Published online January 2, 2007
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e208-e218 (doi:10.1542/peds.2005-1997)

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ARTICLE

Barriers to the Identification and Management of Psychosocial Issues in Children and Maternal Depression

Sarah McCue Horwitz, PhD^a,b, Kelly J. Kelleher, MD, MPH^c, Ruth E.K. Stein, MD^d, Amy Storfer-Isser, MS^a, Eric A. Youngstrom, PhD^e, Elyse R. Park, PhD^f, Amy M. Heneghan, MD^b, Peter S. Jensen, MD^g, Karen G. O'Connor, BS^h, Kimberly Eaton Hoagwood, PhD^g

^a Departments of Epidemiology and Biostatistics
^b Pediatrics, Case Western Reserve University, Cleveland, Ohio
^d Montefiore Medical Center, School of Medicine, New York, New York
^c Department of Pediatrics, College of Medicine and Public Health, Ohio State University, Columbus, Ohio
^e Department of Psychology, University of North Carolina, Chapel Hill, North Carolina
^f Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
^g Department of Psychiatry, Columbia University, New York, New York
^h Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois

CONTEXT. Child psychosocial issues and maternal depression are underidentified and undertreated, but we know surprisingly little about the barriers to identification and treatment of these problems by primary care pediatricians.

OBJECTIVES. The purpose of this work was to determine whether (1) perceived barriers to care for children's psychosocial issues and maternal depression aggregate into patient, physician, and organizational domains, (2) barrier domains are distinct for mothers and children, and (3) physician, patient, and practice/organizational characteristics are associated with different barrier domains for children and mothers.

METHODS. We conducted a cross-sectional survey of the 50818 US nonretired members of the American Academy of Pediatrics. Of a random sample of 1600 members, 832 (745 nontrainee members) responded. This was a mailed 8-page survey with no patients and no intervention. We measured physician assessment of barriers to providing psychosocial care for children's psychosocial problems and maternal depression.

RESULTS. Pediatricians frequently endorse the lack of time to treat mental health problems (77.0%) and long waiting periods to see mental health providers (74.0%) as the most important barriers to the identification and treatment of children's psychosocial problems. For maternal depression, pediatricians most often endorsed lack of training in treatment (74.5%) and lack of time to treat (64.3%) as important barriers. Pediatricians' reports of barriers clustered into physician and organizational domains. Physician domains were distinct for children and mothers, but organizational domains were not. Several physician and practice characteristics are significantly associated with the 4 barrier scales, and different characteristics (eg, sociodemographic, attitudinal, and practice features) were related to each barrier area.

CONCLUSIONS. Pediatricians endorse a wide range of barriers with respect to the diagnosis and treatment of children's mental health problems and maternal depression. The specificity of factors relating to various barrier areas suggests that overcoming barriers to the identification and treatment of child mental health problems and maternal depression in primary care pediatrics is likely to require a multifaceted approach that spans organizational, physician, and patient issues. In addition, comprehensive interventions will likely require social marketing approaches designed to engage diverse audiences of clinicians and their patients to participate.

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Key Words: barriers • maternal depression • child psychosocial problems • primary care

Abbreviations: AAP—American Academy of Pediatrics • PPD—postpartum depression • PS—Periodic Survey • CPT—Current Procedural Terminology

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Accepted Jul 11, 2006.

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