Child sex differences in primary care clinicians' mental health care of children and adolescents

Background: Sex differences in the medical and mental health care of adults are well established. Objective: To study the effect of child patient's sex on whether primary care clinicians (PCCs), including pediatricians, family physicians, and nurse practitioners, found or treated mental health problems in primary care settings. Design: The data were collected by clinicians and parents from 21065 individual child visits (50.3% girls) in 204 primary care practices. Methods: Each PCC enrolled a consecutive sample of approximately 55 children and adolescents aged 4 to 15 years. Parents filled out questionnaires, including the Pediatric Symptom Checklist, before seeing the clinician. Clinicians completed a survey after the visit about the psychosocial problems and recommended treatments, but they did not see the results of the Pediatric Symptom Checklist or any other data collected from the parents. Results: Boys were more likely to be been tor a mental health-related visit and by a clinician who identified them as "my patient," Boys with parent-reported symptom profiles that were similar to those of girls were more likely to be identified as problems or behavior or conduct problems and less likely to be identified a, having internalizing problems. Adjusting for parent-reported Symptom, PCCs were more likely to prescribe medications for boys. Child sex differences in referrals to mental health specialist and the provision of counseling to families were not statistically significant. Conclusion: There are substantial sex differences in the mental health care of children in the primary care system.