Depressed patients take children to GP and A&E more often
This large study from Marion Sills and colleagues, using data drawn from the Kaiser Permanente of Colorado (KPCO) membership system, reinforces what many GPs have come to recognise as one of the effects of a parent's depressive illness on their children: that these children consult more often.
Using the large Kaiser database the authors identified 24,391 children aged 0-17 years whose parents had consulted with depressive illness in the previous six months and compared them with 45,274 controls matched for age and KPCO eligibility criteria whose parents had not consulted with depression. The objective was to determine what effect the parent's illness had on the child's use of medical services. The researchers looked at different age groups of children and examined the different types of clinical contact the children had with medical services (well child care, sick visits to primary care departments, specialty clinic visits, emergency department visits and inpatient visits).
In all age groups the rates of consultation with primary care physicians and hospital emergency departments were significantly higher in children with at least one depressed parent compared with controls. This may be because the parents were less able to cope with the child's illness or had a greater need for reassurance.
Interestingly, attendance at routine well child clinics was not affected by parental depression in the younger age groups, but fell off for adolescents.
What was not clear in this paper was whether the study group was adequately controlled. Single-parent families were accounted for in the analysis but socioeconomic and educational status were not.
This paper emphasises the impact that parental mental health problems have on the whole family. Looking at this from another perspective, one suggestion might be that GPs should think about parental mental health in the case of any child who appears to be a frequent consulter.
Sills MR, Shetterly S, Xu S, et al. Association between parental depression and children's health care use. Pediatrics 2007;119(4);e829-36Reviewer
Dr Peter Saul
GP, Wrexham and hospital practitioner in paediatrics (asthma and allergy)