Rào cản trong việc xác định và quản lý các vấn đề tâm lý xã hội ở trẻ em và trầm cảm ở mẹ

American Academy of Pediatrics (AAP) - Tập 119 Số 1 - Trang e208-e218 - 2007
Sarah McCue Horwitz1,2, Kelly J. Kelleher3, Ruth E. K. Stein4,5, Amy Storfer‐Isser6,1, Eric A. Youngstrom7, Elyse R. Park8, Amy M. Heneghan2, Peter S. Jensen9, Karen G. O’Connor10, Kimberly Hoagwood9
1Departments of Epidemiology and Biostatistics
2Pediatrics, Case Western Reserve University, Cleveland, Ohio
3Department of Pediatrics, College of Medicine and Public Health, Ohio State University, Columbus, Ohio
4Yeshiva University
5Montefiore Medical Center, School of Medicine, New York, New York
6Case Western Reserve University
7Department of Psychology, University of North Carolina, Chapel Hill, North Carolina
8Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
9Department of Psychiatry, Columbia University, New York, New York
10Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois

Tóm tắt

BỐI CẢNH. Các vấn đề tâm lý xã hội ở trẻ em và trầm cảm ở mẹ thường bị nhận diện và điều trị kém, nhưng chúng ta biết surprisingly ít về các rào cản trong việc nhận diện và điều trị những vấn đề này bởi các bác sĩ nhi khoa chăm sóc chính.

MỤC TIÊU. Mục đích của công trình này là xác định liệu (1) các rào cản cảm nhận được đối với việc chăm sóc các vấn đề tâm lý xã hội của trẻ em và trầm cảm ở mẹ có tích tụ thành các miền bệnh nhân, bác sĩ và tổ chức không, (2) các miền rào cản có khác biệt cho mẹ và trẻ em không, và (3) các đặc điểm của bác sĩ, bệnh nhân và thực hành/tổ chức có liên quan đến các miền rào cản khác nhau cho trẻ em và mẹ hay không.

PHƯƠNG PHÁP. Chúng tôi đã tiến hành một cuộc khảo sát cắt ngang đối với 50818 thành viên không nghỉ hưu của Học viện Nhi khoa Hoa Kỳ. Từ một mẫu ngẫu nhiên gồm 1600 thành viên, 832 (745 thành viên không phải là thực tập sinh) đã trả lời. Đây là một cuộc khảo sát gửi qua bưu điện dài 8 trang không có bệnh nhân và không có can thiệp. Chúng tôi đo lường sự đánh giá của bác sĩ về các rào cản trong việc cung cấp chăm sóc tâm lý xã hội cho các vấn đề tâm lý xã hội ở trẻ em và trầm cảm ở mẹ.

Từ khóa

#rào cản #tâm lý xã hội #trầm cảm #bác sĩ nhi khoa #chăm sóc chính

Tài liệu tham khảo

Kelleher KJ, McInerny TK, Garder WP, Childs GE, Wasserman RC. Increasing Identification of Psychosocial Problems: 1979–1996. Pediatrics. 2000;105:1313–1321

American Academy of Pediatrics Task Force. Report on the future role of the pediatrician in the delivery of healthcare [published correction appears in Pediatrics. 1981;88:191]. Pediatrics. 1991;87:401–409

American Academy of Pediatrics, Committee on Psychosocial Aspects of Family Health. The new morbidity revisited: a renewed commitment to the psychosocial aspects of pediatric care. Pediatrics. 2001;108:1227–1229

American Academy of Pediatrics. The Classification of Child and Adolescent Mental Health Diagnoses in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version. Wolraich ML, Felice ME, Drotar D, eds. Elk Grove Village, IL: American Academy of Pediatrics; 1996

Coury DL, Berger SP, Stancin T, Tanner JL. Curricular guidelines for residency training in developmental-behavioral pediatrics. J Dev Behav Pediatrics. 1999;20:S1–S38

National Center for Education in Maternal and Child Health. Bright Futures in Practice: Mental Health. Jellinek MS, Patel BP, Froehle MC, eds. Arlington, VA: National Center for Education in Maternal and Child Health; 2002

Briggs-Gowan MJ, Horwitz SM, Schwab-Stone ME, Leventhal JM, Leaf PJ. Mental health in pediatric settings: distribution of disorders and factors related to service use. J Am Acad Child Adolesc Psychiatry. 2000;39:841–849

US Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Washington, DC: US Government Printing Office; 2000

Leaf PJ, Alegria M, Cohen P, et al. Mental health service use in the community and schools: results from the four-community MECA study. J Am Acad Child Adolesc Psychiatry. 1996;35:889–897

Offord DR, Boyle MH, Szatmari P, et al. Ontario Child Health Study II: six month prevalence of disorder and rates of service utilization. Arch Gen Psychiatry. 1987;44:832–836

Zuckerman BS, Beardslee WR. Maternal depression: a concern for pediatricians. Pediatrics. 1987;79:110–117

Lieman JM, Meyer FE, Rothchild N, Simon LJ. Selected Facts on US Women's Health: A Chart Book. New York, NY: Commonwealth Fund; 1997

Zuckerman B, Parker S. Preventive pediatrics: new models of providing needed health services. Pediatrics. 1995;95:758–762

American Academy of Pediatrics, Task force on the family. Pediatrics. 2003;111:1541–1571

Kahn RS, Wise PH, Finkelstein JA, Bernstein HH, Lowe JA, Homer CJ. The scope of unmet maternal health needs in pediatric settings. Pediatrics. 1999;103:576–581

Williams JW, Rost K, Dietrich AJ, Ciotti MC, Zyzanski SJ, Cornell J. Primary care physicians' approach to depressive disorders. Arch Fam Med. 1999;8:58–67

Horwitz SM, Leaf PJ, Leventhal JM, Forsyth B, Speechley KN. Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics. 1992;89:480–485

Lavigne JV, Binns HJ, Christoffel KK, et al. Behavioral and emotional problems among preschool children in pediatric primary care: prevalence and pediatricians' recognition. Pediatric Practice Research Group. Pediatrics. 1993;1:649–655

Kelleher KJ, Childs GE, Wasserman RC, McInerny TK, Nutting PA, Gardner WP. Insurance status and recognition of psychosocial problems: a report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Networks. Arch Pediatr Adolesc Med. 1997;151:1109–1115

Leaf PJ, Owens PL, Leventhal JM, et al. Pediatricians' training and identification and management of psychosocial problems. Clin Pediatr (Phila). 2004;43:355–365

Gardner W, Kelleher KJ, Wasserman R, et al. Primary care treatment of pediatric psychosocial problems: a study from Pediatric Research in Office Settings and Ambulatory Sentinel Practice Network. Pediatrics. 2000;106:44–52

McLennan JD, Jansen-McWilliams L, Comer DM, Gardner WP, Kelleher KJ. The physician belief scale and psychosocial problems in children: a report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. J Dev Behav Pediatr. 1999;20:24–30

Rushton J, Bruckman D, Kelleher K. Primary care referral of children with psychosocial problems. Arch Pediatr Adolesc Med. 2002;156:592–598

Glied S. Too little time? The recognition and treatment of mental health problems in primary care. Health Serv Res. 1998;33:891–910

Rushton JL, Fant KE, Clark SJ. Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder. Pediatrics. 2004;114:23–28

Shaw KA, Mitchell GK, Wagner IJ, Eastwood HL. Attitudes and practices of general practitioners in the diagnosis and management of attention-deficit/hyperactivity disorder. J Paediatr Child Health. 2002;38:481–486

Williams J, Klinepeter K, Palmes G, Pulley A, Foy JM. Diagnosis and treatment of behavioral health disorders in pediatric practice. Pediatrics. 2004;114:601–606

Olson AL, Kelleher KJ, Kemper KJ, Zuckerman BS, Hammond CS, Dietrich AJ. Primary care pediatricians' roles and perceived responsibilities in the identification and management of depression in children and adolescents. Ambul Pediatr. 2001;2:91–98

Olson AL. Primary care pediatricians' roles and perceived responsibilities in the identification and management of maternal depression. Pediatrics. 2002;110:1169–1176

Wiley CC, Burke GS, Gill PA, Law NE. Pediatricians' views of post-partum depression: a self-administered survey. Arch Womens Ment Health. 2004;7:231–236

Park E, Eaton CA, Goldstein MG, et al. The development of a decisional balance measure of physician smoking cessation interventions. Prev Med. 2001;33:261–267

Heneghan AM, Mercer MB, DeLeone NL. Will mothers discuss parenting stress and depressive symptoms with their child's pediatrician?Pediatrics. 2004;113:460–467

O'Connor BP. SPSS and SAS programs for determining the number of components using parallel analysis and Velicer's MAP test. Behav Res Methods Instrum Comput. 2000;32:396–402

Velicer WF. Determining the number of components from the matrix of partial correlations. Psychometrika. 1976;41:321–327

Downey RG, King CV. Missing data in Likert ratings: a comparison of replacement methods. J Gen Psychol. 1998;125:175–184

Holm S. A simple sequentially rejective multiple test procedure. Scand J Statistics. 1979;6:65–70

SAS Software [computer program]. Release 9.1. Cary, NC: SAS Institute; 2004

SPSS for Windows [computer program]. Release 13.0. Chicago, IL: SPSS, Inc; 2004

Norman GR, Streiner DL. Biostatistics: The Bare Essentials. St Louis, MO: Mosby; 1994

Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res. 2001;35:1347–1355

Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50:1129–1136

Cull WL, O'Connor KG, Sharp S, Tang SS. Response rates and response bias for 50 surveys of pediatricians. Health Serv Res. 2005;40:213–226

Groves RM, Presser S, Dipko S. The role of topic interest in survey participation decisions. Public Opin Q. 2004;68:2–31