Racial/Ethnic Disparities in Youth Mental Health Traits and Diagnoses within a Community-based Sample

BackgroundRacial/ethnic disparities in the prevalence of mental health diagnoses have been reported but have not accounted for the prevalence of the traits that underlies these disorders. Examining rates of diagnoses in relation to traits may yield a clearer understanding of how racial/ethnic youth differ in their access to assessment and care. We sought to examine differences in self/parent-reported rates of diagnoses for obsessive-compulsive disorder (OCD), attention-deficit/ hyperactivity disorder (ADHD), and anxiety disorders after adjusting for differences in trait levels between youth from three racial/ethnic groups: White, South Asian, and East Asian. MethodsWe collected parent or self-reported ratings of OCD, ADHD and anxiety traits and diagnoses for youth (6-17 years) from a general population sample (Spit for Science). We examined racial/ethnic differences in trait levels and the odds of reporting a diagnosis using mixed-effects linear models and logistic regression models. ResultsEast Asian (N = 1301) and South Asian (N = 730) youth reported significantly higher levels of OCD and anxiety traits than White youth (N = 6896). Given the same trait level, East Asian and South Asian youth had significantly lower odds of reporting a diagnosis for OCD (Odds Ratio (OR) East Asian = 0.08 [0.02, 0.41] ; OR South Asian = 0.05 [0.00, 0.81]), ADHD (OR East Asian = 0.27 [0.16, 0.45]; OR South Asian = 0.09 [0.03, 0.30]), and Anxiety (OR East Asian = 0.21 [0.11, 0.39]; OR South Asian = 0.12 [0.05, 0.32]) than White youth. ConclusionsThese results suggest a discrepancy between traits-levels of OCD and anxiety and rates of diagnoses for East Asian and South Asian youth. This discrepancy may be due to increased barriers for ethnically diverse youth to access mental health care. Efforts to understand racial/ethnic barriers to care are needed. Key PointsO_LIDespite having lower prevalence of diagnoses, East and South Asian youth reported significantly higher anxiety and OCD trait levels than White youth C_LIO_LIGiven the same trait level, East Asian youth were at 92% lower odds of having received an OCD diagnosis, 73% lower odds of having received an ADHD diagnosis, and 79% lower odds of having received an Anxiety diagnosis than White youth C_LIO_LIGiven the same trait level, South Asian youth were at 95% lower odds of having received an OCD diagnosis, 91% lower odds of having received an ADHD diagnosis, and 88% lower odds of having received an anxiety diagnosis C_LIO_LIFuture research is needed to understand barriers to mental health care and assessment that may underly the discrepancy between mental health traits and diagnoses for ethnic/racially diverse youth. C_LI