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February 1996, Vol 150, No. 2 >
Article | February 1996

Association Between Child Behavior Problems and Frequent Physician Visits FREE

Barry Zuckerman, MD; Kristin A. Moore, PhD; Dana Glei, MA
Arch Pediatr Adolesc Med. 1996;150(2):146-153. doi:10.1001/archpedi.1996.02170270028004.
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Objective:  To determine the association between parent-reported behavior problems and health care utilization, especially among physically healthy children.

Design:  Analysis of data from the 1988 National Health Interviews Survey—Child Health Supplement. The sample for analysis consisted of 11 840 children aged 5 to 17 years. The independent measure of primary interest are behavior problems as measured by the Behavior Problems Index. For the bivariate analysis, children in the lowest quartile, highest quartile and middle half were compared. For the multivariate analysis, children in the highest quartile with behavior problems were compared with all other children.

Main Outcome Measures:  The number of reported physician visits in the past year and the past 2 weeks, Two common behavior syndromes—antisocial and depressed or anxious—were analyzed separately to determine whether a specific type of behavior problem was associated with frequent health care utilization.

Results:  Eighteen percent of the children aged 5 to 17 years had four or more health visits during the past year, and 2% had two or more visits during the past 2 weeks. Children in the top quartile for parent-reported behavior problems were more likely to have four or more physician visits than children in the middle half and bottom quartile. Children reported to be in "excellent," "very good," or "good" health who were in the top quartile of behavior problems were more likely to report four or more physician visits during the past year, but no statistically significant differences were seen among children reported to be in "fair" or "poor" health. Controling for confounding variables, children in the top quartile of the Behavior Problems Index are significantly more likely to report four or more visits during the past year and two or more visits during the past 2 weeks compared with other children. Anxious or depressed and antisocial subscales of the Behavior Problems Index showed independent and significant associations with four or more physician visits in the past year.

Conclusion:  Children with parent-reported behavior problems are likely to have more frequent physician visits compared with children without behavior problems, even when confounding sociodemographic and health status variables are controlled. The association is concentrated among physically healthy children.(Arch Pediatr Adolesc Med. 1996;150:146-153)

REFERENCES

1 +
Hetherington RW, Hopkins CE.  Symptom sensitivity: its social and cultural correlates . Health Serv Res . Spring 1969;:63-75.
2 +
Becker M, Green LW.  A family approach to compliance with medical treatment: a selective review of the literature . Int J Health Educ . 1975;;18:2-11.
3 +
Gortmaker S, Eckenrode J, Gore S.  Stress and the utilization of health services: a time series and cross-cultural analysis . J Health Soc Behav . 1982;;23: 25-38.
4 +
Katon W, Vonkorff M, Lin E, et al.  Distressed high utilizers of medical care . Gen Hosp Psychiatry . 1992;;12:355-362.
5 +
Escobar JI, Golding JM, Hough RL, et al.  Somatization in the community: relationship to disability and use of services . Am J Public Health . 1987;:77:837-840.
6 +
Tessler RD, Mechanic D, Dimond M.  The effect of psychological distress on physician utilization: a prospective study . J Health Soc Behav . 1976;;17:253-374.
7 +
Roghmann KJ, Haggerty RJ.  Daily stress, illness and use of health services in young families . Pediatr Res . 1973;;7:353-364.
8 +
Levy JC.  Vulnerable children: parents perspectives and the use of medical care . Pediatrics . 1980;;65:956-963.
9 +
Nader PR, Ray L, Brink S.  The new morbidity: use of school and community health care resources for behavioral, educational and social family problems . Pediatrics . 1981;;67:53-60.
10 +
Jacobson AM, Goldberg ID, Burns BJ, Hooper EW, Hankin JR, Hewitt K.  Diagnosed mental disorders in children and use of health services in four organized health care settings . Am J Psychiatry . 1980;:137:559-565.
11 +
Yudkin S.  The children with coughs: the second diagnosis . Lancet . 1961;;2: 561.
12 +
Good M-JD, Good G, Cleary PD.  Do patient attitudes influence physician recognition of psychosocial problems in primary care? J Fam Pract . 1987;;25:53-59.
13 +
Costello EJ. Edelbrook C, Costello AJ, et al.  Psychopathology in pediatric primary care: the new hidden morbidity . Pediatrics . 1988;:82:415-424.
14 +
Dawson DA. Family Structure and Children's Health: United States, 1988. Vital Health Stat 10 . 1991;; No. (178) :44.
15 +
Zill N. The Behavior Problems Index: Descriptive Material . Washington, DC: Child Trends Inc; 1991;.
16 +
Achenbach TS, Edelbrock CS.  Behavioral problems and competencies reported by parents of normal and disturbed children aged four through sixteen . In: Monographs of the Society for Research in Child Development 188 . Chicago, Ill: University of Chicago Press; 1981;;46:No. (1) .
17 +
Rutter M, Tizard J, Whitmore K. Education, Health, and Behavior . New York, NY: Longman Inc; 1970;.
18 +
Graham PJ, Rutter ML.  The reliability and validity of the psychiatric assessment of the child, II: interview with the parent . Br J Psychiatry . 1968;;114:581-592.
19 +
Kellam SK, Brank JD, Agrawal KC, Ensminger ME. Mental Health and Going to School: the Woodlawn Program of Assessment, Early Intervention, and Evaluation . Chicago, Ill: University of Chicago Press; 1975;.
20 +
National Center For Health Statistics. Parent Ratings of Behavioral Patterns of Children, United States . Washington, DC: US Public Health Service; 1971;. Dept of Health, Education, and Welfare publication (HSM) 72-1010, Series 11, No. (108) .
21 +
Newacheck PW, Stoddard JJ.  Prevalence and impact of multiple childhood chronic illnesses , J Pediatr . 1994;;124:40-48.
22 +
Hickson GB, Altemeier WA, O'Connor S.  Concerns of mothers seeking care in private pediatric offices: opportunities for expanding services . Pediatrics . 1983;; 72:619-624.
23 +
Wissow LS, Roter DL, Wilson ME.  Pediatrician interview style and mothers' disclosure of psychosocial issues . Pediatrics . 1994;;93:289-295.
24 +
Boyce WT, Jensen WE, Cassel JC, et al.  Influence of life events and family routines on childhood respiratory tract illness . Pediatrics . 1977;;60:609-615.
25 +
Beautrais AL, Ferguson DM, Shannon FT.  Life events and child morbidity: a prospective study . Pediatrics . 1982;;70:935-940.
26 +
Meyer RJ, Haggerty RJ.  Streptococcal infection in families: factors affecting individual susceptibility . Pediatrics . 1962;;29:539-549.
27 +
Donenberg G, Baker BL.  The impact of young children with externalizing behaviors on their families . J Abnorm Child Psychol . 1993;;21:179-198.
28 +
Befera M, Barkley RA.  Hyperactive and normal girls and boys: mother-child interactions, parent psychiatric status, and child psychopathology . J Child Psychol Psychiatry . 1985;;26:439-452.
29 +
Kelleher K, Starfield B.  Health care use by children receiving mental health services . Pediatrics . 1990;;85:114-118.
30 +
Hankin JR, Kessler LG, Goldberg IM, Steinwachs PM, Starfield BH.  A longitudinal study of offset in the use of nonpsychiatric services following specialized mental health care . Med Care . 1983;;21:1099-1110.
31 +
Parker S, Zuckerman B. Behavioral and Developmental Pediatrics: A Handbook for Primary Care . Boston, Mass: Little Brown & Co Inc; 1994;.

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References

1 +
Hetherington RW, Hopkins CE.  Symptom sensitivity: its social and cultural correlates . Health Serv Res . Spring 1969;:63-75.
2 +
Becker M, Green LW.  A family approach to compliance with medical treatment: a selective review of the literature . Int J Health Educ . 1975;;18:2-11.
3 +
Gortmaker S, Eckenrode J, Gore S.  Stress and the utilization of health services: a time series and cross-cultural analysis . J Health Soc Behav . 1982;;23: 25-38.
4 +
Katon W, Vonkorff M, Lin E, et al.  Distressed high utilizers of medical care . Gen Hosp Psychiatry . 1992;;12:355-362.
5 +
Escobar JI, Golding JM, Hough RL, et al.  Somatization in the community: relationship to disability and use of services . Am J Public Health . 1987;:77:837-840.
6 +
Tessler RD, Mechanic D, Dimond M.  The effect of psychological distress on physician utilization: a prospective study . J Health Soc Behav . 1976;;17:253-374.
7 +
Roghmann KJ, Haggerty RJ.  Daily stress, illness and use of health services in young families . Pediatr Res . 1973;;7:353-364.
8 +
Levy JC.  Vulnerable children: parents perspectives and the use of medical care . Pediatrics . 1980;;65:956-963.
9 +
Nader PR, Ray L, Brink S.  The new morbidity: use of school and community health care resources for behavioral, educational and social family problems . Pediatrics . 1981;;67:53-60.
10 +
Jacobson AM, Goldberg ID, Burns BJ, Hooper EW, Hankin JR, Hewitt K.  Diagnosed mental disorders in children and use of health services in four organized health care settings . Am J Psychiatry . 1980;:137:559-565.
11 +
Yudkin S.  The children with coughs: the second diagnosis . Lancet . 1961;;2: 561.
12 +
Good M-JD, Good G, Cleary PD.  Do patient attitudes influence physician recognition of psychosocial problems in primary care? J Fam Pract . 1987;;25:53-59.
13 +
Costello EJ. Edelbrook C, Costello AJ, et al.  Psychopathology in pediatric primary care: the new hidden morbidity . Pediatrics . 1988;:82:415-424.
14 +
Dawson DA. Family Structure and Children's Health: United States, 1988. Vital Health Stat 10 . 1991;; No. (178) :44.
15 +
Zill N. The Behavior Problems Index: Descriptive Material . Washington, DC: Child Trends Inc; 1991;.
16 +
Achenbach TS, Edelbrock CS.  Behavioral problems and competencies reported by parents of normal and disturbed children aged four through sixteen . In: Monographs of the Society for Research in Child Development 188 . Chicago, Ill: University of Chicago Press; 1981;;46:No. (1) .
17 +
Rutter M, Tizard J, Whitmore K. Education, Health, and Behavior . New York, NY: Longman Inc; 1970;.
18 +
Graham PJ, Rutter ML.  The reliability and validity of the psychiatric assessment of the child, II: interview with the parent . Br J Psychiatry . 1968;;114:581-592.
19 +
Kellam SK, Brank JD, Agrawal KC, Ensminger ME. Mental Health and Going to School: the Woodlawn Program of Assessment, Early Intervention, and Evaluation . Chicago, Ill: University of Chicago Press; 1975;.
20 +
National Center For Health Statistics. Parent Ratings of Behavioral Patterns of Children, United States . Washington, DC: US Public Health Service; 1971;. Dept of Health, Education, and Welfare publication (HSM) 72-1010, Series 11, No. (108) .
21 +
Newacheck PW, Stoddard JJ.  Prevalence and impact of multiple childhood chronic illnesses , J Pediatr . 1994;;124:40-48.
22 +
Hickson GB, Altemeier WA, O'Connor S.  Concerns of mothers seeking care in private pediatric offices: opportunities for expanding services . Pediatrics . 1983;; 72:619-624.
23 +
Wissow LS, Roter DL, Wilson ME.  Pediatrician interview style and mothers' disclosure of psychosocial issues . Pediatrics . 1994;;93:289-295.
24 +
Boyce WT, Jensen WE, Cassel JC, et al.  Influence of life events and family routines on childhood respiratory tract illness . Pediatrics . 1977;;60:609-615.
25 +
Beautrais AL, Ferguson DM, Shannon FT.  Life events and child morbidity: a prospective study . Pediatrics . 1982;;70:935-940.
26 +
Meyer RJ, Haggerty RJ.  Streptococcal infection in families: factors affecting individual susceptibility . Pediatrics . 1962;;29:539-549.
27 +
Donenberg G, Baker BL.  The impact of young children with externalizing behaviors on their families . J Abnorm Child Psychol . 1993;;21:179-198.
28 +
Befera M, Barkley RA.  Hyperactive and normal girls and boys: mother-child interactions, parent psychiatric status, and child psychopathology . J Child Psychol Psychiatry . 1985;;26:439-452.
29 +
Kelleher K, Starfield B.  Health care use by children receiving mental health services . Pediatrics . 1990;;85:114-118.
30 +
Hankin JR, Kessler LG, Goldberg IM, Steinwachs PM, Starfield BH.  A longitudinal study of offset in the use of nonpsychiatric services following specialized mental health care . Med Care . 1983;;21:1099-1110.
31 +
Parker S, Zuckerman B. Behavioral and Developmental Pediatrics: A Handbook for Primary Care . Boston, Mass: Little Brown & Co Inc; 1994;.

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