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Mental health problems of black and white children in a nationally representative epidemiologic survey
Tanner Bommersbach1, Taeho Greg Rhee2, Oluwole Jegede3
1Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55901, USA.
Insights
Black children experience fewer internalizing mental health conditions like anxiety than White children, but may face more conduct problems. Adverse childhood experiences (ACEs) explain these conduct problem disparities.
Area of Science:
- Pediatric mental health
- Health disparities
- Child psychology
Background:
- Socioeconomic disadvantages disproportionately affect Black children compared to White children.
- Existing research on racial differences in child mental health problems is limited.
- Understanding these disparities is crucial for equitable healthcare.
Purpose of the Study:
- To examine racial differences in mental health conditions between Black and White children.
- To investigate whether socioeconomic factors and adverse childhood experiences (ACEs) explain these differences.
- To explore implications for clinical assessment and mental health service delivery.
Main Methods:
- Utilized nationally-representative data from the 2018-2019 National Survey of Children's Health.
- Analyzed mental health conditions in non-Hispanic Black (n=2,890) and White (n=30,015) children aged 6-17.
- Employed multivariate analyses to adjust for potential confounding factors like ACEs, insurance status, and poverty.
Main Results:
- Black children were less likely to have clinically-identified internalizing conditions (e.g., anxiety) but more likely to be identified with conduct problems compared to White children.
- Black children reported higher exposure to ACEs, were more likely to be uninsured, and experienced poverty more frequently.
- After adjusting for confounders, the disparity in internalizing conditions persisted, while the difference in conduct problems was fully explained by ACEs.
Conclusions:
- Racial disparities in clinically-identified internalizing conditions suggest potential assessment bias.
- Adverse Childhood Experiences (ACEs) significantly contribute to conduct problems in Black children.
- Routine screening for depression and anxiety in minority children is recommended, particularly given rising youth suicide rates.
Abstract:
Black children face more numerous socio-economic disadvantages than White children, but whether they have more adverse mental health problems remains understudied. Using nationally-representative data from the 2018-2019 National Survey of Children's Health, we examined differences in mental health problems between non-Hispanic Black (n = 2,890) and White (n = 30,015) children aged 6-17. Multivariate analyses were used to determine whether differences in mental health conditions could be accounted for by other factors. We found Black children were significantly less likely than White children to have clinically-identified internalizing conditions (especially anxiety) and more likely to be identified with conduct problems. Black children were also substantially more likely to have greater exposure to adverse childhood experiences (ACEs), to be uninsured, experience poverty, and less likely to receive needed mental health services. After adjusting for these potential confounders, Black children remained half as likely to have clinically-recognized internalizing conditions, but were no longer more likely to have clinically-identified conduct problems. Differences in ACEs alone fully accounted for the racial difference in conduct problems. These results point to the potential impact of assessment bias by clinicians and underscore the potential benefit of routine screening for depression/anxiety in racial/ethnic minority children, especially in light of rising suicide rates among Black youth.
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