Mental health in pediatric settings: Distribution of disorders and factorsrelated to service use

Objectives: To examine child psychiatric disorders in pediatric settings an d identify factors associated with parents' use of pediatricians as resourc es concerning emotional/behavioral issues and use of mental health services . Method: The sample consists of 5- to 9-year-olds (mean = 7.17 years, SD = 1.41) from a representative sample (N = 1,060) of pediatric practices. Par ent interviews included assessments of psychiatric disorders with the Diagn ostic Interview Schedule for Children (DISC-R), parental depression/anxiety , possible child abuse, stress, support, and the use of mental health servi ces. Results: The prevalence of any DISC disorder was 16.8%. Parental depre ssion/anxiety and possible child abuse were associated independently with 2 - to 3-times higher rates of disorder. Many parents (55%) who reported any disorder did not report discussing behavioral/emotional concerns with their pediatrician. Factors associated with discussing behavioral/emotional issu es were the presence of any disorder and financial stress. Factors related to seeing a mental health professional were discussing behavioral/emotional issues with the pediatrician, single parenthood, and stressful life events . Conclusions: The prevalence rates of disorders in this setting suggest th at pediatricians are well-placed to identify and refer children with psychi atric disorders. However, most parents do not discuss behavioral/emotional issues with their pediatrician. Methods for improving rates of identificati on and referral (e.g., routine screening) are considered.