Related Experiment Video
Updated: May 9, 2026

A Modified Trier Social Stress Test for Vulnerable Mexican American Adolescents
Published on: July 10, 2017
Multiple marginalized identities: Multilevel analysis of COVID-19 impacts on youth mental and behavioral health
Jennifer D Runkle1, Kelsey Herbst1, Sohpia C Ryan2
1North Carolina Institute for Climate Studies, North Carolina State University, Asheville, NC, USA.
Objective:
The COVID-19 pandemic exacerbated youth mental and behavioral health challenges in the United States, disproportionately impacting minoritized groups. Few studies examine how intersecting social determinants jointly shape these outcomes, particularly in underserved regions. This study applied an intersectional framework to assess pandemic-related changes and identify highest-risk strata.
Methods:
We applied a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy model to emergency department data (2010-2022) to estimate pre- and post-pandemic prevalence of depression, anxiety, self-harm, and attention-deficit/hyperactivity disorder among youth (ages 5-26) in western North Carolina (WNC) (n = 934,938) and statewide (n = 11,973,484). Intersectional strata were defined by COVID-19 period, sex, race/ethnicity, insurance type, and age. Predicted prevalence identified highest-risk strata for each outcome and region.
Results:
Lowest-risk strata were consistently pre-COVID, elementary-aged children with self-pay insurance, often male and from minoritized racial/ethnic groups. Highest-risk strata for depression and anxiety were post-COVID, young adult females with insurance across multiple racial/ethnic groups, with prevalence up to 11.9% (depression) and 12.9% (anxiety) in WNC. For self-harm, post-COVID adolescent females with insurance had the highest risk, with slightly higher prevalence in WNC (1.5%) than NC (1.4%). ADHD showed distinct patterns, with highest prevalence among male adolescents with Medicaid (7.1% in WNC, 11.4% statewide).
Conclusions:
Intersectional analysis revealed both shared and region-specific disparities. WNC showed higher top-risk prevalence for depression, anxiety, and self-harm, while statewide strata showed higher ADHD risk. Findings support regionally tailored prevention strategies, including rural workforce expansion, culturally responsive care, and standardized diagnostic practices.
Related Concept Videos
Ethnic Identity within a Larger Culture
Impact of Social Context on Individuals
Stress and Mental Health
Individuals with depression often experience challenges in both their personal and professional...
Bullying
Impact of Groups on Individuals
Influence of Parents and Peers on Identity
Parental Influence on Identity Development
Parents serve as primary guides and managers in an adolescent's life, offering support instrumental in decision-making and personal growth. This guiding role...