Multiracial Adolescents More Prone to Major Depression, Receive Treatment Less Frequently

A new study reveals multiracial adolescents have a higher rate of major depressive disorder (MDD)—or at least they did during the COVID-19 lockdown, according to data analyzed from 2021. The new study also found adolescents who were Asian, Black, Latinx, and/or multiracial r received fewer treatment compared to their White adolescent peers.¹

The study, led by Michael Flores, PhD, MPH, of the department of psychiatry at Harvard Medical School, intended to look at racial and ethnic group disparities in mental health treatment in MDD, as well as telehealth and treatment delays.

COVID-19 certainly impacted results, as the pandemic negatively hurt adolescent’s mental health overall.² In 2021, 20% of adolescents had MDD, with many facing “feelings of emptiness, hopelessness, and loneliness” due to the effects social isolation, virtual schooling, and a general lack of interaction with their peers, investigators noted. Flores and colleagues also wrote that adolescents might be grieving if they lost a loved one due to COVID-19, which could worsen mental health problems.¹

While COVID-19 influenced the study’s results, it was not the primary focus. Rather, the investigators wanted to see how mental health treatment varied between races and ethnicities.

“The high rates of MDD may in part be attributed to the emotional turmoil and trauma from the pandemic that affected adolescent overall but members of racial and ethnic minority groups in particular due to the disproportionate share of COVID-19–related morbidity and mortality,” the investigators wrote.

Participants in the study included adolescents aged 12-17 years old (n = 10,743). Nearly half (48.9%) were female. The study had 4.1% Asian, 14.1% Black, 23.3% Latinx, and 51.2% White patients; 6.3% identified as >1 race.

Ultimately, multiracial adolescents reported the highest MDD rate (26.5%). They also reported the lowest rate of treatment for MDD (21.1%; 95% CI, 11.6 – 30.7), along with Latinx adolescents (29.2%; 95% CI, 22.2 – 36.2), versus White adolescents.

Similarly, compared with White adolescents, Black adolescents also reported lower rates of MDD treatment from any clinician (31.7%; 95% CI, 23.7 - 39.8) and by non-specialist clinicians (8.4%; 95% CI, 3.8 - 13.2).

Latinx adolescents had lower rates of specialist outpatient-related treatment (32.7%; 95% CI, 25.1 - 40.2) and virtual treatment (17.8%; 95% CI, 12.6 - 23.0). Asian adolescents also had lower virtual treatment rates (16.0%; 95% CI, 5.0 - 27.2).

For virtual mental health treatment, Asian (16.0%; 95% CI, 5.0 - 27.2) and Latinx adolescents (17.8%; 95% CI, 12.6 - 23.0) had lower rates compared to White adolescents.

Black (19.1%; 95% CI, 14.1 - 24.2) and Latinx adolescents (17.9%; 95% CI, 15.0 - 21.1) also had fewer appointments switch over to telehealth than White adolescents. Black adolescents had delays receiving their prescriptions (14.1%; 95% CI, 10.7 - 17.4).

Overall, the study found that Black adolescents with MDD had fewer prescription rates than White adolescents (12.6; 95% CI, 4.6 - 20.6%).

“While we found that Black and Latinx adolescents were less likely to experience delays or cancellations in mental health appointments, our results also showed that Black and Latinx adolescents were less likely than their White counterparts to have their face-to-face mental health appointment transition to a telehealth visit,” the investigators wrote. “This latter finding may be attributed to health care facilities not having sufficient interpreters for non–English-speaking patients, not having the technology to engage in telehealth, misinformed heuristics of digital literacy among minority group individuals, or concerns regarding reimbursement.”

The investigators touched on “access barriers,” including insurance status and clinician supply, which can influence race and ethnicity treatment. The low-income populations, often in minority groups, rely on public insurance like Medicaid to receive mental health treatment. Yet only 40% of psychiatrists currently accept Medicaid.

“Culturally responsive clinical practices that remove barriers to accessing treatment, implement individualized care based on patient need, and promote flexible services are crucial to the incorporation and inclusion of groups who have been underserved in mental health settings and are less likely to seek help in the first place,” the team wrote. “Public health, community partnerships, and antistigma initiatives could help to bridge this gap through improved patient engagement efforts that promote and normalize help-seeking and service use for those contemplating mental health care.”

References

1. ^{Flores, M, Sharp, A, Carson, N, et al. Estimates of Major Depressive Disorder and Treatment Among Adolescents by Race and Ethnicity. JAMA Pediatrics. doi:10.1001/jamapediatrics.2023.3996}
2. ^{Walter K. Pediatric Depression, Anxiety Rates Doubled During COVID-19. HCPLive. Published August 11, 2021. Accessed October 9, 2023. https://www.hcplive.com/view/pediatric-depression-anxiety-rates-doubled-covid-19}