Research Article CHILD ANXIETY IN PRIMARY CARE: PREVALENT BUT UNTREATED Denise A. Chavira, Ph.D., 1 * Murray B. Stein, M.D., M.P.H., 1 Kelly Bailey, M.A., 2 and Martin T. Stein, M.D. 3 We present prevalence and treatment utilization rates for child anxiety disorders in a university-affiliated primary care clinic. Families were recruited from a pediatric patient list and 714 families participated in an initial study wherein they completed child anxiety questionnaires. According to parent and child self- report questionnaires (n ¼ 714), 22% and 20% of children, respectively, were above a suggested clinical cutoff on a brief anxiety screen; 19% and 14% of children exceeded clinical cutoffs on a separate social anxiety questionnaire. All families were invited to participate in a second study that included the Anxiety Disorders Interview Schedule for Children-Parent Version and questions about treatment utilization; telephone interviews with 190 parents showed 1-year prevalence rates of DSM-IV child disorders to be 10.0% (se ¼ 2.2%) for specific phobia, 6.8% (se ¼ 1.8%) for social phobia, 3.2% (se ¼ 1.3%) for generalized anxiety disorder, 0.5% (se ¼ .7%) for selective mutism, 1.6% (se ¼ .9%) for major depressive disorder, 1.1% (se ¼ .7%) for dysthymia, and 12.6% (se ¼ 2.4%) for attention deficit–hyperactivity disorder (ADHD). Among children with a current anxiety disorder, 31% had received counseling or medication treatment during their lifetime, compared to 40% of children with depression and 79% with ADHD. Adolescent age and being Caucasian were predictors of psychotherapy use; having an ADHD diagnosis was a predictor of both psychotherapy and medication use. The high prevalence of impairing anxiety disorders, in concert with the very low extent of treatment utilization, suggests a need for methods to identify and disseminate empirically validated treatments for these disorders in the primary care setting. Depression and Anxiety 20:155–164, 2004. & 2005 Wiley-Liss, Inc. Key words: prevalence; primary care; child; anxiety; treatment utilization INTRODUCTION Previous prevalence studies conducted in primary care demonstrate that child DSM-III and DSM-III-R psychiatric disorders are common in this setting. Rates of any psychiatric disorder range from 9–22% [Cost- ello, 1989; Lavigne et al., 1996] and extend to 42% when children with subthreshold diagnoses are in- cluded [Costello and Shugart, 1992]. Although much of the child primary care literature has focused on detecting and treating behavioral problems such as ADHD, epidemiologic findings show that anxiety disorders are also remarkably common in this setting. In the hallmark study by Costello [1989], weighted 1-year prevalence rates of anxiety disorders among DEPRESSION AND ANXIETY 20:155–164 (2004) 1 Department of Psychiatry, University of California San Diego, La Jolla, California 2 Department of Psychology, San Diego State University, San Diego, California 3 Department of Pediatrics, University of California San Diego, La Jolla, California Contract grant sponsor: National Institute of Mental Health; Grant number: K24 MH64122-01. *Correspondence to: Dr. Denise A. Chavira, University of California San Diego, Department of Psychiatry, 8950 Villa La Jolla Drive, Suite C-207, La Jolla, CA 92037. E-mail: dchavira@ucsd.edu Received for publication 28 December 2003; Revised 25 August 2004; Accepted 21 September 2004 DOI 10.1002/da.20039 Published online in Wiley InterScience (www.interscience.wiley. com). & & 2005 WILEY-LISS, INC.