Pitt researchers find gender differences in the mental health care of children

May 14, 2002

PITTSBURGH, May 13 - Mental health care of children has a gender-based difference in the primary care setting, according to an article in the May issue of the Archives of Pediatrics & Adolescent Medicine, a member of the JAMA family of journals.

"We found substantial disparities in the way primary care clinicians identified boys and girls with similar parent-reported symptoms. These disparities in the identification of mental health problems produce differences in their treatment," said William Gardner, Ph.D., professor of medicine and psychiatry, University of Pittsburgh School of Medicine.

Primary care clinicians (PCCs) were more likely to identify boys using the term "my patient." The researchers suggest this may be the case because boys were more likely to be seen by male clinicians, who are more likely to work in settings that support continuity of care. According to the researchers, clinicians who saw their own patients were substantially more likely to find and treat mental health problems in those patients.

The researchers found that compared with girls, visits by boys with similar parent-reported symptoms were more likely to be perceived by the PCC as mental health related. PCCs were more likely to find and treat mental health problems during visits perceived as mental health visits.

"This may have occurred because parents were more likely to label a boy's behavior as a mental health problem. Alternatively, whereas parents may have labeled boys' and girls' behavior similarly, they may have been more likely to seek medical care for such behavior when exhibited by a boy. Finally, because we relied on the PCC's report, it is possible that the clinician was more likely to label the visit as mental health related when the patient was a boy," said Dr. Gardner.

Boys with parent-reported symptoms similar to girls symptoms were more likely to be identified as having attention-deficit/hyperactivity disorder problems or other behavior or conduct problems and less likely to be identified as having internalizing problems, characterized by shyness, withdrawal, inhibition and inability to successfully form friendships.

After adjusting for parent-reported symptoms, medications were more likely to be prescribed for boys. Gender differences were not a significant factor in referral of children and families for mental health professionals.

According to background information in the article, most children are treated in primary care settings for mental health problems. Although it has been shown that boys are more likely than girls to receive a mental health diagnosis in the primary care setting and to receive specialty treatment until adolescence, the nuances of gender differences in similar cases have not been studied. Gender differences are well established in the treatment of adult mental and physical health.

According to the authors, the disparities in the finding and treatment of children's mental health problems may be remedied by finding ways to improve both the screening and identification processes used by PCCs and the communication between parents and clinicians about these issues. They also stated that clinicians should resist the trend toward practice patterns that depersonalize care. Each child should have a clinician who considers them as "their patient," the clinician will then be better prepared to recognize, track and effectively treat mental health problems if they do occur.

The researchers studied data from 21,065 individual child visits (50.3 percent female) in 204 primary care practices to determine gender differences in identification and treatment of mental health problems in primary care practices. The children studied were ages 4 to 15 years. Prior to evaluation, parents completed a questionnaire, which included the Pediatric Symptom Checklist, which was not available to the treating physician.
This study was supported by grants from the National Institute of Mental Health, Bethesda, Md.; the Health Resources and Services Administration Maternal and Child Health Bureau, Rockville, Md.; and by the Staunton Farm Foundation, Pittsburgh, Pa.

University of Pittsburgh Medical Center

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