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Sarah McCue Horwitz, PhD; Kelly Kelleher, MD; Thomas Boyce, MD; Peter Jensen, MD; Michael Murphy, EdD; Ellen Perrin, MD; Ruth E. K. Stein, MD; Michael Weitzman, MD

JAMA. 2002;288:1508-1512.

Context  The 1999 surgeon general's report on mental health concluded that insufficient attention to mental health disorders is being paid in children's primary medical care services. This lack of attention has occurred despite considerable attention to this issue in the planning documents of many federal agencies.

Objective  To assess the extent to which federal agencies' portfolios of funded research grants were consistent with the directives for primary care–based mental health services for children and adolescents featured in their planning documents.

Data Source  A cross-sectional review of the 66 749 abstracts listed in the April 2001 Computer Retrieval of Information on Scientific Projects (CRISP) database of currently funded research grants supported by the US Department of Health and Human Services. Abstracts were rated by whether they targeted primary care, examined behavioral or emotional issues, and examined or modified a facet of primary care.

Data Synthesis  Of the 45 022 research abstracts in the CRISP database, 2720 (6%) contained the words children, adolescents, or youth. Sixty-three abstracts contained work on children, adolescents, or youth in primary care (0.14% of the portfolio). Of these 63 abstracts, only 21 (0.05% of the portfolio) addressed behavioral or emotional issues. Of the 21 projects, only 11 examined aspects of the primary care process. When the distribution of child and adult studies on the treatment of depression within primary care settings was examined, it was found that adults received 15 times the research attention compared with children.

Conclusion  Even though the importance of primary care as a system for identifying and treating behavioral and emotional problems in children has been recognized for more than 20 years, little attention is being paid to this topic in the research portfolios of the National Institutes of Health and other federal agencies that support research.

Author Affiliations: Department of Epidemiology and Public Health, The Child Study Center, Yale University School of Medicine, New Haven, Conn (Dr Horwitz); Children's Research Institute, Ohio State University, Columbus (Dr Kelleher); School of Public Health/Institute of Human Development, University of California, Berkeley (Dr Boyce); Center for the Advancement of Children's Mental Health, Columbia University, New York, NY (Dr Jensen); Child Psychiatry Service, Massachusetts General Hospital, Boston (Dr Murphy); Department of Pediatrics, Tufts University, New England Medical Center, Boston, Mass (Dr Perrin); Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY (Dr Stein); and The American Academy of Pediatrics Center for Child Health Research and the Strong Children's Research Center, the University of Rochester School of Medicine and Dentistry, Rochester, NY (Dr Weitzman). The authors compose the Behavioral Consortium of the American Academy of Pediatrics Center for Child Health Research.

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