Mental Health Burden among Black Adolescents: The Need for Better Assessment, Diagnosis and Treatment Engagement

Perceptions around sleep hygiene practices and beliefs among urban Black adolescents and their caregivers during the COVID-19 pandemic

OBJECTIVE

This study gathered adolescent and caregiver perspectives on sleep hygiene practices and beliefs for Black families living in low-resourced urban communities.

METHODS

Semistructured interviews were conducted with adolescents (n = 9) and caregivers (n = 9) from January-March 2021, during the COVID-19 pandemic. Interview questions included adolescent's current sleep habits, barriers, and home and neighborhood influences. Trained researchers coded data using inductive analysis and a constant comparative method to derive themes.

RESULTS

Two themes focused on sleep hygiene practices, including items used to facilitate sleep (e.g., melatonin, electronics) and COVID-19 consequences on sleep schedules. Two themes focused on sleep hygiene beliefs, including a common value on the importance of sleep and influences on caregiver's bedtime rules.

CONCLUSIONS

Findings provide important insights on sleep hygiene practices and beliefs in a historically marginalized population of Black adolescents and caregivers in urban communities to inform targeted sleep interventions, policies, and programs for optimal sleep and well-being.

Impact of Dialectical Behavioral Therapy on Anxiety Levels Among African American Adolescents

Anxiety and depression among adolescents in the United States has steadily increased. In addition, significant disparities in access to mental health care exist for African Americans. The purpose of the current project was to support the mental health of African American adolescents involved in faith-based youth groups through implementation of dialectical behavioral therapy (DBT). The community partner was an African American church in Southwest Georgia. Mindfulness training modules are offered in monthly sessions. Pre- and post-intervention surveys and the Generalized Anxiety Disorder-7 (GAD-7) were analyzed, comparing mean GAD-7 scores before and after participation. Nurse-led quality improvement initiatives support adolescent mental health and provide sustainable resources for mental health in rural areas. Results of the quality improvement project reveal improvement in self-reported anxiety symptoms among participants after the 4-month DBT intervention. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 7-10.].

Why do young men not seek help for affective mental health issues? A systematic review of perceived barriers and facilitators among adolescent boys and young men

Men are less likely to seek help for their mental health than women, but less is known about the specific patterns of help-seeking in adolescent boys and young men. This is concerning as adolescent boys and young men have high suicide rates but a low take-up of services. It is therefore of particular importance that the access needs of this group are understood. This review sought to identify the barriers and facilitators faced by adolescent boys and young men in help-seeking for affective mental health disorders. A search of the PubMed, APA PsycInfo, and Cochrane databases identified 3961 articles, of which 12 met the inclusion criteria. Six of the studies were qualitative, five were quantitative and one used mixed methods. Two authors independently extracted data and assessed the quality of the articles. Five key themes were identified, including the impact of social norms, with the subthemes of conformity to masculine norms and self-stigma, limited availability of information about mental health, and 'male-friendly' mental health literacy campaigns. Other themes referred to the help-seeking preferences of adolescent boys and young men, in terms of informal or formal and online or offline help-seeking. Some of the factors were well-researched (e.g., conformity to masculine norms as a barrier) whereas other factors (e.g., self-compassion as a facilitator) were less researched. These barriers and facilitators need to be considered in the development of future strategies to improve the help-seeking behaviour of adolescent boys and young men.

Mental Health Diagnoses Risk Among Children and Young Adults With Cerebral Palsy, Chronic Conditions, or Typical Development

Importance

Mental health (MH) issues in children with cerebral palsy (CP) are poorly understood compared with other pediatric populations.

Objective

To examine MH diagnosis code assignment among children and young adults with CP and compare with typically developing (TD) and chronic condition (CC) pediatric populations.

Design, Setting, and Participants

This case-control study used International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to create a CP case set and CC and TD control sets using electronic health record data of children and young adults from a large tertiary care children's hospital in the midwestern United States between 2010 and 2022. Case-control matching was performed to control for demographic factors. Data were analyzed from June to December 2023.

Exposures

All MH diagnosis codes were mapped to ICD-10-CM and categorized using Clinical Classifications Software Refined (CCSR).

Main Outcomes and Measures

The incidence rates of MH CCSR categories were calculated. Descriptive and comparative statistics were used to evaluate the significance and odds associated with factors.

Results

Data from 216 794 individuals (mean [SD] baseline age, 4.3 [5.1] years; 118 562 [55%] male) were analyzed, including 3544 individuals with CP, 142 160 individuals with CC, and 71 080 TD individuals. The CP cohort spread across Gross Motor Function Classification System (GMFCS) levels I (981 individuals [28%]), II (645 individuals [18%]), III (346 individuals [10%]), IV (502 individuals [14%]), and V (618 individuals [17%]). Rates varied significantly for anxiety (824 individuals with CP [23%]; 25 877 individuals with CC [9%]; 6274 individuals with TD [18%]), attention-deficit/hyperactivity disorder (534 individuals with CP [15%]; 22 426 individuals with CC [9%]; 6311 individuals with TD [16%]); conduct or impulse disorder (504 individuals with CP [14%]; 13 209 individuals with CC [5%]; 3715 individuals with TD [9%]), trauma or stress disorders (343 individuals with CP [10%]; 18 229 individuals with CC [8%]; 5329 individuals with TD [13%]), obsessive-compulsive disorder (251 individuals with CP [7%]; 3795 individuals with CC [1%]; 659 individuals with TD [3%]), depression (108 individuals with CP [3%]; 12 224 individuals with CC [5%]; 4007 individuals with TD [9%]), mood disorders (74 individuals with CP [2%]; 4355 individuals with CC [2%]; 1181 individuals with TD [3%]), and suicidal ideation (72 individuals with CP [2%]; 7422 individuals with CC [5%]; 3513 individuals with TD [5%]). There was significant variation in odds of MH diagnoses by GMFCS level (I-II vs III-V: odds ratio [OR], 1.23; 95% CI, 1.09-1.40; P = .001). Among individuals with CP, males were more likely than females to have diagnosis codes for conduct or impulse disorders (OR, 1.41; 95% CI, 1.16-1.73) and attention-deficit/hyperactivity disorder (OR, 1.41 [95% CI, 1.15-1.73]). Black individuals, compared with White individuals, were more likely to have diagnoses for obsessive-compulsive disorder (OR, 1.57 [95% CI, 1.14-2.16]), other mood disorders (OR, 1.85 [95% CI, 1.01-3.38]), and trauma or stress disorders (OR, 1.94 [95% CI, 1.44-2.63]). Odds for trauma or stress disorders were elevated for individuals who identified as other races compared with White individuals (OR, 2.80 [95% CI, 2.03-3.87]).

Conclusions and Relevance

In this case-control study of children and young adults with CP and matched comparisons, anxiety and conduct or impulse diagnoses were higher in individuals with CP. The lower diagnosis rates of depression and suicidal ideation may indicate underdiagnosis among individuals with CP. There is likely a need for assessment tools that are more suitable for children with CP.

Relationship between suicide ideation and attempts, bully victimization, dating violence, and depressive symptoms among Black and Hispanic youth

BACKGROUND

Suicide rates among Black and Hispanic youth have been increasing over the past decade in the United States. The objective of this study was to identify risk factors for suicide ideation and attempt among Black and Hispanic youth in the United States using intersectionality theory and minority stress theory as a framework.

METHODS

Data from the CDC Youth Risk Behavior Surveillance System (YRBSS; 2015-2019) were analyzed and delimited to include only Black and Hispanic youth.

RESULTS

About 37% of the subsample identified as Black and 63% of the subsample identified as Hispanic; mean age was 16 years (SE = 0.02). Weighted multivariate logistic regressions were used to explore associations between suicide ideation and attempt, depressive symptoms, bullying, dating violence, and being threatened with a weapon. Black and Hispanic youth who had depressive symptoms, experienced bullying, dating violence, or threatened with a weapon all had increased odds of having suicide ideation and suicide attempt. Hispanic youth had the higher odds of suicide ideation and attempt than Black youth. Girls in the study also had elevated odds of suicide ideation.

CONCLUSION

This study adds to the literature on risk factors of suicide in Black and Hispanic youth and bringing to awareness the gender disparities in suicide ideation and attempt among youth.

Health disparities in orthopedic trauma: a qualitative study examining providers' perspectives on barriers to care and recovery outcomes

Social workers involved in interdisciplinary orthopedic trauma care can benefit from the knowledge of providers' perspectives on healthcare disparities in this field. Using qualitative data from focus groups conducted on 79 orthopedic care providers at three Level 1 trauma centers, we assessed their perspectives on orthopedic trauma healthcare disparities and discussed potential solutions. Focus groups originally aimed to detect barriers and facilitators of the implementation of a trial of a live video mind-body intervention to aid in recovery in orthopedic trauma care settings (Toolkit for Optimal Recovery-TOR). We used the Socio-Ecological Model to analyze an emerging code of "health disparities" during data analysis to determine at which levels of care these disparities occurred. We identified factors related to health disparities in orthopedic trauma care and outcomes at the Individual (Education- comprehension, health-literacy; Language Barriers; Psychological Health- emotional distress, alcohol/drug use, learned helplessness; Physical Health- obesity, smoking; and Access to Technology), Relationship (Social Support Network), Community (Transportation and Employment Security), and Societal level (Access- safe/clean housing, insurance, mental health resources; Culture). We discuss the implications of the findings and provide recommendations to address these issues, with a specific focus on their relevance to the field of social work in health care.

Feasibility of a universal suicidality tool for adolescents

BACKGROUND

The suicide rate among adolescents has been increasing rapidly over the past several years.

LOCAL PROBLEM

Adequate screening for suicide risk in this population, particularly youth of color, is lacking.

METHODS

The Ask Suicide-Screening Questions (ASQ) tool was implemented at two adolescent-focused health clinics in a large U.S. city.

INTERVENTIONS

This project followed the Ottawa Model of Research Use. Participating clinicians were surveyed before and after receiving an educational module on suicide risk screening, the ASQ tool, and clinical pathways. Clinicians were also asked about the feasibility and acceptability of the ASQ tool in their practice. An electronic medical records software was used to gather data on patients newly screened for suicide risk using the ASQ tool.

RESULTS

Among eligible patients, 40.2% were screened using the ASQ tool during the 4-month duration of the project. Most clinicians reported that using the tool was feasible within their practice (66%) and 100% endorsed its acceptability (i.e., reporting that they were comfortable screening for suicide and that the ASQ was easy to use).

CONCLUSIONS

The ASQ may be a promising screening tool for clinicians to use to address the mental health needs of at-risk youth. This project supports the universal acceptability and feasibility of its use in inner-city primary care clinics.

Developing the Diagnostic Interview for Adolescents and Adults with Mild/Moderate Intellectual Disabilities: An interview schedule of mental disorders (DIAAID)

Introduction

Young people with intellectual disabilities (ID) are at an increased risk for experiencing mental health issues compared to their peers without disabilities. Further, there are limited resources available to help accurately assess mental health disorders and that are accessible for adolescents with ID.

Method

This paper describes the iterative development and pilot testing of the Diagnostic Interview for Adolescents and Adults with Intellectual Disabilities (DIAAID). The authors utilized Evidence Center Design and Universal Design principals to develop the DIAAID; a multi-informant diagnostic interview.

Results

The DIAAID development resulted in the creation of 15 adolescents disorder interviews and 24 caregiver disorder interviews. Preliminary results suggest that the DIAAID is a feasible and accessible diagnostic interview for adolescents with ID and their caregivers.

Discussion

Lessons learned from DIAAID implementation and future areas research are discussed.

The Association Between Racial Attitudes, Alcohol Use and Mood Disorders Among Black Adolescents

Alcohol is the most widely used substance among adolescents. Although Black adolescents use alcohol at lower rates than White adolescents, Black adolescents tend to have worse outcomes. This includes higher rates of mood disorders and criminal justice involvement associated with alcohol use and misuse compared to any other racial group. Black adolescents are also more likely to experience racial discrimination and be exposed to traumatic events within their communities, which may increase their chances of using substances. Understanding the relationship between racial attitudes (towards one's own group and others) and substance use and mental health can provide unique and meaningful insight into prevention programming for Black adolescents. Yet, these concepts have been understudied. To fill this gap, we examined the association between racial attitudes and alcohol use and mood disorders in Black adolescents in Philadelphia, PA (N = 154). We used the revised Adolescent Survey of Black Life to measure pro-Black (positive attitudes toward being Black and factors related to Black people), anti-White (negative attitudes toward White people due to experiences of racism and discrimination) and racism awareness (recognition of racism) domains. Logistic regression analyses were conducted to test the associations. Results showed that: higher pro-Black attitudes were associated with a lower odds of mood disorder (odds ratio [OR] = 0.72, 95% CI = 0.55, 0.89); and higher racism awareness was associated with an increased odds of alcohol use (OR = 1.18, 95% confidence interval [CI] = 1.06, 1.29). Findings provide preliminary support for interventions and policies for Black adolescents that bolster positive racial identity and eliminate experiences of racism as alcohol use and mood disorder prevention strategies.

Utilization of Mental Health Services Among Black Adolescents During the COVID-19 Pandemic: a Narrative Review of the Literature

Purpose of Review

Black youth have disproportionately experienced inequities and barriers to care in accessing mental health services. The purpose of this review is to offer a summary of the currently available literature on mental health service utilization by Black youth during the COVID-19 pandemic, compared to prior. A narrative review was conducted in PubMed, Web of Science, psychINFO, and Embase from March 1, 2020 to September 1, 2022, to find studies that examined differences in the utilization of mental health services among Black youth.

Recent Findings

Our results found only 3 studies which examined pre and during the COVID-19 mental health utilization rates among Black youth. Among these studies, time period, study design, sample size, race data, and change in mental health utilization were evaluated.

Summary

From these results, we found that Black youth were overall less likely to utilize services for mental health during the pandemic. However, there were also findings that offer insights into innovative strategies to meet the needs of this unique population. As mental health service utilization has decreased and been slower to rebound from the pandemic compared to other health services, additional research on this topic is needed to ensure that the mental health needs of Black youth are being met.

A Convergent Mixed Methods Study of Cardiovascular Disease Risk Factors among Young Black Men in the United States

Background

An understanding of the factors that influence cardiovascular (CVD) risk among young Black men is critically needed to promote cardiovascular health earlier in the life course and prevent poor outcomes later in life.

Purpose

To explore how individual (eg, depression, racial discrimination) and environmental factors (eg, neighborhood resources) are associated with CVD risk factors among young Black men.

Methods

We conducted a convergent mixed methods study (qualitative/quantitative, QUAL+quant) with Black men aged 18 to 30 years (N = 21; 3 focus groups). Participants completed a self-administered electronic survey immediately prior to the focus groups.

Results

Participants (M age = 23) reported: two or more CVD risk factors (75%; eg, high blood pressure); racial discrimination (32%); and depressive symptoms in the past 2 weeks (50%). Five themes emerged: 1) emergence and navigation of Black manhood stressors; 2) high expectations despite limited available resources; 3) heart disease socialization: explicit and vicarious experiences; 4) managing health care needs against fear, avoidance and toughing it out; and 5) camaraderie and social support can motivate or deter. The integrated qualitative and quantitative analyses highlight race, gender, and class intersectionality factors that are relevant to what it means to be young, Black, male and of lower socioeconomic status in the United States.

Conclusion

Our findings help to identify modifiable, culturally specific and contextually relevant factors that relate to CVD risk factors among young Black men. Such work is crucial to inform interventions, primary prevention efforts, policies, and social-structural changes to thwart the development of CVD and advanced disease stages.

A Deeper Dive Into the Relation Between Psychotic-like Experiences and Suicidal Ideation and Behaviors in Children Across the United States

BACKGROUND AND HYPOTHESIS

Children who endorse psychotic-like experiences (PLEs) appear to be at a greater risk for suicidal ideation and behavior (SI/SB) compared to their peers who do not endorse PLEs. Despite evidence of differential relations among subtypes of PLEs and SI/SB, the research on which PLE subtypes produce the strongest associations remains mixed. Further, though there is evidence that general psychological distress may help explain the relation between PLEs and SI/SB, no research has investigated the role of distress specific to PLEs in this association.

STUDY DESIGN

The present study sought to assess the associations among individual Prodromal Questionnaire-Brief Child Version (PQ-BC) items and SI/SB, as well as to explore the role of distress associated with PLEs as a mediator and/or moderator in a demographically diverse sample of children across the United States (N = 11 875).

STUDY RESULTS

Results revealed that individual items of the PQ-BC may be differentially predictive of lifetime SI (ßs = 0.000-0.098) and SB (ßs=0.002-0.059), even when controlling for sociodemographic variables, internalizing symptoms, and traumatic experiences, with particularly strong associations observed among items indexing thought control, auditory hallucinations, suspiciousness, and nihilistic thinking/dissociative experiences. Item 13, nihilistic thinking/dissociative experiences, displayed the strongest effect sizes. Findings from moderation and mediation models provided evidence consistent with distress as both a partial mediator and moderator of the relation between total PLEs and individual PQ-BC items with SI and SB.

CONCLUSIONS

Distress specific to PLEs may be an important modifiable risk factor to target in suicide assessment, prevention, and intervention efforts.

Results from Project GOLD: A pilot randomized controlled trial of a psychoeducational HIV/STI prevention intervention for black youth

Black youth face significant disparities in HIV/sexually transmitted infection (STI) disease burden. Mental illness and emotion regulation are ontributors to HIV/STI risk, yet many HIV/STI prevention interventions do not address these factors. Project GOLD was a pilot randomized controlled trial of a psychoeducational HIV/STI prevention intervention designed to address the role of mental illness and emotion regulation in HIV/STI risk among heterosexually active Black youth aged 14-17 (N = 108). Participants were recruited from outpatient mental health treatment programs and general community settings via community partner referrals, face-to-face encounters, flyers and social media. Assessments were conducted pretest, immediate posttest, and at 3-, 6-, and 12-month follow-up. Although there were no statistically significant differences in behavior change from baseline, there were practically significant effect sizes among HIV condition participants when compared to the general health condition (e.g., fewer sexual partners at 6 months). An increase in theoretical mediators (e.g., condom use negotiation beliefs) was sustained at 12 months. HIV condition participants also reported lower depressive symptom severity, with statistical significance noted at immediate post and at 3 months. The findings highlight the importance and challenges of engaging Black youth in culturally and contextually relevant, developmentally and psychologically appropriate HIV/STI prevention interventions.