Abstract
Background
Mental health (MH) conditions are highly prevalent, yet only marginal portions of children receive adequate services. Access to specialized mental healthcare is limited and, consequently, pediatricians remain the source of management and care of children with MH disorders. Despite this, research suggests that pediatricians report lack of access to training and support regarding MH care of youth, leading to discomfort with managing the population they are asked to treat. An additional barrier to care that has less research is perceptions regarding MH disorders among pediatricians. This scoping review aims to describe the state of science regarding perceptions and possible stigma towards MH in pediatric primary care.
Methods
PsychInfo, PubMed Medline, Ovid Medline, CINAHL, and Embase were searched with terms related to stigma, pediatricians, and MH disorders. New research articles were included after review, which addressed stigma in pediatricians treating youth with MH disorders.
Results
Our initial search produced 457 titles, with 23 selected for full-text review, and 8 meeting inclusion criteria, N = 1571 pediatricians.
Conclusions
While a limited number of studies focus on physician-based perceptions/stigma, and even less data on pediatrician stigma towards MH, more studies are needed to explore how this impacts patient care.
Impact
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In this scoping review, we sought to shed light on the limitations regarding MH care access, especially with the increasing need for care and not enough MH specialists, adding to an already tremendous burden pediatric primary care providers face daily.
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We also reviewed barriers to said care within pediatric primary care, including the potential for physician stigma towards MH diagnosis, treatment, and management.
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This review adds a concise summary of the current limited studies on stigma towards MH within primary care pediatricians and the importance of continued research into how perception and stigma affect patient care.
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This material is an original project and has not been previously published.
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This work is not submitted for publication or consideration elsewhere
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References
Dempster, N. R., Wildman, B. G. & Duby, J. Perception of primary care pediatricians of effectiveness, acceptability, and availability of mental health services. J. Child Health Care 19, 195–205 (2015).
Nasir, A., Watanabe-Galloway, S. & DiRenzo-Coffey, G. Health services for behavioral problems in pediatric primary care. J. Behav. Health Serv. Res. 43, 396–401 (2016).
Brauner, C. B. & Stephens, C. B. Estimating the prevalence of early childhood serious emotional/behavioral disorders: challenges and recommendations. Public Health Rep. 121, 303–310 (2006).
Tulisiak, A. K. et al. Antidepressant prescribing by pediatricians: a mixed-methods analysis. Curr. Probl. Pediatr. Adolesc. Health Care 47, 15–24 (2017).
Green, C. et al. Do subspecialists ask about and refer families with psychosocial concerns? A comparison with general pediatricians. Matern. Child Health J. 23, 61–71 (2019).
O’Brien, D. et al. Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners’ perceptions. Br. J. Gen. Pract. 66, e693–e707 (2016).
American Academy of Child and Adolescent Psychiatry. Child and Adolescent Psychiatry Workforce: A Critical Shortage and National Challenge https://www.aacap.org/aacap/resources_for_primary_care/workforce_issues.aspx (2019).
American Academy of Pediatrics. Mental Health Initiatives https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Pages/About-Us.aspx (2019).
Hacker, K. et al. Pediatric provider processes for behavioral health screening, decision making, and referral in sites with colocated mental health services. J. Dev. Behav. Pediatr. 34, 680–687 (2013).
Honorio Neto, F. et al. Attitudes and reported practice of paediatricians and child psychiatrists regarding the assessment and treatment of ADHD in Ireland. Ir. J. Psychol. Med. 35, 181–191 (2018).
Connors, E. H. et al. When behavioral health concerns present in pediatric primary care: factors influencing provider decision-making. J. Behav. Health Serv. Res. 45, 340–355 (2018).
Pidano, A. E. et al. Different mental health-related symptoms, different decisions: a survey of pediatric primary care providers. J. Child Fam. Stud. 26, 3525–3534 (2017).
Bauer, N. S. et al. Computer decision support changes physician practice but not knowledge regarding autism spectrum disorders. Appl. Clin. Inf. 6, 454–465 (2015).
Behrman, G. U. et al. Improving pediatricians’ knowledge and skills in suicide prevention: Opportunities for social work. Qualitative. Soc. Work 18, 868–885 (2018).
Sheldrick, R. C., Mattern, K. & Perrin, E. C. Pediatricians’ perceptions of an off-site collaboration with child psychiatry. Clin. Pediatr. 51, 546–550 (2012).
Kolko, D. J. & Perrin, E. The integration of behavioral health interventions in children’s health care: services, science, and suggestions. J. Clin. Child Adolesc. Psychol. 43, 216–228 (2014).
Baum, R. A., King, M. A. & Wissow, L. S. Outcomes of a statewide learning collaborative to implement mental health services in pediatric primary care. Psychiatr. Serv. 70, 123–129 (2019).
Diamond, G. S. et al. Attitudes, practices, and barriers to adolescent suicide and mental health screening: a survey of pennsylvania primary care providers. J. Prim. Care Community Health 3, 29–35 (2012).
Hajjaj, F. M. et al. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice. J. R. Soc. Med. 103, 178–187 (2010).
Bouchard, L. E. & MacLean, R. Acknowledging stigma. Can. Fam. Physician 64, 91–92 (2018).
Bravo-Mehmedbasic, A. & Kucukalic, S. Stigma of psychiatric diseases and psychiatry. Psychiatr. Danub. 29(Suppl. 5), 877–879 (2017).
Achenbach, T. M. & Edelbrock, C. S. Psychopathology of childhood. Annu. Rev. Psychol. 35, 227–256 (1984).
Goodyear, H. M. et al. Choosing a career in paediatrics: do trainees’ views change over the first year of specialty training? JRSM Open 5, 2054270414536552 (2014).
Horwitz, S. M. et al. Barriers to the identification and management of psychosocial problems: changes from 2004 to 2013. Acad. Pediatr. 15, 613–620 (2015).
Stein, R. E. et al. Attention-deficit/hyperactivity disorder: how much responsibility are pediatricians taking? Pediatrics 123, 248–255 (2009).
Brown, J. D. & Wissow, L. S. Disagreement in parent and primary care provider reports of mental health counseling. Pediatrics. 122, 1204–1211 (2008).
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S.M.I., D.M.D., M.K.M., and M.N. all had substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. S.M.I. and D.D. drafted the article with the aforementioned, along with M.K.M. revising it critically for important intellectual content. Final approval of the version to be published was by M.K.M.
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M.K.M. has received research grants from UH CRC, grant funding from The Hartwell Foundation; research funding from Allergan Pharmaceuticals; research support from the Neurologic and Behavioral Outcomes Center, CWRU, and royalties from the APA. The other authors have no conflicts of interest to disclose.
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Imfeld, S.M., Darang, D.M., Neudecker, M. et al. Primary care pediatrician perceptions towards mental health within the primary care setting. Pediatr Res 90, 950–956 (2021). https://doi.org/10.1038/s41390-020-01349-7
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DOI: https://doi.org/10.1038/s41390-020-01349-7
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