Management of illness and temporary disability in children enrolled in day-care centers. The Health House experience

Screening and identification in pediatric primary care

This article reviews issues related to behavioral screening in pediatric primary care settings. Structural-organizational issues affecting the use of pediatric primary care screening are discussed. This study also reviewed selected screening instruments that have utility for use in the primary care setting. Clinical and research issues related to screening for behavior problems in pediatric primary care are presented.

Factor analysis of the Pediatric Symptom Checklist with a chronically ill pediatric population

The psychometric properties and factor structure of a widely used screening measure for behavioral and emotional dysfunction, the Pediatric Symptom Checklist (PSC), was extended to a population of chronically ill children. Parents of 404 children ranging from 6 to 17 years of age and diagnosed with either insulin-dependent diabetes mellitus (IDDM) or sickle cell disease (SCD) completed the PSC while waiting for a routine medical appointment. The measure's internal consistency was found to be high, Cronbach's alpha = .89, and test-retest reliability across 4 months was observed to be acceptable, r = .77. A principal components analysis with an oblique (promax) rotation yielded a four-factor solution with factors that included items representative of internalizing, externalizing, attention, and chronic illness-related problems, respectively. Cronbach alpha estimates ranged from .78 to .83 for the first three factors but was lower for the chronic illness-related problems factor (Cronbach's alpha = .60). A three-factor solution and reliability estimates were recomputed without the chronic illness items that yielded the same reliability estimates for each of the three factors and for the full scale. The three-factor solution was also found to be similar to a published factor structure obtained with a primary care sample, r(c) = .90-.91. The findings lend support to extending the PSC's clinical utility to tertiary care pediatric settings. Further research is recommended with a broader range of chronic illness groups to increase generalizability.

Parental expectations regarding discussions on psychosocial topics during pediatric office visits

Parents from urban (n=67) and suburban (n=76) primary care settings responded to a survey determining the extent to which 9 common psychosocial concerns have affected their children. Parents also reported their expectations of their pediatrician to discuss such topics during a health care visit. Within both settings, discipline was the most frequently experienced (41%), commonly discussed (34.3%), and frequently expected (75.4%) topic to be discussed. The frequency of discussions on psychosocial topics was less than half that of the actual reported occurrence of the psychosocial concern. When discussions on psychosocial topics did occur, however, most parents (87.3%) perceived pediatricians as helpful.

Awareness, diagnosis, and treatment of depression

OBJECTIVES

To review recent findings on the epidemiology, burden, diagnosis, comorbidity, and treatment of depression, particularly in general medical settings; to delineate barriers to the recognition, diagnosis, and optimal management of depression in general medical settings; and to summarize efforts under way to reduce some of these barriers.

DESIGN

MEDLINE searches were conducted to identify scientific articles published during the previous 10 years addressing depression in general medical settings and epidemiology, co-occurring conditions, diagnosis, costs, outcomes, and treatment. Articles relevant to the objective were selected and summarized.

CONCLUSIONS

Depression occurs commonly, causing suffering, functional impairment, increased risk of suicide, added health care costs, and productivity losses. Effective treatments are available both when depression occurs alone and when it co-occurs with general medical illnesses. Many cases of depression seen in general medical settings are suitable for treatment within those settings. About half of all cases of depression in primary care settings are recognized, although subsequent treatments often fall short of existing practice guidelines. When treatments of documented efficacy are used, short-term patient outcomes are generally good. Barriers to diagnosing and treating depression include stigma; patient somatization and denial; physician knowledge and skill deficits; limited time; lack of availability of providers and treatments; limitations of third-party coverage; and restrictions on specialist, drug, and psychotherapeutic care. Public and professional education efforts, destigmatization, and improvement in access to mental health care are all needed to reduce these barriers.

Consultation of mental health professionals by French adolescents with probable psychiatric problems

A national sample of school-attending adolescents aged 12-20 years (n = 8435) filled out an anonymous self-administered questionnaire. We considered a group of 868 adolescents with probable psychiatric problems (PPP) in order to identify personal, psychological and environmental factors as well as help-seeking behaviour associated with consultation of mental health professionals (MHP). Among the adolescents with PPP, 13.7% consulted MHP at least once during the year. Logistic regression analysis showed that consultation with MHP was more frequent for adolescents with multiple problems (OR = 2.3), functional physical disorders (OR = 1.9), family problems (OR = 2), separated parents (OR = 4.4) or multiple contacts with other doctors (GP, school doctor and other specialists, OR = 2.2, 3.6 and 2.6, respectively), and among those who confided in teachers or youth group advisors (OR = 2.2). Those who confided in peers consulted MHP less often (OR = 0.5). However, consultation with MHP was not associated with other sociodemographic or educational characteristics, with type of problem (internalized or externalized), or with confiding in one's parents.

Help-seeking behaviours among child psychiatric clinic attenders in Hong Kong

This study employed semi-structured interviews and questionnaires to describe the help-seeking processes and examine the determinants of help-seeking behaviours in 100 consecutive referrals to a child psychiatric clinic in Hong Kong. The help-seeking processes were characterized by (1) a sequential pattern of lay consultations starting from the families, relatives, friends and, rarely, neighbours; (2) detour via multiple professionals; (3) delay in reaching specialist services. A total of seven psychosocial variables were used to predict the help-seeking behaviours. The younger the child was, the more likely members outside the families were sought for advice. A large number of professional consultations was predicted by a high symptom score and relative old age in the referred child, less social disadvantages in the family and parental beliefs that family influences were not the cause of the child's problems. A long delay in reaching specialist services was predicted by a high symptom score in the child. Parental beliefs of outside influences being the cause of the child's problems predicted a short delay in reaching the clinic. Low awareness of services was the predominant difficulty parents encountered when they sought psychiatric care for their children. Public health education to demystify the cause of mental disturbances, close networking with teachers and general practitioners, and establishment of community child mental health clinics for easy access are recommended.

Sick child care: a developmental perspective

Sick child care programs provide an alternative when mildly ill children are excluded from their regular child care program. Although infectious disease implications have been addressed, little attention has been directed to the potentially negative consequences of care by unfamiliar providers in unfamiliar settings. Appropriate options for care during illness must be based not only on the physical but the emotional and developmental needs of young children.