Racial and Ethnic Disparities in Mental Health and Mental Health Care During The COVID-19 Pandemic

Abstract

During the pandemic, the overall mental health of the US population declined. Given higher rates of COVID-19 infections and deaths experienced by communities of color along with greater exposure to pandemic-related stressors (e.g., unemployment, food insecurity), we expect that the decline in mental health during the pandemic was more pronounced among Black, Hispanic, and Asian adults, with these groups also having less access to mental health services. We examine two nationally representative US surveys: the 2019 National Household Interview Survey (NHIS; N = 30,368) and the 2020-2021 Household Pulse Survey (HPS; N = 1,677,238). We find mental health of Black, Hispanic, and Asian respondents worsened relative to White respondents during the pandemic, with significant increases in depression and anxiety among racialized minorities compared to Whites. There is also evidence of especially high mental health burden for Black adults around the murder of George Floyd by police and for Asian adults around the murder of six Asian women in Atlanta. White respondents are most likely to receive professional mental health care before and during the pandemic, and Black, Hispanic, and Asian respondents demonstrate higher levels of unmet mental health care needs during the pandemic than White respondents. Our results indicate that within the current environment, White adults are at a large and systemic advantage buffering them from unexpected crises-like the COVID-19 pandemic. Without targeted interventions, the long-term social consequences of the pandemic and other co-occurring events (e.g., death of Black and Hispanic people by police) will likely include widening mental health disparities between racial/ethnic groups.

Keywords: Racism; Race/ethnicity; Mental health; COVID-19 pandemic; Mental health care; Health disparities.

Fig. 1

Predicted probability of depression or anxiety with confidence intervals; National Health Interview Survey, 2019; Household Pulse Survey, April 2020–April 2021; N = 1,707,606. Weighted using sample weights. Post-estimation values were calculated using parameter estimates from logistic regression Model 1a in Supplemental Table A. Adjusted for gender and age with covariates held at their means

Fig. 2

Predicted probability of not receiving mental health care when categorized as having depression or anxiety with confidence intervals; National Health Interview Survey, 2019; Household Pulse Survey, August 2020–April 2021; N = 364,281. Weighted using sample weights. Post-estimation values were calculated using parameter estimates from logistic regression Model 3a in Supplemental Table A. Adjusted for gender and age with covariates held at their means

Fig. 3

Predicted probability of depression or anxiety with confidence intervals; Household Pulse Survey. Weighted using sample weights. Post-estimation values were calculated using parameter estimates from logistic regression Models 1 × and 2 × in Supplemental Tables D and E, adjusting for gender and age and holding covariates at their means