Exploring Racial Disparities in Mental Health Diagnoses and Neighborhood Disorganization Among an Urban Cohort of Children and Adolescents with Chronic Medical Conditions

Parent-Child Nativity, Race, Ethnicity, and Common Mental Health Conditions Among United States Children and Adolescents

OBJECTIVE

To examine associations between race, ethnicity, and parent-child nativity, and common mental health conditions among U.S. children and adolescents.

METHODS

Data were from 2016 to 2019 National Survey of Children's Health, a US population-based, serial cross-sectional survey, and restricted to children who had access to health care. We used weighted multivariable logistic regression to examine the associations between race and ethnicity (Asian, Black, Hispanic, White, Other-race); mental health outcomes (depression, anxiety, and behavior/conduct problems) stratified by household generation; and between household generation and outcomes stratified by race and ethnicity, adjusting for demographics (age, sex, family income to poverty ratio, parental education), and an adverse childhood experience (ACE) score.

RESULTS

When stratifying by household generation, racial and ethnic minority children generally had similar to lower odds of outcomes compared with White children, with the exception of higher odds of behavior/conduct problems among third + -generation Black children. When stratifying by race and ethnicity, third + generation children had increased odds of depression compared to their first-generation counterparts. Third + generation, racial and ethnic minority children had increased odds of anxiety and behavior/conduct problems compared with their first-generation counterparts. The associations generally remained significant after adjusting for the ACE score.

CONCLUSIONS

Lower odds of common mental health conditions in racial and ethnic minority children could be due to factors such as differential reporting, and higher estimates, including those in third + generation children, could be due to factors including discrimination; systemic racism; and other factors that vary by generation and need further investigation to advance health equity.

Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life: A National Study

Children, who enroll in hospice, have complex mental and behavioral health (MHBH) problems. There is limited literature on patterns of these problems among children at their end of life. Using the national database of 6195 children enrolled in hospice between January 1, 2011, and December 31, 2013, and latent class analysis, this study identified 4 distinctive classes of children. Neurodevelopment and anxiety class (26.5% of the sample) had 41.3% of children of 15 years or older, who had an average of 1.4 MHBH comorbidities and took 17 medications; 29.1% had physical health comorbidities, and 23% were dependent on technology. In the Behavior and Neurodevelopment class (20%), 53.1% of the children were between ages 6 and 14 years, who had an average of 2 MHBH comorbidities and took 17 medications. In the Physiology class (43.4%), 65.5% of children were younger than 5 years, had 1 MHBH comorbidity, and took 19 medications. In the Mood, Behaviors, and Anxiety class (10.2%), more than 90% of children were older than 6 years, had 4 MHBH comorbidities, and took 30 medications. In the latter 3 classes, approximately half of the children either had physical health comorbidities or were technology dependent. These findings highlight the importance of end-of-life care that accounts for the likely presence of complicated patterns of MHBH conditions.

Racial/Ethnic Variations in Social Determinants of Mental Health Among Medicare Advantage Beneficiaries

OBJECTIVES

We examine associations between social determinants and mental health and assess how the associations vary by race/ethnicity using a large, diverse sample of older adults.

METHOD

A retrospective study of 444,057 older adults responding to the Medicare Health Outcomes Survey in 2015-2017 was conducted. Using a multilevel linear regression, we examined the associations between the self-reported number of unhealthy days due to mental health and social determinants, stratified by race/ethnicity.

RESULTS

Health factors were most strongly associated with unhealthy days across all racial/ethnic groups. Strength of other factors varied by race/ethnicity. Social/economic factors had stronger associations among Whites, Asians, and multiracial individuals, while such factors were not significant for American Indians/Alaska Natives and Native Hawaiians/Other Pacific Islanders.

DISCUSSION

We found varying degrees of associations between social determinants and poor mental health by racial/ethnic groups. These results suggest that homogeneous interventions may not meet the mental health needs of all.