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Most parents and caregivers said they supported mental health screening for their children in primary care settings, according to a multinational survey.

Among over 900 parents and caregivers from the U.S., U.K., and Canada, as well as 16 other countries, 92.1% said they wanted their child screened for mental health issues at regular intervals, reported Michael Peter Milham, MD, PhD, of the Center for the Developing Brain at the Child Mind Institute in New York City, and colleagues.

Annual screening was preferred by 64.9% of respondents, while 23.3% preferred quarterly screening, they noted in .

"The growing prevalence and burden of mental health disorders in pediatric populations have made clear the need for improved detection of mental disorders," Milham and colleagues wrote. "In particular, early identification of youth mental disorders via universal screening is an increasingly actionable solution with the potential to minimize the severity and progression of illness, mediate long-term impairment, and increase access to care, especially for common problems such as depression and anxiety."

"To date, much of the work around preferences for and acceptability of screening has focused on medical staff," they added. "In this study, we focused on the attitudes of parents and caregivers, which require careful attention to optimize implementation of screening."

Across the entire sample, parents and caregivers were most willing to speak with physicians regarding screening results (89.7%), followed by psychologists (76.4%). Only 4.8% were willing to discuss screening results with general office staff.

A mixed-effects regression model found that parents and caregivers reported decreased comfort with child self-report screening assessments compared with parent-report assessments (b = -0.278, SE [standard error] 0.009, P<0.001). However, for every 1-year increase in their child's age, respondent comfort levels increased (b=0.035, SE 0.008, P<0.001).

Additionally, though parental comfort levels with 21 screening topics differed by country of residence, screening topic, and report option (parent- vs child self-report), respondents were generally comfortable discussing all topics (mean parental comfort level on a 6-point Likert scale ranged from 4.62 to 5.30.)

Topics on which respondents were most comfortable reporting included child sleep problems (mean score 5.30), COVID-19 concerns (5.23), digital media use (5.22), social media use (5.21), and learning concerns (5.20). Parents and caregivers were least comfortable reporting on their child's experience with substance use or abuse (4.78), firearms (4.71), gender identity (4.68), and suicidal ideation (4.62).

"Over 90% of participants agreed (≥4 on 6-point Likert scale) that 'early detection of problems,' 'early intervention,' and 'to learn more about my child' were benefits from mental health screening," Milham and colleagues wrote. "Other reported benefits included better 'access [to] mental health resources,' 'awareness of signs to watch for,' ability 'to accommodate/support my child,' 'management of symptoms,' and 'prevention of problems.'"

, Donald Greydanus, MD, of Western Michigan University in Kalamazoo, pointed out that the survey results showed "that parents around the world are concerned with the mental health of their children and are willing to answer questions regarding these issues."

"Clinicians have a wide variety of options in this regard, as assorted tools (i.e., parent reports, child reports) are being developed to screen parents and children in primary care offices, in the home, and in schools," he noted. "The key is to ask parents about their children and children about themselves using validated screening tools and to find children with various mental health concerns or disorders as early as possible to provide mental health management that may involve integrated mental health screening and management in primary care offices."

For this study, Milham and colleagues used an online survey available from July 11-14, 2021 through Prolific Academic. They included 972 English-speaking parents and caregivers who were at least 21 years old and had at least one child ages 5 to 21 living at home (mean age 11.1).

Mean parent and caregiver age was 39.4 years, 62.3% were women, and 78.8% were white. As for country of residence, 27.2% were from the U.S., 29.0% were from the U.K., 17.6% were from Canada, and 26.1% were from other countries.

Limitations of the study included that respondents were required to be fluent in English and have a knowledge of and access to Prolific Academic, an online resource, Milham and colleagues noted.

There is a need for further study given the lack of racial and ethnic diversity in the study sample, they added. Furthermore, the pandemic's simultaneous occurrence may have influenced participation rates and responses.

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