Identification of Preschool Children with Mental Health Problems in Primary Care: Systematic Review and Meta-analysis

Alice Charach¹, Forough Mohammadzadeh², Stacey A Belanger³, Amanda Easson⁴, Ellen L Lipman⁵, John D McLennan⁶, Patricia Parkin⁷, Peter Szatmari⁸

Affiliations

¹ Department of Psychiatry, University of Toronto Faculty of Medicine, and The Hospital for Sick Children, Toronto, Ontario.
² Department of Psychiatry, The Hospital for Sick Children, Toronto, and Qvella Corporation, Richmond Hill, Ontario.
³ Département de Pédiatrie, Faculté de Médicine, Université de Montréal and CHU Sainte Justine, CIRENE (Centre Intégré du Réseau en Neurodéveloppement de L'Enfant), Montréal, Quebec.
⁴ Department of Psychology, University of Toronto and Rotman Research Institute, Baycrest Center for Geriatric Care, Toronto, Ontario.
⁵ Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences McMaster University, McMaster Children's Hospital and Offord Centre for Child Studies, Hamilton Ontario.
⁶ Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario, and Department of Pediatrics, University of Calgary, Calgary, Alberta.
⁷ Department of Pediatrics, University of Toronto Faculty of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, and The Hospital for Sick Children, Toronto, Ontario.
⁸ Department of Psychiatry, University of Toronto Faculty of Medicine, The Hospital for Sick Children, and The Centre for Addiction and Mental Health, Toronto, Ontario.

PMID: 32405310
PMCID: PMC7213917

Identification of Preschool Children with Mental Health Problems in Primary Care: Systematic Review and Meta-analysis

Alice Charach et al. J Can Acad Child Adolesc Psychiatry. 2020 May.

. 2020 May;29(2):76-105.

Epub 2020 May 1.

Authors

Alice Charach¹, Forough Mohammadzadeh², Stacey A Belanger³, Amanda Easson⁴, Ellen L Lipman⁵, John D McLennan⁶, Patricia Parkin⁷, Peter Szatmari⁸

Affiliations

¹ Department of Psychiatry, University of Toronto Faculty of Medicine, and The Hospital for Sick Children, Toronto, Ontario.
² Department of Psychiatry, The Hospital for Sick Children, Toronto, and Qvella Corporation, Richmond Hill, Ontario.
³ Département de Pédiatrie, Faculté de Médicine, Université de Montréal and CHU Sainte Justine, CIRENE (Centre Intégré du Réseau en Neurodéveloppement de L'Enfant), Montréal, Quebec.
⁴ Department of Psychology, University of Toronto and Rotman Research Institute, Baycrest Center for Geriatric Care, Toronto, Ontario.
⁵ Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences McMaster University, McMaster Children's Hospital and Offord Centre for Child Studies, Hamilton Ontario.
⁶ Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario, and Department of Pediatrics, University of Calgary, Calgary, Alberta.
⁷ Department of Pediatrics, University of Toronto Faculty of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, and The Hospital for Sick Children, Toronto, Ontario.
⁸ Department of Psychiatry, University of Toronto Faculty of Medicine, The Hospital for Sick Children, and The Centre for Addiction and Mental Health, Toronto, Ontario.

PMID: 32405310
PMCID: PMC7213917

Abstract
in English, French

Objective: Primary care practitioners determine access to care for many preschool children with mental health (MH) problems. This study examined rates of mental health (MH) problem identification in preschoolers within primary healthcare settings, related service use, and MH status at follow-up. The findings may inform evidence-based policy and practice development for preschool MH.

Method: For this systematic review, MEDLINE^®, EMBASE^®, PsycInfo^®, and ERIC ^® were searched from inception to March 7, 2018 for reports in which a screening measure was used to identify MH problems in children aged 24-72 months, seen in primary and community health care settings. Meta-analyses, using random effects models to provide pooled estimates, were used when three or more studies examined identification rates. Findings on service use and persistence of disorders are summarized.

Results: Thirty-five publications representing 21 studies met the inclusion criteria. MH problems were identified in 17.6% of preschoolers (95% Confidence Interval (CI): 11.1-24.1), Q = 4.9, p > 0.1 by primary/community healthcare practitioners. Psychiatric diagnoses were identified in 18.4% of preschoolers (95% CI: 12.3 - 24.4), Q= 1.6, p > 0.1. Based on three studies, parents of 67-72% of identified children received advice and 26-42% received specialist referrals. In the subset of studies examining persistence of MH disorders, 25-67% of identified children had MH disorders after one to three years.

Conclusion: While the identification rate by primary/community practitioners is similar to the diagnostic rate, these may not consistently be the same children. Substantial variability in management and outcomes indicate need for more rigorous evaluation of primary care services for this population.

Objectif: Les praticiens des soins primaires déterminent l’accès aux soins pour de nombreux enfants d’âge préscolaire souffrant de problèmes de santé mentale (SM). La présente étude a examiné les taux d’identification des problèmes de SM chez les enfants d’âge préscolaire dans le contexte de soins primaires, de l’utilisation des services connexes et de l’état de la SM au suivi. Les résultats peuvent éclairer l’élaboration des politiques et des pratiques fondées sur des données probantes pour la SM préscolaire.

Méthode: La recherche pour cette revue systématique a été menée dans MEDLINE^®, EMBASE^®, PsycInfo^®, et ERIC ^® du début au 7 mars 2018, et ciblait des études utilisant une mesure de dépistage pour identifier les problèmes de santé mentale chez les 24 à 72 mois, vus dans les soins primaires et communautaires. Les méta-analyses, utilisant des modèles à effets aléatoires pour produire des estimations regroupées, ont été utilisées quand trois ou plusieurs études examinaient les taux d’identification. Les résultats de l’utilisation des services et de la persistance des troubles sont résumés.

Résultats: Trente-cinq publications représentant 21 études satisfaisaient aux critères d’inclusion. Des problèmes de SM ont été identifiés chez 17,6% des enfants d’âge préscolaire (intervalle de confiance IC à 95%: 11,1 à 24,1; Q = 4,9, p > 0,1) par des praticiens des soins primaires/communautaires. Des diagnostics psychiatriques ont été posés chez 18,4 % des enfants d’âge préscolaire (IC à 95%: 12,3 à 24,4; Q = 1,6; p > 0,1). Selon trois études, les parents de 67 à 72% des enfants identifiés recevaient des conseils, 26 à 42 % étaient adressés à des spécialistes. Dans le sous-ensemble des études qui examinaient la persistance des troubles de SM, 25% à 67% des enfants identifiés avaient des troubles de SM d’ici 1 à 3 ans.

Conclusion: Même si le taux d’identification par les praticiens des soins primaires /communautaires est semblable au taux de diagnostics, il ne s’agit peut-être pas constamment des mêmes enfants. La variabilité substantielle de la prise en charge et des résultats indique le besoin d’une évaluation plus rigoureuse des services de soins primaires pour cette population.

Keywords: emotional and behavioral problems; identification of mental health problems; preschool children; primary health care.

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Figures

**Figure 2**
Summary Estimates for Mental Health Problems in Preschool Children in Primary or Community Health Care Settings.

See this image and copyright information in PMC

References

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Identification of Preschool Children with Mental Health Problems in Primary Care: Systematic Review and Meta-analysis

Affiliations

Identification of Preschool Children with Mental Health Problems in Primary Care: Systematic Review and Meta-analysis

Authors

Affiliations

Abstract
in English, French

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous

Abstract in English, French

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous

Abstract
in English, French