Introduction
According to the World Health Organization, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Mental and behavioral health care is an important element of health for all people. However, differences in health care access, social determinants of health, and other structural inequities can all lead to disparities in mental health for marginalized groups and young people.
About 18% of adults in the United States have a mental health disorder, while according to WHO, globally 14%, or one in seven 10- to 19-year-olds, experience a mental health condition. Undiagnosed and untreated mental health disorders among youth can also make it more difficult to lead fulfilling lives for adolescents as they become adults.
Barriers to care for marginalized youth can include lack of health insurance, stigma around mental illness, lack of minority representation and cultural competency among mental health care staff, language barriers, distrust in the health care system, and lack of mental health support in safety net programs such as Medicaid. Different interpretations of behaviors can also lead to disparities, for instance adolescents of a racial or ethnic minority are more likely to be referred to the juvenile justice system instead of mental health care compared with their white counterparts.
Social Media and Adolescent Mental Health
Technology addiction, cyberbullying, social media comparisons, and harassment online are all emerging issues affecting youth mental health. Due to increases in youth mental health disorders, the U.S. Surgeon General has released an advisory on youth mental health and social media, which states that “we have gaps in our full understanding of the mental health impacts posed by social media but at this point cannot conclude it is sufficiently safe for children and adolescents.” In The Anxious Generation, Jonathon Haidt links an increase in adolescent anxiety and depression beginning in the 2010s to smartphones and social media.
Health Equity and Psychological Diagnostic Assessments
While adolescent mental health has been affected by social media, when it comes to health equity for this population, disparities have been studied for Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Giardina et al. define diagnostic inequity as “the presence of preventable unwarranted variations in diagnostic processes among population groups that are socially, economically, demographically, or geographically disadvantaged.” They note that measuring diagnostic error is already difficult because of lack of adequate epidemiological data and standardized methods, and diagnostic errors rooted in marginalization are even more difficult to quantify. Diagnostic error can be mitigated by engaging clinicians, forming community partnerships, and improving telehealth to reduce accessibility and transportation challenges for patients who need care.
Disparities in Diagnosis of Autism Spectrum Disorder
A diagnosis of autism spectrum disorder has been shown to be delayed for young children from lower-income, ethnic and racial minority, and rural backgrounds. A delay in diagnosis can lead to later access to interventions known to improve developmental outcomes. Outreach, targeted education, and intensive practice-based training can lead to better diagnosis for children with ASD.
Disparities in Diagnosis of ADHD
In a cohort of more than 238,000 children, researchers found that “Asian, Black, and Hispanic children were significantly less likely to be diagnosed with ADHD compared with white children,” while white children were more likely to receive ADHD treatment.
For ADHD, the cause of racial and ethnic disparities in diagnosis is not well understood, however cultural and socioeconomic factors may be behind these disparities, such as parents’ care seeking behavior differing among groups, or explicit or implicit bias from clinicians, which leads to behaviors which may be classified as disordered in some children not being classified correctly in others.
Conclusion
Racial and ethnic differences in diagnosis for conditions like ADHD and Autism Spectrum Disorder can lead to disparities in child and adolescent mental health. Fortunately, resources are available for mental health providers who want to use their practices can address health disparities. Steps highlighted by the American Psychological Association to mitigate these disparities begin with committing to improving equity, reflecting as an organization, engaging with the community, establishing a plan, and flexibly monitoring progress. An emphasis on behavioral health equity for adolescents can ensure flourishing of young people as they grow, regardless of age, race, gender, sexual orientation, or disability.
Interested in learning more?
Check out our podcast episodes on Culturally Responsive Assessments here:
Check out our partner organization, the African American Wellness Project’s work related to eliminating disparities in evaluation and treatment.