Psychosocial and Psychosomatic Diagnoses in Primary Care of Children

¹ Departments of Health Services Administration and Pediatrics, The Johns Hopkins University Schools of Hygiene and Public Health and Medicine, and the Pediatric Ambulatory Services, The Johns Hopkins Hospital, Baltimore; the Pediatric Service, Columbia Medical Plan, Columbia, Maryland; Harvard Community Health Plan and Department of Pediatrics, Harvard Medical School, Boston University School of Medicine, and Pediatric Ambulatory Service, Boston City Hospital, Boston; Department of Family Practice, Medical College of Virginia of Virginia Commonwealth University, Richmond; Departments of Family Practice and Pediatrics, Medical University of South Carolina College of Medicine, Charleston; Kaiser-Permanente Medical Center, San Francisco; Division of General Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland

In this study in seven primary care facilities the proportion of children recognized as having behavioral, educational, or social problems was much higher than generally assumed. Although there was great variability among the facilities, at least 5% and as many as 15% of children seen in one year were diagnosed as having these problems in all but the hospital teaching facilities. The prevalence was even higher among children from poor families. The variability among facilities was much less for psychosomatic problems, which were diagnosed in 8% to 10 % of the children. For both psychosocial and psychosomatic types of problems, but especially for psychosocial ones, the proportion of visits with the diagnoses was much lower than the proportion of children with them, so that these problems engendered fewer visits for their management than might have been expected from their frequency in the population. However, available evidence suggests that individuals with unresolved psychosocial problems make more than their share of visits for other diagnoses. The findings of this study have implications for the content of educational programs for primary care practitioners, for the organization of primary care practice, and for the current debate over policy concerning reimbursement and benefit packages.

This article has been cited by other articles:

				J. V. Campo, J. Bridge, A. Lucas, S. Savorelli, L. Walker, C. Di Lorenzo, S. Iyengar, and D. A. Brent Physical and Emotional Health of Mothers of Youth With Functional Abdominal Pain Arch Pediatr Adolesc Med, February 1, 2007; 161(2): 131 - 137. [Abstract] [Full Text] [PDF]

				Y Nakayama, A Horiuchi, T Kumagai, S Kubota, Y Taki, S Oishi, and H M Malaty Psychiatric, somatic, and gastrointestinal disorders, and Helicobacter pylori infection in children with recurrent abdominal pain Arch. Dis. Child., August 1, 2006; 91(8): 671 - 674. [Abstract] [Full Text] [PDF]

				J. M. Zito, D. J. Safer, I. H. Zuckerman, J. F. Gardner, and K. Soeken Effect of Medicaid Eligibility Category on Racial Disparities in the Use of Psychotropic Medications Among Youths Psychiatr Serv, February 1, 2005; 56(2): 157 - 163. [Abstract] [Full Text] [PDF]

				H. M. Malaty, S. Abudayyeh, K. J. O'Malley, M. J. Wilsey, K. Fraley, M. A. Gilger, D. Hollier, D. Y. Graham, and L. Rabeneck Development of a Multidimensional Measure for Recurrent Abdominal Pain in Children: Population-Based Studies in Three Settings Pediatrics, February 1, 2005; 115(2): e210 - e215. [Abstract] [Full Text] [PDF]

				S. A. Reijneveld, E. Brugman, F. C. Verhulst, and S. P. Verloove-Vanhorick Identification and Management of Psychosocial Problems Among Toddlers in Dutch Preventive Child Health Care Arch Pediatr Adolesc Med, August 1, 2004; 158(8): 811 - 817. [Abstract] [Full Text] [PDF]

				J. V. Campo, J. Bridge, M. Ehmann, S. Altman, A. Lucas, B. Birmaher, C. D. Lorenzo, S. Iyengar, and D. A. Brent Recurrent Abdominal Pain, Anxiety, and Depression in Primary Care Pediatrics, April 1, 2004; 113(4): 817 - 824. [Abstract] [Full Text] [PDF]

				T. J. Silber and M. Pao Somatization Disorders in Children and Adolescents Pediatr. Rev., August 1, 2003; 24(8): 255 - 264. [Full Text] [PDF]

				R. D. Anbar Self-Hypnosis for the Treatment of Functional Abdominal Pain in Childhood Clinical Pediatrics, August 1, 2001; 40(8): 447 - 451. [Abstract] [PDF]

				M. Pagano, J. M. Murphy, M. Pedersen, D. Mosbacher, J. Crist-Whitzel, P. Jordan, C. Rodas, and M. S. Jellinek Screening for Psychosocial Problems in 4-5-Year-Olds During Routine EPSDT Examinations: Validity and Reliability in a Mexican-American Sample Clinical Pediatrics, March 1, 1996; 35(3): 139 - 146. [Abstract] [PDF]

				J. Lloyd, M. S. Jellinek, M. Little, J. M. Murphy, and M. Pagano Screening for Psychosocial Dysfunction in Pediatric Inpatients Clinical Pediatrics, January 1, 1995; 34(1): 18 - 24. [Abstract] [PDF]

				J. M. Murphy, H. L. Arnett, S. J. Bishop, M. S. Jellinek, and J. Y. Reede Screening for Psychosocial Dysfunction In Pediatric Practice: A Naturalistic Study of the Pediatric Symptom Checklist Clinical Pediatrics, November 1, 1992; 31(11): 660 - 667. [Abstract] [PDF]

				E. G. Triggs and E. C. Perrin Listening Carefully: Improving Communication About Behavior and Development Recognizing Parental Concerns Clinical Pediatrics, April 1, 1989; 28(4): 185 - 192. [Abstract] [PDF]

				T. Stark and R. Blum Psychosomatic Illness in Childhood and Adolescence: Clinical Considerations Clinical Pediatrics, November 1, 1986; 25(11): 549 - 554. [Abstract] [PDF]

				M. S. Smith Evaluation and Management of Psychosomatic Symptoms in Adolescence Clinical Pediatrics, March 1, 1986; 25(3): 131 - 135. [Abstract] [PDF]

				G. R. Hodas and P. J. Honig An Approach to Psychiatric Referrals in Pediatric Patients: Psychosomatic Complaints Clinical Pediatrics, March 1, 1983; 22(3): 167 - 172. [Abstract] [PDF]