Barriers to the identification and management of psychosocial issues in children and maternal depression.
BACKGROUND
Child psychosocial issues and maternal depression are underidentified and undertreated, but we know surprisingly little about the barriers to identification and treatment of these problems by primary care pediatricians.


OBJECTIVE
The purpose of this work was to determine whether (1) perceived barriers to care for children's psychosocial issues and maternal depression aggregate into patient, physician, and organizational domains, (2) barrier domains are distinct for mothers and children, and (3) physician, patient, and practice/organizational characteristics are associated with different barrier domains for children and mothers.


METHODS
We conducted a cross-sectional survey of the 50,818 US nonretired members of the American Academy of Pediatrics. Of a random sample of 1600 members, 832 (745 nontrainee members) responded. This was a mailed 8-page survey with no patients and no intervention. We measured physician assessment of barriers to providing psychosocial care for children's psychosocial problems and maternal depression.


RESULTS
Pediatricians frequently endorse the lack of time to treat mental health problems (77.0%) and long waiting periods to see mental health providers (74.0%) as the most important barriers to the identification and treatment of children's psychosocial problems. For maternal depression, pediatricians most often endorsed lack of training in treatment (74.5%) and lack of time to treat (64.3%) as important barriers. Pediatricians' reports of barriers clustered into physician and organizational domains. Physician domains were distinct for children and mothers, but organizational domains were not. Several physician and practice characteristics are significantly associated with the 4 barrier scales, and different characteristics (eg, sociodemographic, attitudinal, and practice features) were related to each barrier area.


CONCLUSIONS
Pediatricians endorse a wide range of barriers with respect to the diagnosis and treatment of children's mental health problems and maternal depression. The specificity of factors relating to various barrier areas suggests that overcoming barriers to the identification and treatment of child mental health problems and maternal depression in primary care pediatrics is likely to require a multifaceted approach that spans organizational, physician, and patient issues. In addition, comprehensive interventions will likely require social marketing approaches designed to engage diverse audiences of clinicians and their patients to participate.
Horwitz
Sarah McCue
SM
Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Room W-G 72, 10900 Euclid Ave, Cleveland, Ohio 44106-4945, USA. sarah.horwitz@case.edu
Kelleher
Kelly J
KJ
Stein
Ruth E K
RE
Storfer-Isser
Amy
A
Youngstrom
Eric A
EA
Park
Elyse R
ER
Heneghan
Amy M
AM
Jensen
Peter S
PS
O'Connor
Karen G
KG
Hoagwood
Kimberly Eaton
KE
D002648:Child; D003625:Data Collection; D003695:Delivery of Health Care / Q000458:organization & administration; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D010372:Pediatrics; D010818:Practice Patterns, Physicians'