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William Gardner, PhD; Kathleen A. Pajer, MD, MPH; Kelly J. Kelleher, MD, MPH; Sarah Hudson Scholle, DrPH; Richard C. Wasserman, MD, MPH

Arch Pediatr Adolesc Med. 2002;156:454-459.

Background  Sex differences in the medical and mental health care of adults are well established.

Objective  To study the effect of child patient's sex on whether primary care clinicians (PCCs), including pediatricians, family physicians, and nurse practitioners, found or treated mental health problems in primary care settings.

Design  The data were collected by clinicians and parents from 21 065 individual child visits (50.3% girls) in 204 primary care practices.

Methods  Each PCC enrolled a consecutive sample of approximately 55 children and adolescents aged 4 to 15 years. Parents filled out questionnaires, including the Pediatric Symptom Checklist, before seeing the clinician. Clinicians completed a survey after the visit about the psychosocial problems and recommended treatments, but they did not see the results of the Pediatric Symptom Checklist or any other data collected from the parents.

Results  Boys were more likely to be seen for a mental health–related visit and by a clinician who identified them as "my patient." Boys with parent-reported symptom profiles that were similar to those of girls were more likely to be identified as having attention-deficit/hyperactivity problems or behavior or conduct problems and less likely to be identified as having internalizing problems. Adjusting for parent-reported symptoms, PCCs were more likely to prescribe medications for boys. Child sex differences in referrals to mental health specialists and the provision of counseling to families were not statistically significant.

Conclusion  There are substantial sex differences in the mental health care of children in the primary care system.

From the Departments of Medicine (Dr Gardner), Psychiatry (Drs Gardner, Pajer, Kelleher, and Scholle), and Pediatrics (Drs Kelleher and Scholle), University of Pittsburgh School of Medicine, Pittsburgh, Pa; Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Ill (Dr Wasserman); and the Department of Pediatrics, University of Vermont College of Medicine, Burlington (Dr Wasserman).