Abstract
BackgroundLittle is known about general and family practitioners' (GP/FPs') involvement and confidence in dealing with children with common psychosocial problems and mental health conditions. The aims of this study were to ascertain GP/FPs' preferred level of involvement with, and perceived comfort and skill in dealing with children with behavioral problems, social-emotional difficulties, attention-deficit/hyperactivity disorder (ADHD), and mood disorders; and to identify factors associated with GP/FPs' involvement, comfort and skill.MethodsPostal survey of a representative sample of 801 GP/FPs in British Columbia, Canada, which enquired about level of involvement (from primarily refer out to deal with case oneself); ratings of comfort/skill with assessment/diagnosis and management; beliefs regarding psychosocial problems in children; basic demographics; and practice information.ResultsSurveys were completed by 405 of 629 eligible GP/FPs (64.4%). Over 80% of respondents reported collaborative arrangements with specialists across problem and condition types, although for children with behavior problems or ADHD, more physicians primarily refer (χ2 (1) = 9.0; P < 0.005; and χ2 (1) = 103.9; P < 0.001, respectively). Comfort/skill levels (mean ± s.d) were higher for mood disorders (4.4 ± 1.3) than behavior problems (3.6 ± 1.1; F [3, 1155] = 84.0, P < .0001; effect size = 0.67), but not different from social-emotional difficulties (3.8 ± 1.1) or ADHD (3.9 ± 1.3). Taking primary responsibility for a case was consistently related to self-reported comfort/skill with each condition type (34% to 61% of variance across condition types), while comfort/skill ratings for each condition were related to exposure to relevant continuing medical education (all P ≤ 0.001), and beliefs that these problems are significant and that GP/FPs have a role to play in dealing with them (P values ranged from 0.01 to <0.001).ConclusionSupporting GP/FPs in their care for children with common psychosocial and mental health problems should include efforts to bolster their confidence and modify attitudes in relation towards these problems, especially behavior problems and ADHD, possibly within innovative continuing education programs.
Highlights
Little is known about general and family practitioners' (GP/FPs') involvement and confidence in dealing with children with common psychosocial problems and mental health conditions
Significant psychosocial and mental health problems affect up to 20% of children and youth presenting for primary care services[1]
While GP/FPs feel confident in managing common mental health concerns of adults[4], much less is known about their role or about their level of confidence in working with mental health concerns of children, such as depression, attention-deficit/hyperactivity disorder (ADHD), and behavioral and emotional problems[5]
Summary
Little is known about general and family practitioners' (GP/FPs') involvement and confidence in dealing with children with common psychosocial problems and mental health conditions. US studies tend to group GP/FPs and pediatricians together, while studies specific to GP/FPs, from European countries and Australia, often focus on approaches to a single condition The latter group of studies show that GP/FPs frequently lack confidence in relation to ADHD[6], are reluctant to diagnose and manage cases[7,8], and are doubtful that it can be managed solely within primary care.[9] These GP/FPs express a higher level of confidence in care of children with emotional problems, depression and conduct disorders.[6,9] In US studies, primary care physicians are generally not comfortable with the treatment of children with depression, [5,10], and are more likely to refer children with emotional problems than with ADHD to specialized mental health services[5]. GP/FPs tend to be more comfortable than pediatricians in working with children with depression, and more likely to treat such cases themselves[11]
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