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Child Sex Differences in Primary Care Clinicians' Mental Health Care of Children and Adolescents
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).
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