Child Psychiatry Consult

Screening did not increase mental health consults


SAN DIEGO – Only 1% of families that filled out psychosocial screening questionnaires during medical appointments later sought free mental health consultations, the same rate as for families that were not screened, investigators reported.

“Unless large controlled trials are able to show a process and an outcome benefit, it may be preferable to invest in providing mental health treatment” instead of screening, concluded lead investigator Brianna J. Lewis of the Mount Sinai School of Medicine, New York, and her associates. The researchers presented the findings at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The study was a post-hoc analysis of data on 3,143 patient encounters at a pediatric allergy clinic in New York City between March and September 2013. Two to five days a week, the investigators had asked children aged 8 years and older and their parents to fill out one-page questionnaires about problems such as distress, anxiety, bullying, and quality-of-life issues. They did not screen patients on the other days, “creating a naturalistic opportunity to compare between screened and nonscreened cohorts,” they added. Because screening was part of regular care, participants did not need to provide informed consent, which eliminated the possibility of selection bias, the researchers said.

In all, 6.1% of families who underwent screening were referred to a mental health consultation, but only 1% followed up, even though consults were offered for free and without third-party billing, the researchers said. The follow-up rate also was 1% for the 1,972 families that were not screened. Among the families who pursued a follow-up consult, 56% of the screened group and 67% of the unscreened group received a psychiatric diagnosis (P = 0.26), Ms. Lewis and her associates reported.

Past studies by the investigators showed that screening children and adults during medical care appointments is “hard to justify,” they noted.

The Jaffe Family Foundation, Pine/Segal Family, and Vanech Family Foundation supported the research. The investigators declared no conflicts of interest.

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