Mental health problems of black and white children in a nationally representative epidemiologic survey

Abstract

Black children face more numerous socio-economic disadvantages than White children, but whether they have more adverse mental health problems remains understudied. Using nationally-representative data from the 2018–2019 National Survey of Children's Health, we examined differences in mental health problems between non-Hispanic Black (n = 2,890) and White (n = 30,015) children aged 6–17. Multivariate analyses were used to determine whether differences in mental health conditions could be accounted for by other factors. We found Black children were significantly less likely than White children to have clinically-identified internalizing conditions (especially anxiety) and more likely to be identified with conduct problems. Black children were also substantially more likely to have greater exposure to adverse childhood experiences (ACEs), to be uninsured, experience poverty, and less likely to receive needed mental health services. After adjusting for these potential confounders, Black children remained half as likely to have clinically-recognized internalizing conditions, but were no longer more likely to have clinically-identified conduct problems. Differences in ACEs alone fully accounted for the racial difference in conduct problems. These results point to the potential impact of assessment bias by clinicians and underscore the potential benefit of routine screening for depression/anxiety in racial/ethnic minority children, especially in light of rising suicide rates among Black youth.