This proposal for a Mentored Clinical Scientist Career Development Award will prepare the candidate to independently design and conduct intervention studies for pediatric internalizing disorders in the primary care setting. Anxiety Disorders are the most common pediatric internalizing disorders. They are prevalent, impairing, often persistent, may be associated with increased health service use and are eminently treatable. Yet they are amongst the mental health disorders least likely to be recognized in primary care and, when recognized, are typically not optimally treated. Existing studies of community prevalence rates of Anxiety Disorders have not been linked to prognosis, functional impairment and treatment needs, with resultant difficulties in setting intervention thresholds for primary care. Over three and a half years, the proposed research study will recruit and follow for six months 200 school age children with anxiety disorder, identified by screening in a primary care practice. A detailed baseline evaluation will be obtained in order to study predictors of persistent anxiety disorder and of health service use and health care costs. A control group will also be recruited and followed in order to estimate group differences in health care costs between anxious children and non-anxious children: The study is the first to focus specifically on childhood Anxiety Disorders in primary care, the first to study predictors of the six month course of childhood Anxiety Disorders and the first to explore associated health service use and costs. The data generated will yield clinical profiles of children in primary care whose anxiety is likely to be persistent or costly. This is a necessary step towards the long-term goal of designing intervention protocols to improve outcomes for anxious children in primary care and of evaluating cost-effectiveness and cost offsets. The candidate is a board certified Child and Adolescent psychiatrist with ten years of post-residency experience, currently Medical Director for Clinical Program Development in Primary Care in the Division of Child and Adolescent Psychiatry at the University of Pittsburgh. Dr. David Brent will serve as preceptor. The consultant panel includes experienced investigators both in the phenomenology and treatment of pediatric Mood and Anxiety Disorders, and in mental health intervention in adult primary care. Course work and guided readings in epidemiology; biostatistics; research design, methods, and ethics; health services research concepts and procedures; health economics and policy; and relevant applications of information technology will complement the research plan.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Clinical Investigator Award (CIA) (K08)
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Special Emphasis Panel (ZMH1-SRV-C (01))
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Ringeisen, Heather
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Stanford University
Schools of Medicine
United States
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Wren, Frances J; Berg, Eric A; Heiden, Lynda A et al. (2007) Childhood anxiety in a diverse primary care population: parent-child reports, ethnicity and SCARED factor structure. J Am Acad Child Adolesc Psychiatry 46:332-40
Wren, Frances J; Scholle, Sarah H; Heo, Jungeun et al. (2005) How do primary care clinicians manage childhood mood and anxiety syndromes? Int J Psychiatry Med 35:1-12
Wren, Frances J; Bridge, Jeffrey A; Birmaher, Boris (2004) Screening for childhood anxiety symptoms in primary care: integrating child and parent reports. J Am Acad Child Adolesc Psychiatry 43:1364-71
Wren, Frances J; Scholle, Sarah H; Heo, Jungeun et al. (2003) Pediatric mood and anxiety syndromes in primary care: who gets identified?. Int J Psychiatry Med 33:1-16