Physicians' attention to parents' concerns about the psychosocial functioning of their children

Background: Epidemiological data indicate that approximately 20% of childre n have psychosocial problems, yet less than 2% of children are seen by ment al health specialists each year. Primary care physicians tend to identify c hildren with psychosocial problems when parents discuss concerns with them. Objective: To examine factors related to physicians' attention to parental disclosures. Design: Parents reported the psychosocial functioning of themselves and the ir children. Physicians reported the psychosocial functioning of 75; childr en and whether the parent disclosed psychosocial concerns to them. Setting: Ambulatory care clinic of a community-based, university-affiliated , residency training program. Participants: Seventy-five parents of children aged 2 to 16 years who prese nted for routine primary care, and 26 physicians. Main Outcome Measures: Beck Depression Inventory (parental distress), Eyber g Child Behavior Inventory (child behavior problems) , physician and parent report. Results: Physicians identified 50.0% of children with clinically significan t behavior problems. Logistic regression indicated that parental disclosure was the only significant predictor of physician identification (P<.002). W hen children had clinically significant behavior problems, physicians were more likely to report disclosures by parents (45.0% vs 5.7% for parents of children with and without behavior problems, respectively). Physicians were more likely to report parental disclosure when parents reported personal p sychosocial distress (38.9% for distressed vs 5.7% nondistressed parents). Conclusions: Parental disclosure of concerns was a better predictor of phys ician identification of child psychosocial problems than was the presence o f child behavior problems. Physicians responded more frequently to the disc losures of potential problems by parents of children with clinically signif icant psychosocial problems. They also attended more frequently to disclosu res about behavior problems when the parent was also experiencing psychosoc ial distress.