The compounded effect of the dual pandemic on ethnic-racial minority adolescents' mental health and psychosocial well-being

Exploring mechanisms behind the increasing gender gap in adolescent psychological symptoms, 2002-2022: the role of national-level gender equality

BACKGROUND

Internalising problems have increased considerably among adolescents in the last decades, particularly among girls, resulting in widening gender gaps. This study examined whether the gender gap in psychological symptoms increased more in more gender-equal countries in the period 2002-2022, and if so, to what extent this could be explained by changes over time in the experience of stressors (i.e. schoolwork pressure, body dissatisfaction, low classmate support) among boys and girls in these countries.

METHODS

National data on gender inequality (UNDP Gender Inequality Index) were combined with aggregated individual-level data from the Health Behaviour in School-aged Children (HBSC) study (2002-2022) across 43 countries (N = 1,268,220). Absolute and relative gender gaps in psychological symptoms were regressed on survey cycle, GII and their interaction. Next, interactions of survey cycle and either schoolwork pressure, body dissatisfaction or classmate support were added to the model.

RESULTS

Increases in the absolute and relative gender gap in psychological symptoms between 2002 and 2022 were stronger in more gender-equal countries, mainly due to larger increases in psychological symptoms among girls in these countries. Also, less favourable time trends for schoolwork pressure and classmate support were found in more gender-equal countries for boys and especially girls. The larger increase in schoolwork pressure among girls in more gender-equal countries partly explained the increased absolute gender gap in psychological symptoms in these countries.

CONCLUSIONS

While national-level gender equality was positively associated with boys' and girls' mental health in the early 2000s, this association has become negative for girls in more recent years. The benefits of gender equality for girls' mental health may have become overshadowed by the increased experience of stressors, especially schoolwork pressure. Far from advocating that gender equality is a negative situation, these findings suggest that much work remains to achieve full gender equality, where men and women really share the burdens and stressors in everyday life.

The Moderating Effect of Coping on Stress and Childhood Obesity-Related Health Behaviors among Non-Hispanic Black Caregivers

Child health behaviors and weight status may be affected by caregivers' perception and experience of stress. However, little is known about the influence of caregiver coping strategies on childhood overweight and obesity, particularly among non-Hispanic Black caregivers. This study examined associations among specific caregiver stress types (i.e., general, parenting, race-related), child weight status, and health-related behaviors (i.e., intake of fruits and vegetables, consumption of fast food, engagement in physical activity) as well as the moderating effect of caregiver coping strategies. In addition to general coping, the study examined the role of religious coping. This cross-sectional study included 157 non-Hispanic Black caregiver and child (aged 3-7 years) dyads; all caregivers identified as Christian Protestant. Logistic regression models were fit to explore the associations among caregiver stress and child outcomes and to investigate moderation effects of caregiver coping. Models were adjusted for sociodemographic covariates. Association between parenting stress and child weight status was significantly moderated by acceptance coping while the relationship between general stress and child sugary drink intake was moderated by emotional coping. The combination of three stress types was significantly associated with increased child fast food intake. Future research should examine specific coping strategies to address varying levels and types of stress experienced by caregivers from minoritized backgrounds.

Social Determinants, Mental Well-Being, and Disrupted Life Transitions Among Young Adults with Disabling Mental Health Conditions

This study sought to understand how young adults (age 18-25) with histories of mental health disorders are coping with disrupted transitions to adulthood during the COVID-19 pandemic. A cross-sectional web survey was conducted in March-June 2021 of 967 US young adults with pre-pandemic psychiatric disability to assess their current psychiatric status, interrupted transitions, and associations with social determinants including income, community participation, and social context. Mental health was assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and PTSD Checklist-Civilian Version. Social determinants were identified with the Epidemic-Pandemic Impacts Inventory. Interrupted transitions were measured with the Young Adult Disrupted Transitions Assessment. Multivariable logistic regression models predicted four types of transition disruptions and associations with current mental health, social determinants, and demographic factors. Disruptions were reported by 81.1% including interrupted education completion (38.3%), employment careers (37.6%), residential independence (27.7%), and intimate partner relationships (22.9%). Many screened positive for major depressive disorder (81.7%), PTSD (85.5%), or GAD (58.6%). Disruption in establishing intimate partner relationships was associated with depression, anxiety, and PTSD. Interrupted residential independence was associated with anxiety. Interrupted education completion was associated with PTSD. Interrupted employment was associated with anxiety. Social determinants significant in these models included social connections, community participation, income, and racial/ethnic identification. Results illuminate ways that current mental health and social determinants affect transition interruptions during the pandemic. Findings suggest the need for interdisciplinary approaches, integrated models of care, and assistance accessing treatment, rehabilitation, and community support services from adult service systems.

Child Well-Being and Family Quality of Life During the COVID-19 Pandemic

BACKGROUND

Little is known about changes in child well-being and family quality of life (QoL) among children seeking emergency department care because of mental health concerns over the course of the pandemic.

METHODS

Prospective cohort study of children < 18 who visited two paediatric EDs in Alberta, Canada, for an acute mental health concern. Early and late pandemic time periods were defined as 15 March 2020-14 March 2021 and 1 July 2021-30 June 2022, respectively. The Stirling Children's Well-being and Warwick-Edinburgh Mental Well-being scales quantified well-being; the Family Quality of Life Scale assessed family QoL. These scales were completed as soon as possible following the ED visit. Linear regression models assessed the association between pandemic period and the change in well-being and family QoL.

RESULTS

One thousand four hundred four children were enrolled during the study time periods (50.4% early, 49.6% late). Seventy-two percent (1009/1404) of participants were White, 53.8% (744/1404) were female, and the median age was 13 (IQR, 11-15) years. Well-being remained unchanged between time periods, whereas family QoL was lower in the late pandemic time period than in the early period (mean difference: -2.16, 95% CI: -3.79, -0.53; p = 0.01). Among children < 13 years, previous mental health care and requiring inpatient admission were negatively associated with well-being. Having an autism diagnosis and a comprehensive ED mental health evaluation were negatively associated with well-being in older children.

CONCLUSIONS

Reduced family QoL may signal stressors experienced by caregivers and the lingering consequences of the pandemic. Resources that address well-being and support the family unit are needed to improve the mental health of children.

Parenting in African American families: Profiles of general and culturally specific dimensions of parent-adolescent relationships during late adolescence

Developmental and parenting frameworks suggest that factors at the individual-level and multiple levels of adolescents' contexts are important determinants of how African American parents prepare their children to live in a racially stratified society. Using a person-centered approach, this study explored heterogeneity in profiles of African American parent-adolescent relationships (PARs) using indicators of parent-reported ethnic-racial socialization (cultural socialization, preparation for bias), general parenting practices (autonomy support, monitoring, behavioral control), and relationship quality (warmth, communication, conflict). We also examined how adolescents' characteristics, parents' personal and psychological resources, and contextual sources of stress and support contributed to profile membership. Data were from the Maryland Adolescent Development in Context Study (1991-2000) and consisted of 589 African American caregiver-adolescent dyads (caregivers: 89% female; 57.2% married; adolescents: 50.7% female; Mage = 17, SD = 0.64, range = 15-19 years old). Latent profile analysis revealed four profiles: (a) No-Nonsense High Socializers, (b) Indulgent Average Socializers, (c) Unengaged Silent Socializers, and (d) Authoritative Cultural Socializers. Adolescent characteristics (gender, depression, and problem behavior), parents' personal and psychological resources (parenting self-efficacy, centrality, private regard, and depression), and contextual sources of stress and support (stress: economic hardship, family stress, neighborhood disadvantage and support: marital status, family cohesion, family organization) were correlated with profile membership. Findings suggest that variability in African American PARs is shaped by an extensive set of individual and contextual factors related to adolescents and the family and neighborhood context. These findings have important implications for future research and how to target multiple potential levers for change in African American parenting practice.

Short-term changes in mental health help-seeking behaviors following exposure to multiple social stressors and a natural disaster

In 2020, unprecedented circumstances led to significant mental health consequences. Individuals faced mental health stressors that extended beyond the devastating impact of the COVID-19 pandemic, including widespread social unrest following the murder of George Floyd, an intense hurricane season in the Atlantic, and the politically divisive 2020 election. The objective of this analysis was to consider changes in help-seeking behavior following exposure to multiple social stressors and a natural disaster. Data from Crisis Text Line (CTL), a national text-based mental health crisis counseling service, was used to determine how help-seeking behavior changed in the wake of each event. Wilcoxon rank sum tests assessed changes in help-seeking behavior for each event in 2020 as compared to the same period in 2019. AutoRegressive Integrated Moving Average (ARIMA) models examined if changes in crisis conversation volumes following each event differed. Higher median conversation volumes noted for the COVID-19 pandemic (+1 to +5 conversations), Hurricane Laura (+1 to +7 conversations) and the 2020 Election (+1 to +26 conversations). ARIMA models show substantial increases in help-seeking behavior following the declaration of a national emergency for the COVID-19 pandemic (+4.3 to +38.2%) and following the 2020 election (+3 to +24.44%). Our analysis found that the mental health response following social stressors may be distinct from natural events, especially when natural disasters occur in the context of multiple social stressors. This analysis adds to the growing body of literature considering the mental health impact of exposure to multiple co-occurring societal stressors, like police violence and a global pandemic.

Emerging Risk of Adolescent Depression and Suicide Detected Through Pediatric Primary Care Screening

OBJECTIVE

The goal of the current study was to document patterns of stability and change in adolescent depression and suicide risk detected via universal depression screening in pediatric primary care and to determine who may go on to experience emerging risk.

METHODS

Retrospective electronic health record information (sociodemographic data and depression screening results for 2 timepoints) was extracted for adolescents aged 12-17 who attended well-visits between November 15, 2017, and February 1, 2020, in a large pediatric primary care network. A total of 27,335 adolescents with 2 completed depression screeners were included in the current study.

RESULTS

While most adolescents remained at low risk for depression and suicide across the 2 timepoints, others experienced emerging risk (i.e., low risk at time 1 but elevated risk at time 2), decreasing risk (i.e., high risk at time 1 but low risk at time 2) or stable high risk for depression or suicide. Odds of experiencing emerging depression and suicide risk were higher among adolescents who were female (compared to males), Black (compared to White), and had Medicaid insurance (compared to private insurance). Odds of experiencing emerging depression risk were also higher among older adolescents (compared to younger adolescents) as well as adolescents who identified as Hispanic/Latino (compared to non-Hispanic/Latino).

CONCLUSIONS

Findings can inform symptom monitoring and opportunities for prevention in primary care.

Race-based biases in psychological distress and treatment judgments

Racism creates and sustains mental health disparities between Black and White Americans and the COVID-19 pandemic and ongoing harassment directed at Black Americans has exacerbated these inequities. Yet, as the mental health needs of Black Americans rise, there is reason to believe the public paradoxically believes that psychopathology hurts Black individuals less than White individuals and these biased distress judgments affect beliefs about treatment needs. Four studies (two pre-registered) with participants from the American public and the field of mental health support this hypothesis. When presented with identical mental illnesses (e.g., depression, anxiety, schizophrenia), both laypeople and clinicians believed that psychopathology would be less distressing to Black relative to White individuals. These distress biases mediate downstream treatment judgments. Across numerous contexts, racially-biased judgments of psychological distress may negatively affect mental healthcare and social support for Black Americans.