Disparities in Pediatric Mental and Behavioral Health Conditions

Abstract

Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.

Figure 1.. Sociocultural framework for understanding and addressing racial and ethnic disparities in children’s mental health (Alegría et al., 2022)

This figure is reprinted from Child and Adolescent Psychiatric Clinics of North America, 31 (2), Alegría M, O’Malley I, DiMarzio K, Zhen-Duan J. A framework for understanding and addressing racial and ethnic disparities in children’s mental health, 179–191, Copyright (2022), with permission from Elsevier. a. Jones CP. Toward the science and practice of anti-racism: Launching a national campaign against racism. Ethn Dis. 2018;28(Suppl 1):231–234.