Primary care physicians play substantial role in pediatric mental health

1. In a nationally representative sample of children age 2 to 21 years old, over a third of patients with mental health conditions saw a primary care physician (PCP) for care and medications. More children with attention-deficit/hyperactivity disorder (ADHD) saw their PCP for care compared to those with anxiety/mood disorder.

2. PCPs were more likely to prescribe medications for ADHD, and anxiety/mood disorders, than psychiatrists.

Evidence Rating Level: 2 (Good)           

Study Rundown: Approximately 12% of US children and youth have a diagnosis of ADHD, depression, or anxiety, while only half receive appropriate mental health care. To address this deficiency in care, the American Academy of Pediatrics (AAP) has encouraged PCPs to play a more active role in managing the mental health care needs of these patients. This study is the first to use a nationally representative sample to evaluate the context in which children and young adults with mental health diagnoses are managed. From 2008 through 2011, slightly over one third of children went to their PCP for mental health care, while about a quarter went to a psychiatrist. A greater proportion of children with ADHD were cared for solely by a PCP, compared to children with anxiety/mood disorders. Children with ADHD who saw their PCP were more likely to be prescribed medication than children who saw a psychiatrist for the same condition. Enhancing the availability of education and resources on diagnosing and treating mental health conditions for PCPs would be a worthwhile endeavor in the context of these findings. While this study emphasizes the need for such efforts, it is limited by the inherent recall bias within the data collection methods.

Click to read the study published today in Pediatrics

Relevant Reading: Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status

Study Author, Dr. Jeanne Van cleave, MD, FRCPC, talks to 2 Minute Medicine: University of British Columbia, Medical Director, Thrombosis Program, Associate Professor of Medicine, Division of Hematology.

“As medical students and residents are considering a variety of careers, pediatric primary care and child psychiatry are options. This study provides an overview of outpatient mental health care for children and adolescents in the US, and emphasizes the substantial role primary care pediatrics plays in treating children with mental health conditions. It speaks to need for future primary care physicians and psychiatrists to be receptive to collaborating with each other to care for this population.”

In-Depth [retrospective cohort study]: This study used nationally representative data on children and young adults 2 to 21 years old, from the Medical Expenditure Panel Survey between the years 2008 through 2011. Of the sample (n = 43 235), 5.2% of subjects had a mental health condition-related outpatient visit. Among the subjects with mental health conditions, 34.8% saw a PCP only, 26.2% saw a psychiatrist only, 15.2% saw a psychologist/social worker for their issue. Morehildren with ADHD saw a PCP only, compared to children with anxiety/mood disorder (41.8% vs 17.2%, respectively). Significantly more children with ADHD were prescribed medications such as stimulants or alpha-agonists when seen by their PCP for management, compared to those who saw a psychiatrist (73.7% vs 61.4%, p = 0.02). Though not statistically significant, greater proportion of children seeing their PCP for anxiety/mood disorder were prescribed medication compared with those seeing a psychiatrist only (59.7% vs 45.9%).

Image: PD

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