Commentary of Fred A. Baughman Jr., M.D. on the following:
They stressed that their findings did not necessarily mean the children were mentally ill, but did show that emergency room workers have a unique opportunity to find children who may need mental health care. "The pediatric emergency department may be the only interaction mothers have with a health care provider," Dr. Jacqueline Grupp-Phelan of the Cincinnati Children's Hospital Medical Center in Ohio told a meeting of the Pediatric Academic Societies in Baltimore. "If we do not take advantage of the emergency department visit to identify and treat families with mental health problems, these children may fall through the cracks." More than 40,000 Americans have no medical insurance, and in many areas they heavily use emergency rooms for medical care because of laws that require emergency departments to treat everyone, regardless of whether they have insurance.
Grupp-Phelan said 60 percent of the patients in the study were using the Medicaid state-federal health insurance program for the poor. She and colleagues gave a mental health screening test to 600 mothers and their children who visited Cincinnati Children's emergency department for non-urgent complaints. A quarter of the children had symptoms of four or more mental health disorders such as anxiety, depression, conduct disorders and attention deficit hyperactivity disorder, Grupp-Phelan said. Three quarters of the children had symptoms of at least one mental health disorder, the study found. A FEW SIMPLE QUESTIONS Her team used tests that over time have been shown to do a good job in finding people likely to be diagnosed with a mental illness. Such screening tests involve a few simple questions. They include asking parents, "Has (your child) seemed to worry a lot when making small mistakes doing homework or other activities?" or, "Has she often complained of stomachaches?" Another set of questions asks, "Has she refused to do what you or her teachers tell her to do" and, "Has your child bullied another child?" "If your kid says yes to all of these, she's pretty symptomatic," Grupp-Phelan said in an interview.
Now her team is doing studies to see just how closely an emergency department screening test like this one correlates with actual mental illness diagnosed in a visit with a psychiatrist or other trained professional. She said it is possible the people who use emergency rooms for routine medical care are stressed by their lives in general. It also is possible that having a sick child can cause stress levels to rise high enough to show up on a screening test -- but Grupp-Phelan said the tests are designed to find more than just the expected levels of stress. Her team also found that 18 percent of the mothers screened positive for either anxiety or depression. And 92 percent of the children of these mothers also screened positive for a mental health disorder.
Grupp-Phelan suggests that busy emergency room workers could ask two simple questions of all mothers. Those who show symptoms of mental illness then could be screened more closely and their children could be screened. She said her team has asked patients if they would mind being screened for mental illness, or having their children screened, and said most would like it.
"They think their doctors will take better care of them," she said.
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