Racial Disparities in Mental Health Disorders in Youth with Chronic Medical Conditions

Authors

Vincent J Gonzalez
Rachel T Kimbro
John C Shabosky
Stefan Kostelyna
Titilope Fasipe
Natalie Villafranco
Katherine E Cutitta
Keila N Lopez

Publication Date

8-1-2023

Journal

The Journal of Pediatrics

DOI

10.1016/j.jpeds.2023.113411

PMID

37030612

PMCID

PMC10524229

PubMedCentral® Posted Date

4-6-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Child, Humans, Adolescent, Mental Health, Cross-Sectional Studies, Mental Disorders, Anxiety, Ethnicity, Chronic Disease, Heart Defects, Congenital

Abstract

OBJECTIVE: To evaluate the association between race/ethnicity, poverty, and mental health in youth with chronic conditions.

STUDY DESIGN: A cross-sectional comparative study was performed using the records of a tertiary care center from 2011 to 2015.

INCLUSION CRITERIA: children aged 4-17 years with ≥1 hospitalization or emergency department visit. Exclusion criteria were those with arrhythmias or treatment with clonidine/benzodiazepines. The primary outcome variable was diagnosis or medication for anxiety, depression, or attention deficit hyperactivity disorder. The primary predictor variable was diagnosis of cystic fibrosis (CF), sickle cell disease (SCD), or congenital heart disease (CHD).

RESULTS: We identified 112 313 patients, 0.2% with CF, 0.4% with SCD, and 1.0% with CHD. Patients with CF had the highest prevalence (23%) and odds (OR, 4.21; 95% CI, 3.07-5.77) of anxiety or depression, whereas patients with SCD had the lowest prevalence (7%) and odds (OR, 1.54; 95% CI, 1.11-2.14). Those with CHD had a prevalence of up to 17%, with 3-4 times higher odds of anxiety or depression (OR, 3.70; 95% CI, 2.98-4.61). All non-White participants were less likely to be diagnosed or treated for anxiety or depression and attention deficit hyperactivity disorder. Although poverty increased the probability of anxiety or depression in patients with CHD, this finding was not seen in patients with CF or SCD.

CONCLUSIONS: Children with CF, SCD, and CHD are at increased risk of anxiety or depression; however non-White patients are likely being underdiagnosed and undertreated. Increased screening and recognition in minority children are needed to decrease disparities in mental health outcomes.