Interventions needed to overcome racial, ethnic disparities in depression care among youth

Key takeaways:

• Self-stigma levels were associated with depression severity.
• Parental education and community- and family-based interventions were most effective in addressing ethnic and racial depression care disparities.

NEW YORK — Children and adolescents experience substantial racial and ethnic disparities in depression care that require interventions to address, according to a poster presented at the American Psychiatric Association Annual Meeting.

Vanessa C. D’Souza, MD, a child and adolescent psychiatrist in the department of psychiatry and psychology at Mayo Clinic in Rochester, Minnesota, and colleagues aimed to review current racial and ethnic disparities in depression care for children and adolescents and identify strategies to eliminate these disparities.

Depressive disorders, present in about 3% of youth, can lead to increased risk for school failure, social isolation, substance abuse and suicide, according to the researchers. Children and adolescents who belong to historically underrepresented groups are particularly vulnerable.

D’Souza and colleagues performed a systematic search of studies using APA PsycInfo, Cochrane databases and Ovid MEDLINE to identify studies from 1990 to June 2023 that involved depression care among children and adolescents, postpartum, late life and patients with medical comorbidities. However, the current analysis focused specifically on presenting the results concerning children and adolescents.

The researchers screened 1,211 abstracts, only a few of which met the inclusion criteria by focusing on ethnic/racial disparities, depression treatment, cultural interventions and access to care.

Researchers identified several barriers to depression care among children and adolescents from racial and ethnic underrepresented groups, including that they appeared more susceptible to self-stigma than adults.

“The perceived stigma — [how] others would perceive their mental health — has a big impact on the severity of [the] depression,” D’Souza told Healio. “The [more] they have a sense of perceived stigma, the [more severe] the depression.”

Additionally, the researchers reported that a history of moral and ethical misconduct within the medical system contributed to mistrust in this population.

Also, white youths appeared more likely to receive mental health services than youths from underrepresented groups, who are often observed to have a smaller number of medical claims. However, the researchers acknowledged that nontraditional care settings used by these groups can be overlooked.

Some of the studies reviewed by the researchers also discussed different interventions and care models that aimed to address these disparities.

Cultural modifications made to brief behavioral therapy interventions had superior benefits compared with care as usual, the researchers found. Another effective intervention involved patients discussing their language proficiency, beliefs about mental health, reasons for seeking treatment and expectations regarding the doctor-patient relationship with their caregiver.

The studies reviewed also suggested that promoting awareness of sociocultural factors in the presentation of depression, such as the higher levels of sadness among Hispanic youth and the prevalence of low mood with irritability among Black adolescents, is an effective intervention method.

“We found that some of the interventions, even though they’re small scale, have had a lot of impact. It’s mainly the cultural modifications — incorporating their language, their values and different approaches. Even changing the setting [from] your day-to-day office settings and having more community-based programs can be helpful,” D’Souza said.