Addressing Social Determinants of Health on Children’s Mental Health 3/25/2021

The American Academy of Pediatrics recognizes the pervasive effects of systemic racism (Trent et al, 2019) on the health of children and others, most particularly, their mothers, but not excluding fathers. The more we know about the impacts of racism on child development, the more we can tackle the problems head on.  A recent review of the literature on social determinants of health (Berry et al., 2021), summarizes the state of the evidence.

“Racism is a social determinant of health and affects health and well-being along the developmental spectrum beginning in pregnancy and extending throughout all periods of early child development” . (our italics)

Recent literature has explored the sequelae of racism and the mechanism of impact. In addition to structural or institutional racism (for example in legal or educational systems), the authors highlight the impact of racism that a child may experience in day to day life, described as “personally mediated racism”.

“Personally mediated racism can …have deleterious effects on both maternal and infant mental health…[and] includes experiences of stereotypes and prejudices about an individual’s ability, motives, or intent on the basis of their race….[this] can be expressed implicitly (unconscious) or explicitly (conscious), and can be experienced directly or indirectly (vicariously). Examples of vicarious exposures include listening to a parent/caregiver describe unfair treatment at work, witnessing discriminatory behaviors towards a caregiver in a store, or reading about an event of a loved one from the news or social media”

According to a review of evidence over the past five years, the impacts of the racism can include,

  • Increased rates pre-term birth
  • Decreased access to high quality hospital care
  • Adverse impacts on care-giver well-being, which may impact early dyadic experiences
  • Increased separation challenges
  • Higher rates of post-partum depression
  • Decreased infant sleep duration
  • Increased rates of school age sleep problems, anxiety, depression, suicide risk, low self-esteem and disruptive behaviors

Some approaches to consider (among many others)

  • Create a culturally-safe medical home where the providers acknowledge and are sensitive to the racism that children and families experience by integrating patient and family-centered communications and evidence-based screening tools that incorporate valid measures of perceived and experienced racism into clinical practice.
  • Promote programs that increase access to care for members of underserved communities.
  • For patients who report experiencing racism, empathically assess for associated mental health conditions, including signs of posttraumatic stress, anxiety, grief, and depressive symptoms, using validated screening tools and a trauma-informed approach to make referrals to mental health services as needed”
  • Conduct quality-assurance assessments that include analyses of quality of care and patient satisfaction by race, and respond accordingly
  • Encourage policies to foster interactive learning communities that promote cultural humility and provide simulation opportunities to ensure that both senior and junior pediatricians are competent in delivering culturally appropriate and patient and family-centered care.
  • Attend to issues of bias at individual, team, organizational, economic and other levels, and explore opportunities to address the negative impacts of conscious and unconscious bias on health care delivery and outcomes.

 

Berry OO, Londoño Tobón A, Njoroge WFM. Social Determinants of Health: the Impact of Racism on Early Childhood Mental Health. Curr Psychiatry Rep. 2021 Mar 12;23(5):23. doi: 10.1007/s11920-021-01240-0. PMID: 33712922.

Trent, M., Dooley, D. G., Dougé, J., & On, S. (2019). The Impact of Racism on Child and Adolescent Health, 144(2). Policy Statement American Academy of Pediatrics.

 

 

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