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Mental Health Factors in the Utilization of Pediatric Primary Care

  • Published:
Mental Health Services Research

Abstract

The relationship of mental health factors to use of pediatric medical care in a 12-month period is examined using cross-sectional and prospective data from a community-based cohort of children (aged 4–8 years at baseline) and their families. Results from this study demonstrate that mother's self-reported mental health is statistically significantly related to the number of pediatric visits. In the cross-sectional analysis, the effect of mothers's mental health on children with 5 or more pediatric visits is moderated by poverty and mothers with depressive symptoms are much more likely than those without such symptoms to have children who are very high service users (10 visits or more). In the longitudinal analysis, an inconsistent pattern of mothers' mental health problems over a 24-month period increases the likelihood of high use in the third year and the persistence of maternal mental health problems increases the likelihood of very high use.

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REFERENCES

  • Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4–18 and 1991 profile. Burlington: University of Vermont Department of Psychiatry.

    Google Scholar 

  • Alexander, C. S., & Markowitz, R. (1986). Maternal employment and use of pediatric clinic services. Medical Care, 24, 134-147.

    Google Scholar 

  • Angel, R. J., & Angel, J. L. (1996). Physical comorbidity and medical care use in children with emotional problems. Public Health Reports, 111, 140-145.

    Google Scholar 

  • Angold, A., Messer, S. C., Stangel, D., Farmer, E. M. Z., Costello, E. J. & Burns, E. J. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88, 75-80.

    Google Scholar 

  • Burns, B. J., Costello, J. E., Angold, A., Tweed, D., Stangl, D., Farmer, E. M. Z., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14(3), 147-159.

    Google Scholar 

  • Cameron, L., Leventhal, E. A., & Leventhal, H. (1995). Seeking medical care in response to symptoms and life stress. Psychosomatic Medicine, 57, 37-47.

    Google Scholar 

  • Costello, E. J., Edelbrock, C., Costello, A. J., Dulcan, M. K., Burns, B. J., & Brent, D. (1988). Psychopathology in pediatric primary care: The new hidden morbidity. Pediatrics, 82, 415-424.

    Google Scholar 

  • Forsyth, B. W. C., Horwitz, S. M., Leventhal, J. M., Burger, J., & Leaf, P. J. (1996). The child vulnerability scale: An instrument to measure parental perceptions of child vulnerability. Journal of Pediatric Psychology, 21, 89-101.

    Google Scholar 

  • Garralda, M. E., & Bailey, D. (1989). Psychiatric disorders in general paediatric clinics. Archives of the Diseases of Childhood, 64, 1727-1733.

    Google Scholar 

  • Hankin, J. R., Starfield, B., Steinwachs, D. M., Benson, P., Livingston, G., & Katz, H. P. (1984). The relationship between specialized mental health care and patterns of primary care use among children enrolled in a prepaid group practice. Research in Community and Mental Health, 4, 203-220.

    Google Scholar 

  • Horwitz, S. M., Leaf, P. J., Leventhal, J. M., Forsyth, B., & Speechley, K. N. (1992). Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics, 89, 480-485.

    Google Scholar 

  • Horwitz, S. M., Morgenstern, H., & Berkman, L. F. (1985a). The impact of social stressors and social networks on pediatric medical care use. Medical Care, 23, 946-959.

    Google Scholar 

  • Horwitz, S. M., Morgenstern, H., & Berkman, L. F. (1985b). The use of pediatric medical care: A critical review. Journal of Chronic Diseases, 38, 935-945.

    Google Scholar 

  • Howie, J. G. R., & Bigg, A. R. (1980). Family trends in psychotropic and antibiotic prescribing in general practice. British Medical Journal, 22, 836-838.

    Google Scholar 

  • Kessler, R. C., Frank, R. G., Edlund, M., Katz, S. J., Lin, E., & Leaf, P. (1997). Differences in the use of psychiatric outpatient services between the United States and Ontario. New England Journal of Medicine, 336, 551-557.

    Google Scholar 

  • Kessler, R. C., & Neighbors, H. W. (1986). A new perspective on the relationship among race, social class, and psychological distress. Journal of Health and Social Behavior, 27, 107-115.

    Google Scholar 

  • Krystal, J. H., Leaf, P. J., Bruce, M. L., & Charney, D. S. (1992). Effects of age and alcoholism on the prevalence of panic disorder. Acta Psychiatrica, Scandinavica, 85, 77-82.

    Google Scholar 

  • Lin, E. H., Katon, W., VonKorff, M., Bush, T., Liscomb, P., Russo, J., & Wagner, E. (1991). Frustrating patients: Physician and patient perspectives among high users of medical services. Journal of General Internal Medicine, 6, 241-246.

    Google Scholar 

  • Loftus, E. F., Smith, K. D., Klinger, M. R., & Fiedler, J. (1991). Memory and mismemory for health events. In J. M. Tanur (Ed.), Questions about questions: Inquiries into the cognitive bases of surveys (pp. 102-137). New York: Russell Sage Foundation.

    Google Scholar 

  • Manning, W. G., & Wells, K. B. (1992). The effects of psychological distress and psychological well-being on use of medical services. Medical Care, 30, 541-553.

    Google Scholar 

  • Newacheck, P. (1992). Characteristics of children with high and low usage of physician services. Medical Care, 30, 30-42.

    Google Scholar 

  • Newacheck, P. W., & Halfon, N. (1986). The association between mother's and children's use of physician services. Medical Care, 24, 30-38.

    Google Scholar 

  • Olfson, M., Gilbert, T., Weissman, M., Blacklow, R. S., & Broadhead, W. E. (1995). Recognition of emotional distress in physically healthy primary care patients who perceive poor physical health. General Hospital Psychiatry, 17, 173-180.

    Google Scholar 

  • Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2-21.

    Google Scholar 

  • Regier, D. A., Goldberg, I. D., Kessler, L. G., & Burns, B. (1980) Overview of the three reports covering the four health care settings. In Use of health and mental health outpatient services in four organized health care settings (chap. 1, DHHS Publication No. (ADM)80-859, Superintendent of Documents). Washington, D.C.: U.S. Government Printing Office.

    Google Scholar 

  • Riley, A. W., Finney, J. W., Mellits, E. D., Starfield, B., et al.. (1993). Determinants of children's health care use: An investigation of psychosocial factors. Medical Care, 31, 767-783.

    Google Scholar 

  • Roghmann, K. J., & Haggerty, R. J. (1973). Daily stress, illness and use of health services in young families. Pediatric Research, 7, 520-526.

    Google Scholar 

  • Rutter, M. (1994). Beyond longitudinal data: Causes, consequences, changes, and continuity. Journal of Consulting and Clinical Psychology, 62, 928-940.

    Google Scholar 

  • Schor, E., Starfield, B., Stidley, C., & Hankin, J. (1987). Family health, utilization and effects of family membership. Medical Care, 25, 616-626.

    Google Scholar 

  • Starfield, B., Hankin, J., Steinwachs, S., et al. (1985). Utilization and morbidity: Random or tandem? Pediatrics, 75, 241-247.

    Google Scholar 

  • Starfield, B., van der Berg, B. J., Steinwachs, D. M., Katz, H. P., & Horn, S. D. (1979). Variations in utilization of health services by children. Pediatrics, 63, 633-641.

    Google Scholar 

  • Tessler, R., & Mechanic, D. (1978). Psychological distress and perceived health status. Journal of Health and Social Behavior, 19, 254-262.

    Google Scholar 

  • Vinokur, A., & Selzer, M. L. (1975). Desirable versus undesirable life events: Their relationship to stress and mental distress. Journal of Personality and Social Psychology, 32, 329-337.

    Google Scholar 

  • Ward, A., & Pratt, C. (1996). Psychosocial influences on the use of health care by children. Australian and New Zealand Journal of Public Health, 20, 309-316.

    Google Scholar 

  • Watson, J. M., & Kemper, K. J. (1995). Maternal factors and child's health care use. Social Sciences and Medicine, 40, 623-628.

    Google Scholar 

  • Widmer, R. B., Cadoret, R. J., & North, C. S. (1980). Depression in family practice: Some effects on spouses and children. Journal of Family Practice, 10, 45-51.

    Google Scholar 

  • Wierson, M., & Forehand, R. (1994). Introduction to special section: The role of longitudinal data with child psychopathology and treatment: Preliminary comments and issues. Journal of Consulting and Clinical Psychology, 62, 883-886.

    Google Scholar 

  • Wolfe, B. L. (1980). Children's utilization of medical care. Medical Care, 18, 1196-1207.

    Google Scholar 

  • Woodward, C. A., Boyle, M. H., Offord, D. R., Cadman, D. T., et al. (1988). Ontario child health study: Patterns of ambulatory medical care utilization and their correlates. Pediatrics, 82, 425-434.

    Google Scholar 

  • Zahner, G. E. P., Pawelkiewicz, W., DeFrancesco, J. J., & Adnopoz, J. (1992). Children's mental health service needs and utilization patterns in an urban community: An epidemiological assessment. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 951-960.

    Google Scholar 

  • Zeger, S. L., & Liang, K. Y. (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics, 42, 121-130.

    Google Scholar 

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Authors and Affiliations

  1. Department of Mental Hygiene, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, 21205

    Dalal C. Tonb & Philip J. Leaf

  2. Dalal Tonb, Wilmington, Delaware, 19803

    Sarah M. Horwitz

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  1. Dalal C. Tonb
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  2. Sarah M. Horwitz
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  3. Philip J. Leaf
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Tonb, D.C., Horwitz, S.M. & Leaf, P.J. Mental Health Factors in the Utilization of Pediatric Primary Care. Ment Health Serv Res 1, 47–57 (1999). https://doi.org/10.1023/A:1021983218577

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