Do Pediatricians Think They Are Responsible for Identification and Management of Child Mental Health Problems? Results of the AAP Periodic Survey

doi:10.1016/j.ambp.2007.10.006

Ambulatory Pediatrics

Volume 8, Issue 1, January 2008, Pages 11-17

https://doi.org/10.1016/j.ambp.2007.10.006 Get rights and content

Objective

Childhood psychosocial problems have profound effects on development, functioning, and long-term mental health. The pediatrician is often the only health professional who regularly comes in contact with young children, and it is recommended that health care supervision should include care of behavioral and emotional issues. However, it is unknown whether pediatricians believe they should be responsible for this aspect of care. Our objective was to report the proportion of physicians who agree that pediatricians should be responsible for identifying, treating/managing, and referring a range of behavioral issues in their practices, and to examine the personal physician and practice characteristics associated with agreeing that pediatricians should be responsible for treating/managing 7 behavioral issues.

Methods

The 59th Periodic Survey of members of the American Academy of Pediatrics was sent to a random sample of 1600 members. The data that are presented are based on the responses of 659 members in current practice and no longer in training who completed the attitude questions.

Results

More than 80% of respondents agreed that pediatricians should be responsible for identification, especially for attention-deficit/hyperactivity disorder (ADHD), eating disorders, child depression, child substance abuse, and behavior problems. In contrast, only 59% agreed that pediatricians were responsible for identifying learning problems. Seventy percent thought that pediatricians should treat/manage ADHD; but for other conditions, most thought that their responsibility should be to refer. Few factors were consistently associated with higher odds of agreement that pediatricians should be responsible for treating/managing these problems, except for not spending their professional time exclusively in general pediatrics.

Conclusions

These data suggest that pediatricians think that they should identify patients for mental health issues, but less than one-third agreed that it is their responsibility to treat/manage such problems, except for children with ADHD. Those not working exclusively in general pediatrics were more likely to agree that pediatricians should be responsible for treating and managing children's mental health problems.

Section snippets

Design/Methods

Data were obtained from the 59th Periodic Survey conducted by the American Academy of Pediatrics (AAP), which represents approximately 80% of pediatricians in the United States. At the time of the survey, there were 50 818 nonretired US members. The survey was pretested and approved by the AAP Institutional Review Board before the initial mailing. Details of the survey have been reported elsewhere.²²

Results

Among the1294 members who had completed training, 57% responded (N = 745). The final multivariable logistic regression model estimating the probability of response included age group (≥40 vs <40), gender, and the 2-way interaction between age and gender. Sample weights were created and rescaled such that the mean was unity and the sum is equal to the analytic sample size: males <40 years of age: 1.28; males ≥40 years of age: 1.10; females <40 years of age: 0.93; females ≥40 years of age: 0.87.

Discussion

This study demonstrates a gap between pediatricians' perceived responsibilities for identification and for treatment/management of 7 important mental health conditions. This gap has been previously reported in a study by Olson and colleagues²³ in assessing pediatrician's attitudes and behaviors toward their patients with depression. In both studies, ∼90% thought they should be responsible for identification, whereas 25% to 27% thought that it was their responsibility to treat, suggesting that

Acknowledgments

Supported in part by and reviewed by the American Academy of Pediatrics; funded by the Annie E. Casey Foundation.

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Citation Excerpt :
For example, patients presenting with risk factors perceived as being pertinent to a given health topic (e.g., report of sexually active peers, “warning signs”) were more likely to be screened than peers who were perceived as being at lower risk (n = 5) [6,46,62,63]. There were also documented disparities in screening (n = 5) based on patient race/ethnicity [54,59], age [46], and gender [21]. For instance, Meredith et al. (2018) [62] found that while older adolescent age was associated with higher odds of screening for substance use, adolescents who identified as Black, Hispanic, Multiracial, or other non-White race/ethnicity had lower odds of being screened.
We sought to aggregate common barriers and facilitators to screening adolescents for sensitive health topics (e.g., depression, chlamydia) in primary care, as well as those that are unique to a given health topic. We conducted a literature search of three databases (PsycInfo, MEDLINE, and CINAHL) and reference lists of included articles. Studies focused on barriers and facilitators to screening adolescents (ages 12–17 years) for sensitive health topics in primary care that are recommended by national guidelines. Articles were peer-reviewed, presented empirical data, and were published in English in 2006–2021. We coded barriers and facilitators using the Consolidated Framework for Implementation Research, a well-established framework within implementation science. In total, 39 studies met inclusion criteria and spanned several health topics: depression, suicide, substance use, HIV, and chlamydia. We found common barriers and facilitators to screening across health topics, with most relating to characteristics of the primary care clinics (e.g., time constraints). Other factors relevant to screening implementation ranged from confidentiality concerns to clinician knowledge. Barriers and facilitators specific to certain health topics, such as the availability of on-site laboratories for HIV screening, were also noted. Findings can guide refinements to screening implementation.
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The mind and the body are not separate, and fragmentation within health does not create ideal outcomes. Therefore, in the last decade the number of health care professionals advocating for integrated primary care (IPC), which merges medical services with behavioral seervices, has exploded. IPC emerged because primary care has been the de facto mental health system (Regier et al., 1993) for over three decades and continues to be so today, as most patients receive treatment for mental health and substance abuse services in the primary care setting. This trend to integrate behavioral health and primary care has increasingly been embraced in health care systems across the world (McDaniel and deGruy, 2014; SAMHSA-HRSA Center for Integrated Health Solutions, 2020; WHO, 2008).

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: Presented in part at the Pediatric Academic Societies' Annual Meeting, Washington, DC, May 2005.

: The views herein are of the authors and are not necessarily those of the Annie E. Casey Foundation or the American Academy of Pediatrics.

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Special Section on Mental Health Issues in Children and AdolescentsDo Pediatricians Think They Are Responsible for Identification and Management of Child Mental Health Problems? Results of the AAP Periodic Survey

Objective

Methods

Results

Conclusions

Section snippets

Design/Methods

Results

Discussion

Acknowledgments

J Am Acad Child Adolesc Psychiatry

Ambul Pediatr

Ambul Pediatr

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Prev Med

Mental Health: A Report to the Surgeon General

Emotional, developmental, and behavioral health of american children and their families: a report from the 2003 National Survey of Children's Health

Pediatrics

Increasing identification of psychosocial problems: 1979–1996

Pediatrics

American Academy of Pediatrics Task Force on the Family. Family pediatrics: report of the Task Force on the Family

Pediatrics

Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication

Arch Gen Psychiatry

Diagnosis and treatment of behavioral health disorders in pediatric practice

Pediatrics

The de facto US mental health services system: a public perspective

Arch Gen Psychiatry

Special Section on Mental Health Issues in Children and Adolescents
Do Pediatricians Think They Are Responsible for Identification and Management of Child Mental Health Problems? Results of the AAP Periodic Survey