ABSTRACT
Presented at the Pediatric Academic Societies annual meeting, May 2005
Rural-Urban Comparisons
of Child and Maternal Mental Health Barriers
Robert B. Penfold, Kelly J. Kelleher, Sarah M. Horwitz, Ruth
E.K. Stein, et. al. OCS, CHI, Columbus, OH; OCS, CHI, Columbus, OH; Epidemiology,
Case School of Medicine, Cleveland, OH; Pediatrics, AECOM/CHAM, Bronx, NY.
BACKGROUND: Little is known about rural pediatricians' attitudes
towards mental health care barriers within the health systems context.
OBJECTIVE: To test the hypotheses
that a) rural pediatricians will be more likely to agree that there are
barriers to identifying, treating and referring patients, b) rural physicians
will be less likely to identify mothers' MH problems and more likely to
treat child MH problems relative to their urban counterparts, c) to identify
the contextual variables that explain these differences.
DESIGN/METHODS: Data were collected via
the 59th AAP Periodic Survey. Survey data were linked to the
2003 Area Resource File and the 2000 Census via Geographic Information systems
(GIS). Difference of means tests, logistic regression, and spatial statistics
were used to test hypotheses.
RESULTS: With few exceptions, rural
pediatricians are more likely to agree that barriers exist to identifying,
treating and referring both child and maternal mental health problems. The
largest differences in perceived barriers between rural and urban pediatricians
are with respect to lack of MH providers (88% vs 60%), inadequate reimbursement
for MH treatment (62% vs 42%), and long waiting periods to see MH providers
(89% vs. 73%). With the exception of eating disorders, rural pediatricians
are more likely to treat child MH problems (75% vs 40% for ADHD, 31% vs
15% for Depression, and 25% vs 10% for Anxiety disorder). Rural pediatricians
are less likely to inquire about maternal MH problems (19% vs 35% for caregiving
problems, 22% vs 36% for substance abuse) with the exception of smoking
(73% vs 66%). However, rural pediatricians are slightly more likely to treat
maternal MH problems than their urban counterparts. Physician characteristics,
patient characteristics, and health system characteristics are all significant
predictors of these differences.
CONCLUSIONS: Rural pediatricians are
more likely to treat MH problems but face significantly greater barriers
to providing MH services. It is critical to understand the interaction between
physician, patient and health system characteristics in order to understand
pediatricians' attitudes towards barriers and the likelihood of identifying,
treating and referring child and maternal mental health problems.