of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria during office visits.


METHODS
The data were obtained from 3674 children ages 4-15 years who were recognized as having one or more MH problems during office visits by clinicians participating in the Child Behaviour Study. Parents completed questionnaires before seeing the clinician. Clinicians completed a survey after the visit. The primary outcome was whether PCCs used standardized criteria to generate a diagnosis for children with recognized MH problems.


RESULTS
Clinicians used DSM criteria in 23% of visits in which a psychosocial problem was recognized, and 57% of PCCs reported no use of DSM. DSM criteria were used most frequently (38% of visits) when PCCs reported attention problems. Medications were much more likely to be prescribed during visits when PCCs diagnosed using DSM criteria (63% of visits vs. 19% when criteria were not used). However, only 51% of psychotropic medication prescriptions were based on a DSM diagnosis.


CONCLUSIONS
Clinicians used standardized criteria infrequently, and primarily to diagnose attention problems.
Gardner
W
W
Department of Pediatrics and the Children's Research Institute, The Ohio State University, Ohio 43205, USA. GardnerW@pediatrics.ohio-state.edu
Kelleher
K J
KJ
Pajer
K A
KA
Campo
J V
JV
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis; D001291:Attitude of Health Personnel; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis; D002675:Child, Preschool; D003376:Counseling; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000188:drug therapy; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires