Mental Health in Communities of Color Emerging from the Pandemic

by Erika Roach, M.A., University of California, Berkeley

The COVID-19 era has been challenging on multiple fronts. While some degree of normalcy is emerging, so too are the mental health ramifications of the past year. As Dr. David Williams, Harvard Professor of Public Health, said, “There is a vaccine for the COVID-19 virus, but there is no vaccine for mental health.”¹ A recent survey conducted by the National Center for Health Statistics (NCHS) and Census Bureau estimated the national percentage of individuals with anxiety or depression symptoms across all racial groups is 30.4%–down from a peak of 42.6% in 2020, but still nearly triple the rate of 10.8% in 2019.² It is evident that the COVID-19 era has taken a toll on the mental health of individuals across racial backgrounds. However, it is also the case that the mental health of people of color was hit particularly hard.³ Risk factors for poor mental health outcomes such as COVID-19 deaths, job loss, housing instability, food insecurity, as well as a rash of high profile racist incidents disproportionately impacted communities of color.³ ⁴ July is BIPOC Mental Health Month, and this is an opportune time for mental health professionals, public health officials, and community leaders to work collectively to provide support and resources for these communities.

Mental Health Trends in Communities of Color Over the Past Year

In the early months of the pandemic, a CDC report found that young adults and Black and Latino people of all ages were experiencing disproportionately worse mental health outcomes, including elevated suicidal ideation and increased substance use.⁵ Between April 23, 2020 and June 21, 2021, approximately 42% of Latinos nationwide reported experiencing frequent symptoms of anxiety or depression, up from 10.3% during the first half of 2019.² ⁶ Black youth, in particular, began the pandemic in an already disconcerting state. The suicide death rate for Black youth under 13 has been increasing faster than any other racial group and is twice as high as their white counterparts.⁷ This was the fragile context pre-pandemic and rates of anxiety and depression have worsened.³

Asian Americans currently report similar rates of anxiety and depression as white Americans.² However, the increase in anxiety and depression symptoms among Asian Americans from 2019 was the most drastic of any racial group, growing nearly six-fold from 5.5% to 30.9% compared to four-fold for Black and Hispanic people and two-fold for white people.² ⁶ The recent wave of anti-Asian, COVID-related racism was likely a contributing factor. One study of 543 Chinese American parents and their children found that nearly half of parents and youth reported being directly targeted by COVID-related racial discrimination online or in person. Higher levels of perceived racism and racial discrimination were associated with poorer mental health outcomes.⁸

We lack conclusive data examining the full impact of COVID-19 on the mental health of Indigenous communities. This is largely due to inconsistencies in data collected between tribes, regional health departments, and national agencies, as well as misattributions to other ethnic groups. Similar challenges exist with Middle Eastern Americans.⁹ ¹⁰ That said, a report by Mental Health America analyzing over 400,000 mental health screens from January to August 2020 found that Native Americans had the higher overall rates of depression than any other racial or ethnic group.³ Indigenous people also had the highest rate of COVID-19 deaths of any ethnic group in the United States and were already facing long-standing mental health disparities due to historical trauma and systemic inequities far before the pandemic.¹¹ ¹² Indigenous people have the highest suicide rate of any racial group in the U.S. according to the CDC.¹³ The CDC also reports that Indigenous people in the U.S. experience serious psychological distress at a rate that is 2.5 times higher than the general population and the suicide death rate for Indigenous adolescents between 15–19 in the U.S. is more than double that of their white counterparts.¹⁴

For some people, the feelings of anxiety and depression that peaked during the pandemic will mitigate as in-person routines resume. For others, the impact will be longer-lasting or emerge down the road. In order to mitigate these effects and support healing in BIPOC communities now and moving forward, psychologists should consider the following evidence-based tips (adapted from Liu et al., 2020) and relevant resources when applicable. These are general tips that may be helpful for racial trauma in particular. However, it is always important to consider the diversity of experiences and identities among patients of color. First and foremost, take a humble stance, don’t assume certain racial and cultural constructs are relevant, and address the role of cultural factors collaboratively with your client.¹⁶

Tips and Resources:

Highlight Resilience. Focus on inherent strengths and previous experiences of resilience by individuals and their community. Cultural identity–a positive sense of one’s self as belonging to a certain culture–is a protective factor against racial trauma, particularly if one’s group has collectively experienced and overcome past adversities.¹⁷ Of equal importance is being cognizant of the fact that the oppressions people of color face do not define them.¹⁸

Resources:

University of Michigan Medicine Department of Psychiatry Mental Health toolkit for Communities of Color (link)

Mental Health America: BIPOC mental health and racial trauma resources (side menu) (link)

Acknowledge racism and systemic inequities. Moving beyond individual factors and acknowledging the role of structural factors and systems that perpetuate inequities can mitigate undue self-blame and promote psychological healing. ¹⁸ Furthermore, when an individual’s emotions stemming from racist experiences are invalidated, it can lead to suppression and denial of emotions, which can lead to experiential avoidance and anxiety.¹⁹ French et al. (2020) propose a healing model that acknowledges systemic racism and also fosters a sense of agency and hope for justice.

Encourage patients to connect to social support. For many people of color, grieving and mourning are collective. Healing can also be experienced collectively, so promoting social support and thinking outside the box to consider how healing can be experienced within community settings is helpful.¹⁸

Take a trauma and culturally-informed approach to working with clients who have been exposed to racial or vicarious trauma over the past year. Carter et al. (2015) provide guidance on how to use the Race-Based Traumatic Stress Symptom Scale in practice to assess the emotional impact of race-based stress (link).

Citations:

1. How unjust police killings damage the mental health of Black Americans. (2021, May 13). Harvard Gazette. https://news.harvard.edu/gazette/story/2021/05/how-unjust-police-killings-damage-the-mental-health-of-black-americans/
2. National Center for Health Statistics (NCHS) and Census Bureau. Mental Health — Household Pulse Survey — COVID-19. (2020–21). Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm
3. NPR, Robert Wood Johnson Foundation, Harvard T.H. Chan School of Public Health.(2020).The Impact of Coronavirus on Households by Race and Ethnicity. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/94/2020/09/NPR-Harvard-RWJF-Race-Ethnicity-Poll_091620.pdf
4. Czeisler, M. É. (2020). Mental Health, Substance Use, and Suicidal Ideation during the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(32). https://doi.org/10.15585/mmwr.mm6932a1
5. Percentages of Selected Mental Health Indicators for Adults Aged 18 and Over, by Race and Hispanic Origin: United States. (2019). https://www.cdc.gov/nchs/data/nhis/earlyrelease/ERmentalhealthbyrace-508.pdf
6. Bridge, J. A., Horowitz, L. M., Fontanella, C. A., Sheftall, A. H., Greenhouse, J., Kelleher, K. J., & Campo, J. V. (2018). Age-Related Racial Disparity in Suicide Rates Among US Youths From 2001 Through 2015. JAMA Pediatrics, 172(7), 697. https://doi.org/10.1001/jamapediatrics.2018.0399
7. Mental Health America. (2021). The State of Mental Health in America | Mental Health America. Mhanational.org. https://mhanational.org/issues/state-mental-health-america
8. Cheah, C. S. L., Wang, C., Ren, H., Zong, X., Cho, H. S., & Xue, X. (2020). COVID-19 Racism and Mental Health in Chinese American Families. Pediatrics, 146(5). https://doi.org/10.1542/peds.2020-021816
9. Jim, M. A., Arias, E., Seneca, D. S., Hoopes, M. J., Jim, C. C., Johnson, N. J., & Wiggins, C. L. (2014). Racial Misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area. American Journal of Public Health, 104(S3), S295–S302. https://doi.org/10.2105/ajph.2014.301933
10. Hatcher, S. M., Agnew-Brune, C., Anderson, M., Zambrano, L. D., Rose, C. E., Jim, M. A., Baugher, A., Liu, G. S., Patel, S. V., Evans, M. E., Pindyck, T., Dubray, C. L., Rainey, J. J., Chen, J., Sadowski, C., Winglee, K., Penman-Aguilar, A., Dixit, A., Claw, E., Parshall, C., … McCollum, J. (2020). COVID-19 Among American Indian and Alaska Native Persons — 23 States, January 31-July 3, 2020. MMWR. Morbidity and mortality weekly report, 69(34), 1166–1169. https://doi.org/10.15585/mmwr.mm6934e1
11. APM Research Lab Staff. (2020). COVID-19 deaths analyzed by race and ethnicity. APM Research Lab. https://www.apmresearchlab.org/covid/deaths-by-race
12. John-Henderson, N. A., & Ginty, A. T. (2020). Historical trauma and social support as predictors of psychological stress responses in American Indian adults during the Covid-19 pandemic. Journal of psychosomatic research, 139,110263.https://doi.org/10.1016/j.jpsychores.2020.110263
13. CDC/WISQARS (Web-based Injury Statistics Query and Reporting System)/Injury Center|. (2019). https://www.cdc.gov/injury/wisqars/index.html
14. Azar, A., Redfield, R., Rothwell, C., & Director, M. (2017). Health, United States, 2017, With Special Feature on Mortality. http://www.cdc.gov/nchs/data/hus/hus17.pdf
15. Liu, S. R., & Modir, S. (2020). The outbreak was always here: Racial trauma in the context of Covid-19 and implications for mental health providers [Editorial]. Psychological Trauma: Theory, Research, Practice, and Policy, 12(5), 439–442. http://dx.doi.org/10.1037/tra0000784
16. Hong, J. J. (2013). An idiographic evidence-based approach to addressing cultural factors in treatment: A case example. The Behavior Therapist, 36(6), 143–146.
17. Ahmed, S. R., Kia-Keating, M., & Tsai, K. H. (2011). A structural model of racial discrimination, acculturative stress, and cultural resources among Arab American adolescents. American Journal of Community Psychology, 48, 181–192. https://doi.org/10.1007/s10464-011-9424-3
18. French, B. H., Lewis, J. A., Mosley, D. V., Adames, H. Y., Chavez-Dueñas, N. Y., Chen, G. A., & Neville, H. A. (2019). Toward a Psychological Framework of Radical Healing in Communities of Color. The Counseling Psychologist, 001100001984350. https://doi.org/10.1177/0011000019843506
19. Hayes-Skelton, S. A., & Eustis, E. H. (2020). Experiential avoidance. In J. S. Abramowitz & S. M. Blakey (Eds.), Clinical handbook of fear and anxiety: Maintenance processes and treatment mechanisms (pp. 115–131). American Psychological Association.
20. Carter, R. T., & Sant-Barket, S. M. (2015). Assessment of the impact of racial discrimination and racism: How to use the Race-Based Traumatic Stress Symptom Scale in practice. Traumatology, 21(1), 32–39. https://doi.org/10.1037/trm0000018