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Background: Problem perception and perceived need for professional care are important determinants that can contribute to ethnic differences in the use of mental health care. Therefore, we studied ethnic differences in problem perception and perceived need for professional care in the parents and teachers of 5- to 6-year-old children from the general population who were selected for having emotional and behavioural problems. Methods: A cross-sectional study with data of 10,951 children from grade two of the elementary schools in the Rotterdam-Rijnmond area, the Netherlands. Parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ) as well as questions on problem perception and perceived need for care. The SDQ was used to identify children with emotional and behavioural problems. We included Dutch, Surinamese, Antillean, Moroccan and Turkish children in our sample with high (greater than P90) SDQ scores (N = 1,215), who were not currently receiving professional care for their problems. Results: Amongst children with high SDQ scores, problem perception was lower in non-Dutch parents than in Dutch parents (49% vs. 81%, p less than 0.01). These lower rates of problem perception could not be explained by differences in socioeconomic position or severity of the problems. No ethnic differences were found in parental perceived need and in problem perception and perceived need reported by teachers. Higher levels of problem perception and perceived need were reported by teachers than by parents in all ethnic groups (PP: 87% vs. 63% and PN: 48% vs. 23%). Conclusions: Child health professionals should be aware of ethnic variations in problem perception as low problem perception in parents of non-Dutch children may lead to miscommunication and unmet need for professional care for the child. (Contains 3 tables and 1 figure.)

In a multiethnic community sample of 1,170 preadolescent children, it was investigated whether discrepancies in parent-child reports of internalizing problems are related with gender, ethnic background (Dutch, Surinamese/Antillean, Moroccan, Turkish, Other) and with future internalizing problems. No significant differences in discrepancy scores between boys and girls were found. Parent-child disagreement of internalizing problems varied across ethnic groups, with significant differences among children from Surinamese/Antillean (children reporting more internalizing problems than their parents) and Turkish background (parents reporting more internalizing problems than their children). Disagreement between parents and their preadolescent child significantly contributed to the prediction of self-reported internalizing problems in early adolescence. For the early identification of internalizing problems, it is recommended to include both parent and child self-reports as part of routine health examinations in the setting of preventive youth health care because when parents underreport problems relative to their child, this can predict future internalizing problems. (Contains 4 tables and 1 note.)

In a multiethnic community sample of 1,170 preadolescent children, it was investigated whether discrepancies in parent-child reports of internalizing problems are related with gender, ethnic background (Dutch, Surinamese/ Antillean, Moroccan, Turkish, Other) and with future internalizing problems. No significant differences in discrepancy scores between boys and girls were found. Parent-child disagreement of internalizing problems varied across ethnic groups, with significant differences among children from Surinamese/ Antillean (children reporting more internalizing problems than their parents) and Turkish background (parents reporting more internalizing problems than their children). Disagreement between parents and their preadolescent child significantly contributed to the prediction of self-reported internalizing problems in early adolescence. For the early identification of internalizing problems, it is recommended to include both parent and child self-reports as part of routine health examinations in the setting of preventive youth health care because when parents underreport problems relative to their child, this can predict future internalizing problems. [ABSTRACT FROM AUTHOR]

Introduction: Stepped care strategies are potentially effective to organise integrated care but unknown is whether they function well in practice. This paper evaluates the implementation of a stepped care programme for depression in primary care and secondary care. Theory and methods: We developed a stepped care algorithm for diagnostics and treatment of depression, supported by a liaison-consultation function. In a 21/2 year study with pre-post design in a pilot region, adherence to the protocol was assessed by interviewing 28 caregivers of 235 patients with mild, moderate, or severe major depression. Consultation and referral patterns between primary and secondary care were analysed. Results: Adherence of general practitioners and consultant caregivers to the stepped care protocol proved to be 96%. The percentage of patients referred for depression to secondary care decreased significantly from 26% to 21% (p=0.0180). In the post-period more patients received treatment in primary care and requests for consultation became more concordant with the stepped care protocol. Conclusions: Implementation of a stepped care programme is feasible in a primary and secondary care setting and is associated with less referrals. Discussion: Further research on all subsequent treatment steps in a standardised stepped care protocol is needed. [ABSTRACT FROM AUTHOR]

We reviewed 23 studies on the association between noncognitive mental disorders and the use of general health care services by medical patients admitted to a general hospital. Only studies with a prospective design and with a correction for possible confounding factors were included. In most studies, only service use during index admission was observed, but eight studies included a longer observation period during follow-up after hospital discharge. The 15 studies that were restricted to service use during index admission showed mixed results: length of hospital stay was related to common mental disorders in some studies, but other studies did not find such an association. The eight studies that used a longer observation period showed findings that are more consistent. They demonstrated mainly that symptoms or complaints of depression are related to a higher resource use within general medical services.