Comfort Level of Pediatricians and Family Medicine Physicians Diagnosing and Treating Child and Adolescent Psychiatric Disorders

Abstract

Context: Twelve to twenty-one percent of children and adolescents have psychiatric disorders with at least mild functional impairment. Pediatricians and family medicine physicians prescribe 85% of psychotropic medications taken by children. However, little is known about the comfort level of these physicians with the diagnosis and treatment of psychiatric disorders in children. Objective: To determine the comfort level of physicians in diagnosing and treating psychiatric disorders in children. Method: An anonymous survey was sent to pediatricians and family medicine physicians in upstate New York. Of 483 surveys, 200 surveys were returned. Outcome Measures: To compare differences between pediatricians and family medicine physicians in comfort in diagnosing and prescribing medications for psychiatric disorders. Results: After controlling for age, race, and years since residency, pediatricians were more comfortable in diagnosing (O.R. = 3.05, C.I. = 1.40–6.63) and prescribing stimulants for (O.R. = 4.16, C.I. = 1.96–8.84) Attention Deficit Disorder. Family medicine physicians were more comfortable in diagnosing (O.R. = .28, C.I. = .14-.57) and prescribing medication for (O.R. = .44, C.I. = .22-.87) anxiety and depression. Despite the differences in comfort, there were no differences in the percentage of each group prescribing the different medications. Of those who were comfortable in making the diagnoses, 13%−64% were not comfortable in prescribing medications, although they did prescribe. Conclusions: Pediatricians and family medicine physicians who prescribe the majority of psychotropic medications for children report disconcerting degrees of discomfort with the diagnosis and treatment of children's psychiatric disorders. The authors discuss the multiple factors that may impact primary care physician's comfort in diagnosing and treating children and adolescents with psychiatric disorders.