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. 2020 Mar;20(2):208-215.
doi: 10.1016/j.acap.2019.11.006. Epub 2019 Nov 18.

The Relationship Between Social Risks and the Mental Health of School-Age Children in Primary Care

Andrea E Spencer  1 , Tithi D Baul  2 , Jennifer Sikov  2 , William G Adams  2 , Yorghos Tripodis  3 , Olivia Buonocore  2 , Michael Jellinek  4 , J Michael Murphy  4 , Arvin Garg  5
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The Relationship Between Social Risks and the Mental Health of School-Age Children in Primary Care

Andrea E Spencer et al. Acad Pediatr. 2020 Mar.

Abstract

Background and objective: The study's goal was to measure the association between social risks and the mental health of school-age children in primary care.

Methods: We conducted a cross-sectional study in an urban safety-net hospital-based pediatric clinic using data collected from 2 standardized screening tools administered at well-child care visits for children age 6 to 11. Psychosocial dysfunction was measured with the Pediatric Symptom Checklist-17 (PSC-17), and 6 social risks (caregiver education, employment, child care, housing, food security, and household heat) were measured with the WE CARE screener. Multivariable linear and logistic regression analyses were conducted to measure the association between scores while controlling for sociodemographic characteristics.

Results: Among N = 943 patients, cumulative social risks were significantly associated with a positive PSC-17 total score (adjusted odds ratio [aOR] 1.2; 95% confidence interval [CI] 1.1-1.5; P = .02), indicating psychosocial dysfunction. Children with ≥3 social risks were 2.4 times more likely to have a positive PSC-17 total score compared to children with <3 social risks (95% CI 1.5-3.9; P < .001). Of the individual social risks measured, only food insecurity significantly predicted a positive PSC-17 total score (aOR 1.9; 95% CI 1.1-3.2; P = .02) and attention score (aOR 1.9; 95% CI 1.1-3.4; P = .03).

Conclusion: Number of risks on a social risk screener was associated with psychosocial dysfunction in school-age children. Food insecurity was the only individual risk associated with psychosocial dysfunction, in particular attention problems. Screening tools for social risks could be used to identify at-risk children whose mental health may be adversely impacted by their social conditions.

Keywords: child psychiatry; mental health; pediatrics; primary care; social determinants of health.

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Conflict of interest statement

Potential Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1a.
Figure 1a.
Receiver Operating Characteristic curve of positive PSC-17 total score at possible WE CARE cut-offs
Figure 1b.
Figure 1b.
Odds of positive PSC-17 total score at possible WE CARE cut-offs
Figure 2.
Figure 2.
Bivariate analysis comparing percent of children with positive PSC-17 total scores with and without individual social risks.
See this image and copyright information in PMC

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