printable versionDoctors miss signs of anxiety, depression in low-income Latino children
BY KRISTA CONGER
Primary-care providers need to do a better job of diagnosing psychosocial problems such as anxiety and depression in low-income Latino children, according to a recent study by researchers at the School of Medicine and Lucile Packard Children's Hospital. Coupling a normal well-child exam with a parent questionnaire that asks about a child's behavior will increase the chances that affected children can be singled out for help before problems worsen, they found.
"Concerns about mental illness in children stretch across cultural groups," said Thomas Tarshis, MD, a child psychiatrist at the hospital. "Even when providers are very aware of the high prevalence of psychosocial issues in the Latino population, they still miss lots of kids who could benefit from early intervention."
Tarshis is the first author of the study, which was published in the May issue of the Journal of Health Care for the Poor and Underserved.
Latino children, particularly those from low-income families, are significantly more likely than Caucasian children to suffer from poor mental health outcomes, according to a 2001 report by the U.S. Surgeon General. This may be because Latino parents are less likely to discuss their child's mental health with a doctor, either because they are ashamed or because they don't consider the symptoms to be a medical problem.
For the current study, the researchers enlisted the help of four bilingual, highly culturally competent primary-care providers—three pediatricians and one pediatric nurse practitioner—in a family health clinic in East Palo Alto. From March 2001 to January 2002, the parents or guardians of 269 Latino children ages 2 to 16 who came to the clinic for well-child visits or immunizations were asked to answer a few demographic questions and to fill out a behavioral questionnaire about the child. Among the items on the document were questions asking parents about what sports and hobbies the child participated in, how many close friends he or she had, and how the child acted at home and performed in school.
After the appointment, the health-care providers filled out a checklist about the child asking about indicators of possible developmental or psychosocial problems. Both forms are known to be reliable ways to identify mental health problems in minority children.
Although the primary-care providers identified psychosocial problems in nearly 40 percent of the patients, they recognized only nine of the 48 children whose parental responses indicated clinically significant problems with aggression, attention or hyperactivity and none of the 30 children with probable anxiety or depression. All told, the providers missed about 38 percent of children whose parental questionnaires indicated clinically significant psychosocial problems. Children whose parents rated their problems as more severe or numerous were most likely to be identified by their health-care providers.
The clinicians were also more likely to recognize children struggling with language or learning disabilities and those in difficult family situations such as divorce or a parent with mental illness or drug addiction, as well as children with developmental problems such as slow weight gain or obesity. The researchers noted that these categories match closely the traditional emphases of pediatric medical training.
The researchers suggested that providers should increase the frequency with which they discuss symptoms of internalizing disorders such as anxiety and depression in Latino children. "If we can identify these kids early," said Tarshis, "we can get treatment started and maybe end up only doing a brief intervention. The longer you wait to start treatment, though, the more difficult it can be. We need to be aware of the need for better mental health screening in this population."
Tarshis' colleagues on the study include Lynne Huffman, MD, and Douglas Jutte, MD. Huffman is an associate professor of pediatrics and psychiatry at the medical school and the outcomes measurement and research director at the Children's Health Council in Palo Alto. Jutte is a postdoctoral fellow in the Robert Wood Johnson Health and Society Scholars Program at UC-Berkeley and UC-San Francisco. The study was funded by a grant from Stanford's Children's Health Initiative and another from the National Institutes of Health.