Mental health is recognized as a central determinant of individual well-being, family relationships, and engagement in society, yet there are considerable variations in mental health and mental health care according to race and ethnicity among youth in the U.S.
In this report, Margarita Alegría and colleagues investigate disparities in mental health and mental health services for minority youth. Taking a developmental perspective, the authors explore four areas that may give rise to inequalities in mental health outcomes, highlight specific protective factors and barriers to care, and, finally, outline an agenda for future research.
The authors write, “Over the past decade, the study of inequality in health and mental health has grown rapidly, with researchers seeking to quantify the extent of the problem, identify causal mechanisms, and develop interventions to eliminate specific disparities. Even so, inequity persists, and in most areas of health care progress has been limited and incremental in nature. There is good reason to believe that a renewed focus on prevention of youth mental health problems among minorities could not only yield more rapid results, but could also drastically reduce overall inequality in the long-term.”
Summary and Key Findings
Evidence consistently suggests that, across the life course, mental disorder prevalence varies significantly according to race and ethnicity, but few studies have investigated the mechanisms that underlie racial and ethnic disparities in mental health.
- Nearly half of the US population develops a mental disorder in their lifetime, and most psychiatric disorders have an onset in childhood or adolescence, increasing the risk for poor outcomes later in life.
- Mental health care is one of the fastest areas of spending growth in child health care, accounting for much of the spending on health care for children (up to age 12) and youth (ages 13–18).
- The individual burdens and systemic costs underscore need for more effective prevention and raise the critical issue of mental health equity for low-income and minority youth.
- Evidence consistently suggests that, across the life course, mental disorder prevalence varies significantly according to race and ethnicity, but few studies have investigated the mechanisms that underlie racial and ethnic disparities in mental health.
Four Possible Sources of Disparities in Mental Health Outcomes
Research has shown that risk factors may accrue incrementally over time to impede recovery from mental disorders, highlighting the importance of research disentangling the associations of race and ethnicity with different stages of development for targeting interventions. The relatively early age of disorder onset amplifies the importance of a developmental perspective in understanding trajectories of mental health and mental health service use. This paper focuses on four mechanisms possibly responsible for disparities in mental health outcomes as minority children and adolescents transition into adulthood:
- Low Socio-Economic Status:
Instead of seeing SES as the sole cause of disparities, recent theoretical models have taken an intersectional approach that views SES as interacting with a number of other social and environmental factors to cause health disparities.
- Childhood Adversities:
Exposure to early toxic stress, including maltreatment, family violence, and parental instability, has immediate and lasting disruptive effects on physiological development, health, and mental health.
- Family Structure:
Few studies have examined the contribution of family structure, role constellations, or changes in those structures across the life course as a contributor to racial and ethnic disparities in mental health outcomes of children and youth.
- Neighborhood-level Factors:
As ethnic minorities disproportionately reside in high-poverty, segregated neighborhoods with high levels of concentrated disadvantage, understanding the contribution of neighborhood context as a mechanism for explaining disparities in mental health outcomes is particularly critical.
Areas for Future Research
The next generation of mental health research on minority adolescents could address the diffuse but interconnected network of factors that combine to cause mental health and service disparities by taking an ecological and multilevel approach to the study of inequalities.
- Key Periods of Developmental Risk and Vulnerability
More research is needed to identify which periods of development play an especially large role in mental health and which factors are more important at specific points in development.
- Socioeconomic Disparities
Mental health researchers could examine the potential of poverty reduction programs both as a means of incentivizing prevention programs for children and for the potential mental health benefits of poverty reduction on its own.
- Addressing Childhood Adversities
Researchers should =clearly identify which groups can benefit from such interventions such as parent training programs, the ideal duration and type of programs to provide, and how such initiatives could be implemented and administered on a large scale.
- Targeting Family-Level Mechanisms For Mental Health Disparities
Given the proven effectiveness of early-childhood programs targeting a broad range of factors, future research in this area should examine how early-childhood interventions can be combined with later interventions to have a greater and longer lasting effect on the success and psychological well-being of minority youth.
- Improving Neighborhood Conditions
Researchers who have documented the link between neighborhood conditions, social capital, and mental health outcomes often suggest targeting neighborhood conditions as a means of reducing disparities, but concrete, evidence-based strategies for neighborhood improvement are lacking.
- Reducing Neighborhood Violence
Researchers should develop methods of reducing violence in minority neighborhoods that do not add to the already large number of incarcerated blacks and Latinos. While somewhat effective at reducing violence in the short term, mass incarceration may actually cause more violence by contributing to neighborhood instability and increasing the number of minority youth with incarcerated parents.
- Expanding Access To Care And Improving Opportunities For Minority Youth In Schools
Schools have often been hostile and challenging environments for minority youth, due both to individual discrimination from other students and teachers, as well as the institutional racism that results in chronic underfunding of schools that serve minority populations. Research should study new ways to construct positive school environments that engage minority students, build their trust in the school system, and avoid the disproportionate impact of harsh disciplinary policies on minority youth and their mental health.
- Studying Provider-Side Mechanisms Of Mental Health Disparities
Some research has shown that minority youth are more likely to drop out of mental health care, but there has been less attention devoted to communication and provider-related factors affecting the mental health treatment of minority youth. This gap in the literature should be addressed to ensure that communication problems do not create yet another barrier to accessing mental health care.