Many studies link life stress and medical or psychiatric illness, yet most pediatricians do not systematically screen for life stressors in families of children in their practice. Trainess ask, “Why screen?” when they can offer no relief. This study was part of the validation of the CRISYS, a 50-item instrument designed to identify contemporary urban stressors. Adult care givers were interviewed while waiting in the resident continuity clinic of an inner city academic medical center prior to a scheduled (non-illness) medical visit. Caregiver depression was scored (CES-D > 15). Care givers received a resource directory of agencies addressing each item on the CRISYS, regardless of any expressed need. Care givers were called about 2 weeks later to ask if the directory had been useful.

311 care givers, mostly young single mothers, were interviewed. The mean number of life events over a 6 mo reporting period was 8.2 (S.D. 4.6, range 0-24), with the greatest number hearing violence (70%), seeing drug dealing(53%), feeling unsafe (56%). 34% scored above the CES-D cut-off for depression. The correlation coefficient for life events and CES-D was 0.49 (p< 0.01), with a substantial increase in the risk of depression for care givers with 4 or more events (Chi-square 1 = 13.88, p < 0.01). 59% of respondents (n = 183) were reached by telephone, 80% of those reached had reviewed the directory, 64% had some interest in pursuing services and 17% (n= 30) had attempted contact. 73% of these (n = 22) had been successful, and 65% (n = 15) had received assistance. The greatest barrier to service was failure to meet eligibility criteria (22%). Depressed care givers were just as likely to pursue services as non-depressed respondents (p>0.05).

Identification of life stressors is important because they may 1) affect a family's ability to follow a treatment plan; and 2) be the cause of additional morbidity. Families served by the resident continuity clinic showed high levels of life stress and depression, but the care givers were self-motivated to pursue services, even if provided only with a resource directory.