title: Factors associated with the referral of anxious children to mental health care: the influence of family functioning, parenting, parental anxiety and child impairment.
abstract: This study aims to identify factors that predict the mental health care referral of anxious children. In total, 249 children and families, aged 8-13 years, participated: 73 children were referred with anxiety disorders to mental health care [mean (M) age = 10.28, standard deviation (SD) = 1.35], 176 non-referred anxious children recruited in primary schools (M age = 9.94, SD = 1.22). Child anxiety and other disorders were assessed with semi-structured interviews. Child anxiety symptoms, behavioural problems, parental anxiety, the parenting styles overprotection, autonomy encouragement, rejection, and the family functioning dimensions control and relational functioning, were assessed with child, father and mother report on questionnaires. The summed interference rating of children's anxiety disorders was a predictor of referral, consistent over child and parent reports, but not comorbidity. Most family and parenting variables did not predict referral, nor differed between the referred and non-referred sample. Contrary to our hypothesis, maternal self-reported anxiety decreased the odds of referral and child reported parental autonomy granting increased, while child reported overprotection decreased the odds of referral. The impairment for the child due to the number and severity of their anxiety disorder(s) is, based on child, mother and father report associated with referral. This indicates that those who need it most, receive clinical treatment.
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Loes
authors.initials: L
authors.lastname: Jongerden
authors.forename: Ellin
authors.initials: E
authors.lastname: Simon
authors.forename: Denise H M
authors.initials: DH
authors.lastname: Bodden
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
authors.forename: Susan M
authors.initials: SM
authors.lastname: Bögels
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003695:Delivery of Health Care / Q000379:methods*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016487:Parenting / Q000523:psychology*; D011788:Quality of Life; D012017:Referral and Consultation; D011795:Surveys and Questionnaires
keywords: Child anxiety; family functioning; impairment; parenting; service utilization