PSYCHIATRIC INTERVENTION IN PRIMARY-CARE FOR MOTHERS WHOSE SCHOOLCHILDREN HAVE PSYCHIATRIC-DISORDER

Background. Psychiatric disorder in schoolchildren has been linked to increased general practice attendance rates. This increase may, in par t, be a result of maternal stress focused on the disturbed child, and of a decrease in confidence in parenting. Aim. A study was undertaken to pilot the feasibility of a single session, psychiatric intervention in primary care for mothers of disturbed children and to examine upta ke rates and reported immediate and long-term effects. Method. Single psychiatric sessions by a child psychiatrist in general practice were offered to mothers of 26 schoolchildren. The schoolchildren (age range 7-12 years, mean nine years) were frequent attenders in general pract ice with physical symptoms, and were identified from research intervie ws carried out with a parent (usually their mother) as psychiatrically disordered. The main outcome measures were the mothers' ratings of he lpfulness of the intervention; degree of behavioural, emotional or hea lth problems in their children and confidence in managing them; the Ru tter A parental behaviour questionnaire; and children's yearly general practice attendance rates. Results. Sixteen mothers (62%) who were of fered appointments attended for the intervention. Nine of the 14 who r esponded at three-month follow up (64%) reported that the intervention had been markedly or extremely helpful. The main areas of perceived i mprovement at both three months and at 18-24 months were in the child' s behaviour, emotional and health problems, and in the mother's confid ence in dealing with these. Mothers also found the specific advice dis cussed and the ability to talk to somebody about the problems helpful. Mothers were less likely to find the intervention extremely or marked ly useful where the child had had previous psychiatric intervention. T he mean yearly attendance rate for the whole group of 23 children (dat a missing for three) decreased from 6.5 consultations before the inter vention to 2.8 afterwards; there was a non-significant trend for the d rop in attendance to be more marked in the group whose mothers attende d the intervention and who felt helped by it, than among the group of children whose mothers only reported finding the intervention slightly useful. Conclusion. Standardized child psychiatric interventions whic h may be used in the primary care setting appear acceptable and may be helpful to mothers in addressing psychiatric disorders associated wit h somatic presentation in their schoolchildren,