After 9/11: Anxiety Plagues Children, Parents Aren't Connecting

Children and teens in the United States who were surveyed after the Sept. 11 attacks were significantly more worried about how to cope with stress than those surveyed before, while parents surveyed after 9/11 actually worried less about their children coping, according to surprising results of a national survey.

The 24-state survey, conducted in summer and fall 2001 by the National Association of Pediatric Nurse Practitioners (NAPNAP) and the University of Rochester School of Nursing, also found a major gap between the perception of children and their parents as to how much the two groups talk to each other about children's anxiety, depression and stress, and a serious deficiency in discussion between children and their primary health care providers about their mental health problems. The findings will appear in the Sept. 18 issue of the Journal of Pediatric Health Care and on Sept. 11 on the journal's Web site, http://www.mosby.com/pedhc.

The gap between increased worries in children after Sept. 11 and parents' concerns about their children's worries was significant. Before 9/11, 21 percent of children and teens worried often, nearly always or always about coping with stressful things; after 9/11, 32 percent did. But among parents before 9/11, 39 percent worried often, nearly always or always about their children's ability to cope with stress, while after 9/11 only 26 percent did. One factor, hypothesizes Bernadette Melnyk, Ph.D., R.N. and primary investigator of the study, is that parents might have been more focused on how they could help the families directly affected by the tragedy -- a common coping strategy.

Regardless of the reason, it points to a widening gap in parent-child communication and perception. Approximately 80 percent of parents said they talk to their children at least sometimes about anxiety, while only about 37 percent of their children said the same about talking with their parents. And 72 percent of parents said they talk at least sometimes with their children about depression, while only 36 percent of their children said the same.

"Parents think they're talking to their kids, but their kids don't think so or they're not hearing it," says Melnyk. "Many of the children and teens said they needed more information about mental health problems. It's an area where health care providers need to focus more of their attention."

The study bears this out. A large percentage of children and teens reported having mental health and psychosocial worries (25 percent worried often, nearly always or always about how to cope with stressful things, and 36 percent worried sometimes; 49 percent worried sometimes, often, nearly always or always about depression). Yet very few talked to their nurse practitioner or doctor about those worries. Eighty percent said they never talked about depression to their nurse practitioner or doctor.

Since depression and similar problems can be factors in risky behavior such as substance abuse and unsafe sex, Melnyk sees this lack of communication as a lost chance to help children.

"Pediatric health care providers should see office visits as windows of opportunity to draw out their patients' concerns and worries," Melnyk says. "The key is providing the right environment to get children, teens and parents to talk more about these mental health issues."

One promising solution comes from the survey itself. Simply from answering the survey questions about their worries and concerns,

* 48.5 percent of children and 50 percent of their parents reported better awareness of emotions and behaviors affecting children and teens

* 41 percent of the children and 52 percent of parents said that answering the survey will lead them to get more information about emotional and behavioral problems affecting children and teens

* 44 percent of the children and 63.5 percent of parents said that answering the survey will help them talk to their child/parent about these issues

* And 32.5 percent of children and 56 percent of parents said that answering the survey will help them talk to their nurse practitioner or doctor about these issues.

"Having this survey or similar ones for children, teens and their parents to complete while waiting to see their primary care providers could serve as a good way to screen for these problems," says Melnyk. "That could lead to earlier intervention with children and teens affected by mental health problems."

A total of 1224 children, teens and their parents completed the survey, part of the Keep your Children/yourself Safe and Secure (KYSS) campaign launched by Melnyk in July 2001 with the backing of NAPNAP. With recent funding from the U.S. Department of Health and Human Services/Maternal-Child Health Bureau, the KySS campaign will convene a summit of experts in April to plan ways to help primary care providers intervene earlier with children who have mental health/psychosocial problems.

The University of Rochester School of Nursing is addressing these same issues with its new dual Pediatric Nurse Practitioner and Psychiatric Mental Health Nurse Practitioner Master's program -- one of the first of its kind in the country. The nurse practitioner role has been shown to be crucial in initial detection of mental health problems and eventual treatment.

"In this program, we want to provide a new, holistic model of primary care for children geared not just to their biological needs but also their psychological and social health care needs," says Melnyk.