The Effects of Social Determinants of Health on Child and Family Mental Health: Implications of the COVID-19 Pandemic and Beyond

The Toxic Stress of Racism and Its Relationship to Frailty

Significant morbidity and mortality from COVID-19-related illnesses have been observed among people of color within the United States. While theories involving healthcare inequity and political division have emerged to explain this observation, the role of chronic stress and inflammation is also being explored. Toxic stress is experienced disproportionately by race, ethnicity, and socioeconomic status and increases frailty and vulnerability to diseases such as COVID-19. C-reactive protein (CRP) is a biomarker associated with the inflammatory response that is typically elevated due to exposure to acute or chronic traumatic stress, as well as COVID-19. This study explored the relationship between CRP and Hispanic/non-Hispanic ethnicity among adults hospitalized with COVID-19 via a secondary analysis of retrospective electronic health record (EHR) data collected from a community healthcare system in Southern California. A total of 1,744 cases representing hospitalized adults with COVID-19 were reviewed. Data were extracted from the EHR to reflect demographics, medical diagnoses, medications, CRP, and comorbidity burden. Frequencies, percentages, and measures of central tendency were assessed to understand the distribution of data. Associations were conducted using Pearson's r and the chi-square test of independence. Differences between groups were examined via independent samples t-tests. The sample was 52% Hispanic, 56% male, and the mean age was 62 years (SD = 16.1). The mean age of Hispanic cases was younger than non-Hispanic cases (p < .001, η = 0.289). Serum CRP was significantly higher in the Hispanic cases, with a high degree of association (p < .001, η = 0.472). In addition, higher CRP levels were significantly associated with the need for mechanical ventilation (p < .001, φc = 0.216). No significant relationships were found between CRP and age, body mass index (BMI), or comorbidity burden. Findings challenge the assumption that the disproportionate morbidity and mortality suffered by the Hispanic population due to COVID-19 was due to age, BMI, or comorbidities such as metabolic syndrome or heart disease. CRP in the Hispanic population should be further investigated to understand its relationship to chronic stress, frailty, and risk for COVID-19 in this population.

Editorial: Cash Transfers to Families Living in Poverty: Can Benefits for Children Extend to the Next Generation?

Childhood poverty is the most widespread and important modifiable risk factor for the development of a range of health outcomes, including childhood-onset mental health problems.1 In the United States, 30 million children are growing up impoverished, which ranks among the highest per capita rates of child poverty among high-income countries.2 As a nation, the United States does less to support its poor children and their families than any other wealthy country, despite scientific evidence that growing up in poverty significantly increases lifetime risk of physical and mental health problems, reduces likelihood of academic and vocational success, and leads to poorer social outcomes for children.1 Meanwhile, 2 decades of research in low- and middle-income countries has demonstrated that directly providing poor families with financial support (commonly referred to as cash transfer programs)-delivered as one-time lump sum or smaller payments over time-produces reliably positive effects on a range of outcomes, including improved parental mental health, food security, housing security, educational and vocational attainment, female empowerment within families, as well as family savings and ownership of durable goods.3-6 Critics of cash transfer programs, who argue that poor families will exhibit temptation spending patterns (ie, alcohol, entertainment, etc), are increasingly being proven wrong by this literature, as studies have shown that recipient families tend to invest in the supports their children need to thrive.7.

Editorial: Can Mobile Crisis Response Help Mitigate Racialized Disparities in Acute Child Mental Health Care?

Mobile crisis response (MCR) is a community-based intervention designed to provide de-escalation and relief to individuals experiencing a behavioral health or substance use-related crisis wherever they are, including at home, at work, at school, or in the community. Often it is the first, or only, option for youth who experience barriers to accessing traditional mental health care in the community. Elevated rates of mental health needs and suicidality among children and adolescents in the United States make availability of quality MCR increasingly important. Studies suggest that an estimated 70% to 80% of children with mental health disorders do not receive care, and minoritized children are even less likely to access community-based behavioral health care services.1 MCR can act as a bridge for securing treatment for children in acute distress. However, until recently, few studies have demonstrated the outcomes of MCR services for children and adolescents or more specifically for minoritized youth.