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Trends in Prevalence and Management of Childhood Anxiety by Australian Pediatricians

  • Margie Danchin
    Correspondence
    Address correspondence to Margie Danchin, MBBS, FRACP, MD, Department of General Medicine, Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria 3052, Australia
    Affiliations
    Department of General Medicine (M Danchin, D Efron, and H Hiscock)

    Murdoch Children's Research Institute (M Danchin, A Gulenc, D Efron, E Sciberras, C Symeonides, and H Hiscock)

    Department of Paediatrics (M Danchin, D Efron, C Symeonides, and H Hiscock), The University of Melbourne, Parkville, Victoria, Australia
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  • Alisha Gulenc
    Affiliations
    Centre for Community Child Health (A Gulenc, D Efron, and C Symeonides), The Royal Children's Hospital

    Murdoch Children's Research Institute (M Danchin, A Gulenc, D Efron, E Sciberras, C Symeonides, and H Hiscock)
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  • Daryl Efron
    Affiliations
    Department of General Medicine (M Danchin, D Efron, and H Hiscock)

    Centre for Community Child Health (A Gulenc, D Efron, and C Symeonides), The Royal Children's Hospital

    Murdoch Children's Research Institute (M Danchin, A Gulenc, D Efron, E Sciberras, C Symeonides, and H Hiscock)

    Department of Paediatrics (M Danchin, D Efron, C Symeonides, and H Hiscock), The University of Melbourne, Parkville, Victoria, Australia
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  • Emma Sciberras
    Affiliations
    Murdoch Children's Research Institute (M Danchin, A Gulenc, D Efron, E Sciberras, C Symeonides, and H Hiscock)

    School of Psychology (E Sciberras), Deakin University, Geelong, Victoria, Australia
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  • Christos Symeonides
    Affiliations
    Centre for Community Child Health (A Gulenc, D Efron, and C Symeonides), The Royal Children's Hospital

    Murdoch Children's Research Institute (M Danchin, A Gulenc, D Efron, E Sciberras, C Symeonides, and H Hiscock)

    Department of Paediatrics (M Danchin, D Efron, C Symeonides, and H Hiscock), The University of Melbourne, Parkville, Victoria, Australia
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  • Harriet Hiscock
    Affiliations
    Department of General Medicine (M Danchin, D Efron, and H Hiscock)

    Centre for Community Child Health (A Gulenc, D Efron, and C Symeonides), The Royal Children's Hospital

    Murdoch Children's Research Institute (M Danchin, A Gulenc, D Efron, E Sciberras, C Symeonides, and H Hiscock)

    Department of Paediatrics (M Danchin, D Efron, C Symeonides, and H Hiscock), The University of Melbourne, Parkville, Victoria, Australia
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Published:August 09, 2018DOI:https://doi.org/10.1016/j.acap.2018.08.001

      Abstract

      Objective

      Rising anxiety rates and equity of care are ongoing concerns. Through 2 pediatric practice audits conducted 5 years apart, we aimed to determine the change in 1) anxiety diagnoses; 2) associated comorbid diagnoses; 3) variance in management by location; and 4) child, family, and pediatrician predictors of management.

      Methods

      Members of the Australian Paediatric Research Network (APRN) were invited to participate in patient-level prospective national pediatric practice audits in 2008 and 2013. Pediatricians were asked to complete standardized forms for 100 consecutive patients or all patients seen over 2 weeks, whichever was completed first. Demographic data, diagnoses, medications, and referrals were collected. Logistic regressions were conducted, clustered at the pediatrician level.

      Results

      Of eligible APRN pediatricians in 2013 and 2008, 48% and 66% participated and contributed 7102 and 8345 consultations, respectively. Anxiety diagnoses increased over the 5-year period (4.4% vs 7.6%; P < .001), as did proportions with comorbid autism spectrum disorder (18.4% vs 29.5%; P < .001) and sleep problems (5.1% vs 9.5%; P = .02). There was an increase in the prescription of core anxiety medications, with prescription of selective serotonin reuptake inhibitors increasing from 2.0% to 27.7% (P = .01). Children were more likely to be referred to a psychologist if they were seen in metropolitan practices (odds ratio = 2.0; 95% confidence interval, 1.1–3.9; P = .03) or had learning difficulties (odds ratio = 2.1; 95% confidence interval, 1.1–3.9; P = .03).

      Conclusions

      Prevalence of anxiety among children and adolescents attending pediatricians nearly doubled over the 5-year period. Children in regional and remote locations are less likely to be referred to psychological services, prompting concerns about inequity in access to care.

      Keywords

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