State-level analysis of mental health disparities between White, Black, and Hispanic populations before and after COVID-19

The COVID-19 pandemic had disparate impacts on Black and Hispanic Americans, as observed in mortality and infection rates. The mental health impact of the pandemic is less clear, with little research exploring mental health disparities and differences by state and region. Using the Behavioral Risk Factor Surveillance System (BRFSS), state-level differences in unhealthy mental health days were examined between 2019 and 2021 for White, Black, and Hispanic respondents. Nonparametric tests assessed group differences in unhealthy mental health days, while state-level within- and between-group difference scores highlighted areas with the greatest disparities. Both White and Black respondents experienced significantly more unhealthy mental health days in 2021 than in 2019; though Hispanic respondents reported more unhealthy days in 2021 than in 2019, this finding was not statistically significant. Black respondents, but not Hispanic, reported significantly more unhealthy mental health days than White respondents in 2021. Missouri had the worst outcomes for Black respondents, with the greatest increase in unhealthy mental health days between 2019 and 2021 and the greatest difference between White and Black groups in 2021. Regionally, the Northeast had the best outcomes for Black respondents and the Midwest had the worst. These findings can help identify population groups and geographic areas most in need of disaster-preparedness efforts and policy interventions for future public health emergencies. Practitioners and state health officials can use these findings to identify potentially impactful community interventions, or to develop infrastructure for addressing community mental health.