Kerker Bonnie D, Storfer-Isser Amy, Szilagyi Moira, Stein Ruth E K, Garner Andrew S, O'Connor Karen G, Hoagwood Kimberly E, Horwitz Sarah M
Nathan Kline Institute of Psychiatric Research, Orangeburg, NY; Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
Statistical Research Consultants, LLC., Schaumburg, Ill.
Acad Pediatr. 2016 Mar;16(2):154-60. doi: 10.1016/j.acap.2015.08.002. Epub 2015 Oct 31.
The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs.
Data were collected from 302 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2013 American Academy of Pediatrics Periodic Survey. Pediatricians indicated whether they usually, sometimes, or never inquired about or screened for 7 ACEs. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted.
Only 4% of pediatricians usually asked about all 7 ACEs; 32% did not usually ask about any. Less than 11% of pediatricians reported being very or somewhat familiar with the ACE study. Pediatricians who screened/inquired about ACEs usually asked about maternal depression (46%) and parental separation/divorce (42%). Multivariable analyses showed that pediatricians had more than twice the odds of usually asking about ACEs if they disagreed that they have little effect on influencing positive parenting skills, disagreed that screening for social emotional risk factors within the family is beyond the scope of pediatricians, or were very interested in receiving further education on managing/treating mental health problems in children and adolescents.
Few pediatricians ask about all ACEs. Pediatric training that emphasizes the importance of social/emotional risk factors may increase the identification of ACEs in pediatric primary care.
与童年不良经历（ACEs）相关的压力具有即时和长期的影响。本研究的目的是调查：1）儿科医生询问患者家庭ACEs情况的频率；2）儿科医生对原始ACE研究的熟悉程度；3）与询问ACEs相关的医生/执业特征、医生的心理健康培训以及医生的态度/信念。
数据收集自302名专门从事普通儿科的非实习儿科医生，他们完成了2013年美国儿科学会定期调查。儿科医生表明他们通常、有时还是从不询问或筛查7种ACEs。使用样本权重来减少无应答偏差。进行加权描述性和逻辑回归分析。
只有4%的儿科医生通常会询问所有7种ACEs；32%的医生通常不会询问任何一种。不到11%的儿科医生报告对ACE研究非常或有些熟悉。筛查/询问ACEs的儿科医生通常会询问母亲抑郁（46%）和父母分居/离婚（42%）情况。多变量分析表明，如果儿科医生不同意ACEs对影响积极育儿技能几乎没有影响，不同意筛查家庭内的社会情感风险因素超出儿科医生的范围，或者对接受关于管理/治疗儿童和青少年心理健康问题的进一步教育非常感兴趣，那么他们通常询问ACEs的几率会高出两倍多。
很少有儿科医生询问所有的ACEs。强调社会/情感风险因素重要性的儿科培训可能会增加在儿科初级保健中对ACEs的识别。
