Primary care role in the management of childhood depression: a comparison of pediatricians and family physicians.

OBJECTIVE To provide a self-described assessment of pediatricians' and family physicians' management of childhood depression. DESIGN Mail survey of 595 general pediatricians and 557 family physicians in North Carolina. RESULTS The response rate was 66%. Most primary care physicians used referral (65%) and counseling (61%) for management of childhood depression. Family physicians used medications more commonly (18% vs 9%), and pediatricians referred patients more commonly (77% vs 48%). In logistic regression analysis, physicians comfortable with management of depression (odds ratio [OR], 4.8: 2.7-8.4), physicians who believed that antidepressants are more effective than counseling (OR, 2.6: 1.4-4.8), and family physicians (OR, 2.2: 1.9-4.1) were more likely to have used medications for childhood depression. CONCLUSIONS Most primary care physicians refer pediatric patients with depression; however, practice patterns vary by specialty and other factors. Future studies must consider the role of primary care and evaluate how interspecialty variations affect costs and outcomes of childhood depression.