Study Finds Racial Disparities in Treatment Rates for Teen Depression

Treatment rates for major depressive disorder (MDD) varied among U.S. adolescents during the COVID pandemic, depending on race/ethnicity, according to a cross-sectional study.

Compared with white kids ages 12 to 17, the lowest rates of any MDD treatment were observed among Latinx adolescents (difference -15.9 percentage points, P<0.001) and those self-reporting more than one race or ethnicity (difference -24.0 percentage points, P<0.001), reported Michael William Flores, PhD, MPH, of Cambridge Health Alliance in Massachusetts, and colleagues.

These groups also had significantly lower rates of MDD treatment from any clinician, a mental health specialist, a non-specialist clinician, and use of any psychotropic medication prescription, they noted in JAMA Pediatrics.

“Adolescents are an especially vulnerable population given the disruptions to normal social and emotional growth that they experienced during the pandemic,” Flores and team wrote. “This, combined with significant shortages in clinicians for youth mental health treatment, may lead to high levels of unmet treatment need.”

“Of further concern are racial and ethnic minority groups, who have historically experienced lower rates of mental health treatment access and are at higher risk of experiencing adverse mental health effects due to their disproportionate share of COVID-19-related morbidity and mortality,” they continued.

“Examining disparities between racial and ethnic minority groups and the referent majority white group allows us to generate evidence demonstrating the unjust distributions of health care services, recognizing that inequities are driven by racism and long-standing structural disparities in social determinants of health,” they added.

When looking at receipt of any mental health treatment, Black adolescents had lower rates of mental health appointments being moved to telehealth versus white adolescents (difference -8.5 percentage points, P<0.01), as well as greater delays in getting mental health prescriptions (difference 4.6 percentage points, P=0.02). Asian adolescents had lower virtual treatment rates compared with white teens (difference -11.8 percentage points, P=0.04).

Latinx adolescents had lower rates of mental health appointments being moved to telehealth (difference -9.7 percentage points, P<0.001), though they also had lower rates of mental health appointments being delayed or canceled (difference -5.4 percentage points, P<0.001).

For this study, Flores and colleagues used data collected from Jan. 14 to Dec. 20, 2021 from the nationally representative National Survey on Drug Use and Health (NSDUH), and included 10,743 adolescents (51.1% male).

Self-reported race and ethnicity indicated that 5.1% were Asian, 14.1% were Black, 23.3% were Latinx, 51.2% were white, and 6.3% were more than one race or ethnicity. Ages were evenly distributed: 34% were 12 to 13, 33.3% were 14 to 15, and 32.7% were 16 to 17.

Relative to white adolescents, those in minority groups were more likely to live in poverty (e.g., 10.6% vs 36.4% of Black teens), be covered by Medicaid or the Children’s Health Insurance Program (28.9% vs 56.5% of Latinx kids), and reside in large metropolitan areas (47.6% vs 72.5% of Asian kids). Latinx adolescents were more likely to report fair or poor health (6.5% vs 4.3% of white kids), while Black teens were less likely to have alcohol use disorder (1.1% vs 3.8%) or nicotine dependence (0.1% vs 0.7%) compared with white adolescents.

In age- and sex-adjusted estimates, rates of MDD ranged from 14.5% to 26.5%. Black and Asian adolescents had lower rates of MDD relative to white adolescents (14.5% and 14.6% vs 20.2%). Among adolescents of more than one race, the rate of MDD (26.5%) was 6.3 percentage points higher than among white adolescents (P=0.03).

The NSDUH is cross-sectional, which prohibited causal inferences, Flores and team noted. Furthermore, data were based on self-reporting, and therefore dependent on respondent recall.

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