For generations, Black children have faced a unique set of challenges regarding their mental health, from enduring more adversity to a lack of access to effective treatment. Finally, a new study pinpoints structural racism as a potential cause.
"Black youth in the United States experience significant illness, poverty, and discrimination," according to the American Psychological Association. "These issues put them at higher risk for suicide, depression, and other mental health problems."
For example, a recent study in Pediatrics found Black youth ages 5 to 24 saw a much greater increase in suicide deaths than white youth during the first 10 months of the pandemic when looking at the expected suicide rate versus the actual rate. A 2021 report from the U.S. surgeon general noted that suicide rates in Black kids under 13 have risen so much in recent years that they’re now almost twice as likely to die by suicide as white kids.
A 2022 study published in the journal Current Psychiatry Reports found that rates of depression, anxiety, post-traumatic stress, substance use disorders and suicide are rising in minority youth.
But at the same time, Black kids are less likely to receive mental health treatment for a range of reasons, from stigma to a lack of a diverse providers, the American Psychological Association stated. And when they do receive treatment, it's less likely to be evidence-based, per a 2020 study in Children and Youth Services Review.
These disparities have been understudied for decades, experts tell TODAY.com. The new, first-of-its-kind study, published in the American Journal of Psychiatry on Feb. 1, will help close some of these gaps, they hope.
"Toxic stress" and the developing brain
The new study found that Black kids were more likely than white kids to experience "toxic stress," which it defined as “prolonged exposure to adverse experiences that leads to excessive activation of stress response systems and an accumulation of stress hormones.” Toxic stress can contribute to changes in the volume, size and shape of certain regions of the brain that are linked to PTSD, depression and anxiety, according to the study.
The study found the link by analyzing MRI brain scans of Black kids and white kids across the country, as well as surveys completed by the kids and their parents about their race, parental education and employment, income, measurements of neighborhood disadvantage and conflicts within the home.
Nathaniel Harnett, Ph.D, led the study and tells TODAY.com that the conclusions do not indicate a genetic, race-related difference in the child participants' brains.
"We have the folklore belief that Black and white people just have categorically different brains, but ... what we really want to point out here, when we interpret these data, is that these are not children with just different brains," Harnett explains. "They’re children with different experiences that shaped and molded how they develop, and how they might develop through to adulthood."
Harnett, director of the Neurobiology of Affective Traumatic Experiences Laboratory at McLean Hospital in Massachusetts, worked with a team of researchers to analyze data from more than 7,300 white children and nearly 1,800 Black children in the U.S. who were 9 and 10 years old.
They found that three areas of the brain — the amygdala, hippocampus and prefrontal cortex — were slightly smaller in volume, size and shape in Black children compared to white children. These regions of the brain regulate fear, threat perceptions, emotions and memory.
“What we’ve seen in PTSD and, in some cases, depression and anxiety, is that the actual size of some of these brain regions, particularly the hippocampus and prefrontal cortex, are smaller in individuals with PTSD compared to those without PTSD,” Harnett explains.
Physical changes in these brain regions, the study suggests, may be due to how much race-related trauma Black children witness or experience firsthand.
The study found that white children on average experience less family conflict, material hardship, neighborhood disadvantage, and fewer traumatic events compared to Black children. For example, white children’s parents were three times more likely to be employed than Black children’s parents; 75% of white parents had a college degree compared to nearly 41% of Black parents; and about 88% of white parents made $35,000 a year or more compared to about 47% of Black parents who made as much.
“Individuals exposed to more childhood trauma have a greater risk for developing (PTSD) later in life, suggesting that changes in these brain regions may be particularly important mediators of actually developing that disorder,” Harnett says.
Harnett plans to continue to evaluate the same group of kids every couple of years to better understand the longterm effects of the traumas they experience. With further research, he’s hoping to find out if changing a child’s environment and exposure levels to adversity can reverse the changes in the brain.
“All children are susceptible to these effects of adversity, but ... we ultimately really need ... changes to the levels of adversity that we expose kids to,” he says. “We really need to pay attention to the groups that are disproportionately affected,” such as Black children.
Racial mental health disparities in kids have been historically understudied due to "structural racism in medicine," Dr. Cheryl Wills, a board member of the American Psychiatric Association, tells TODAY.com, adding that the few ideas that did manage to get the green light were not taken as seriously as other non-race related studies in the field.
"In the '80s, people began to talk about it, and in the '90s, people began to deal with it," and slowly smaller research projects came out, but many ideas failed to get funding, she explains.
Racial bias "has made it difficult to find studies of this caliber and scale and to conduct them," she says, referring to Harnett's study. "People have done small studies here and there. ... However, this is the first study where you had funding and a database that by design has incorporated diversity into it."
Dr. Melissa Vallas, a children's psychiatrist and medical director of Southern California Evolve-PC Residential Treatment Centers, published a paper in 2010 in the journal Child and Adolescent Psychiatric Clinics of North America that had similar findings on home life and poverty. But the fact that Harnett could connect adversity and stress to physical changes in the brain adds another layer of understanding of these racial disparities.
Vallas tells TODAY.com that another reason more research in this area has not happened is because psychiatry is a relatively new field that wasn't originally created to study this issue.
"When we go back and understand the history of psychiatry specifically, it's important to know that the founders of psychiatry were all white men," she says. "Between the '30s and the '50s is when psychiatry was really (coming into) its own."
At that time, "Black people in this country were really more focused on just trying to survive and have equal rights," she adds.
In fact, the American Psychiatric Association recognized the structural racism in its profession with a 2021 statement apologizing for "enabling discriminatory and prejudicial actions within the APA and racist practices in psychiatric treatment for Black (people)."
"Early psychiatric practices laid the groundwork for the inequities in clinical treatment that have historically limited quality access to psychiatric care for (Black people). These actions sadly connect with larger social issues, such as race-based discrimination and racial injustice, that have furthered poverty along with other adverse outcomes," the APA wrote.
Mental health care for Black youth today
The history of racism in the U.S. still impacts Black youth's mental health today. Chase Casine, a clinical therapist in New Orleans whose caseload is 40% Black youth, tells TODAY.com that structural racism's impact on the brain often goes misdiagnosed.
For example, the amygdala, home to the fight-or-flight response, can lead a child to act hyperactive if it's triggered constantly, which can make it seem like the child has ADHD when they actually have PTSD, Casine explains.
"Research (shows) our kids being overly medicated, misdiagnosed, often labeled with ADHD or conduct disorder," he says, adding that these misdiagnoses can lead to incorrect treatment plans and stereotypes about Black kids when "it’s not even what they have."
"I'm a trauma informed therapist, and I take culture into consideration, but a lot of other practitioners who don't look like (me) don't take culture into consideration," he continues. "Looking at the whole person takes into account what happened to you."
He says he thinks non-Black practitioners don't usually have this approach because they don't want to contribute to racial stereotypes.
"As much as we want to strive to live in a colorblind society ... that type of a toxic positivity is more of an avoidance of what's in front of us," he explains. "There is a clear divide between Blacks and whites. The research consistently and continually shows that there is an obvious disconnect."
Casine emphasizes that culturally competent mental health care is not just about being the same race. It's also about using the same reference points.
"I'm a person-centered therapist. ... I allow the clients to lead," he says. For example, if a client tells him they're spiritual or into music, he'll use scriptures or songs to help them process their thoughts.
What can parents do?
Vallas and Casine say white children can start learning about privilege and structural racism at an age-appropriate level, and there are resources available to help teach them.
For Black parents, Harnett, Vallas and Casine realize that many factors that may contribute to toxic stress — such as their income and educational levels — are difficult, if not impossible, to change, so they say it’s important for Black parents to give themselves grace.
Vallas, who is a mother to a 14-year-old and twins who are 12, stresses the importance of listening to your children, especially as a Black parent.
"I think the first step is just being aware (of) what's happening, so if you see your child acting out, they don't necessarily just need a (punishment). Maybe the first step is to just try to have a conversation with them," Vallas advises.
She says her line of work "(puts) into perspective how easily kids can have these lives that parents don’t know."
"It teaches me a lot about the importance of the connection that you need to have with your kids in order for them to feel comfortable to communicate with you," she adds.