One in three children who were diagnosed and treated for mental health conditions on an outpatient basis saw their primary-care doctors for this care, a new study reports.
Using data from a nationally representative survey, the researchers found that about 35 percent of children receiving mental health care in the past year had appointments only with their primary-care physicians compared with about 26 percent who saw only psychiatrists and 15 percent who saw only psychologists or social workers.
The findings highlight the role that primary-care providers are playing on a national level in caring for children with mental health conditions, said Dr. Jeanne Van Cleave, a pediatrician at MassGeneral Hospital for Children in Boston. She is the lead author of the study, published online today (Oct. 12) in the journal Pediatrics.
About one in 10 school-age children in the United States has a mental health condition, and there are not enough child psychiatrists to care for them, Van Cleave told Live Science. She explained that in recent years, primary-care providers, which for many youngsters often means their pediatricians, have gotten more involved in identifying and managing kids' mental health conditions because of a shortage of mental health professionals for children. [11 Warning Signs Help Spot Mental Illness in Children]
To get a glimpse at who provides outpatient mental health services to children throughout the country and the types of diagnoses and medications prescribed, the researchers analyzed data from about 43,000 children in the United States ages 2 to 21 between the years 2008 and 2011.
Among the nearly 1,800 kids who were identified as having a mental health condition in the past year, attention-deficit /hyperactivity disorder (ADHD) and anxiety/mood disorders accounted for the large majority of outpatient care received.
The research did not include information about mental health services provided by schools, juvenile justice programs and child-welfare agencies, and it did not capture the number of kids who may have a mental health problem, but don't seek treatment for it.
The study showed that about 74 percent of children with ADHD were prescribed a medication for this condition by their primary-care provider, while nearly 60 percent of kids with anxiety and mood disorders were put on medications by their primary-care providers. For both mental health conditions, primary-care providers were more likely to put children on mood-altering medications than child psychiatrists.
Although the research didn't look at doctors' rationale for prescribing medication, Van Cleave speculated that the higher prescribing patterns among primary-care providers probably occurs because child psychiatrists might see particularly difficult mental health cases or they might see children who don't respond to a prescribed drug. She also said that parents who might not want to put their child on medication may seek additional services from a mental health specialist.
"Primary-care physicians provide a good home for children's mental health conditions," Van Cleave said. She said that because of recent treatment guidelines for ADHD and teen depression issued by the American Academy of Pediatrics, pediatricians feel fairly comfortable managing most cases of ADHD in children, and they are starting to feel more comfortable managing anxiety disorders.
Some areas identified by the study where primary-care doctors could be doing better is in collaborating more with child psychiatrists, psychologists and social workers, and co-managing cases they refer to these mental health specialists.
The study's findings help demonstrate that primary care is a good area to put more supports in place for children's mental health, Van Cleave said. These supports may include better access to child psychiatrists or mental health experts for questions that doctors might have about a child's treatment plan, as well as better communication with mental health experts involved in a child's care to make sure therapy is going well and the child is progressing along a good treatment path, she said.
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