Barriers to the identification and management of psychosocial issues in children and maternal depression
Barriers to the identification and management of psychosocial issues in children and maternal depression
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DOI：
10.1542/peds.2005-1997
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发表时间：
2007-01-01
期刊：
影响因子：
8
通讯作者：
Eaton Hoagwood, Kimberly
中科院分区：
文献类型：
--
作者：
McCue Horwitz, Sarah;Kelleher, Kelly J.;Eaton Hoagwood, Kimberly
上下文。儿童心理社会问题和母亲抑郁的认识和治疗不足，但我们对初级保健儿科医生识别和治疗这些问题的障碍知之甚少。目的本研究的目的是确定(1)儿童心理社会问题和母亲抑郁的感知障碍是否聚合到患者、医生和组织领域，(2)母亲和儿童的障碍领域是不同的，(3)医生、患者和实践/组织特征与儿童和母亲的不同障碍领域相关。方法：我们对美国儿科学会50 818名美国非退休成员进行了横断面调查。在随机抽样的1600名成员中，有832名(745名非受训成员)做出了回应。这是一份邮寄的8页调查，没有病人，也没有干预。我们测量了医生对为儿童的心理社会问题和母亲抑郁提供心理社会护理的障碍的评估。结果：儿科医生经常认为，缺乏时间治疗心理健康问题(77.0%)和等待较长的时间去看心理健康服务提供者(74.0%)是儿童心理社会问题识别和治疗的最重要障碍。对于产妇抑郁，儿科医生最常认为缺乏治疗培训(74.5%)和缺乏治疗时间(64.3%)是重要的障碍。儿科医生关于障碍的报告集中在医生和组织领域。医生领域对于孩子和母亲是不同的，但组织领域不是。几个医生和执业特征与4个障碍量表显著相关，不同的特征(如社会人口学、态度和执业特征)与每个障碍领域相关。结论：儿科医生认可在诊断和治疗儿童心理健康问题和母亲抑郁方面存在广泛的障碍。与各种障碍领域相关的因素的特殊性表明，在初级保健儿科中克服识别和治疗儿童心理健康问题和母亲抑郁的障碍可能需要跨越组织、医生和患者问题的多方面方法。此外，全面的干预可能需要社会营销方法，旨在吸引临床医生及其患者的不同受众参与。
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 50 818 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.