Black adolescents with psychological distress are less likely to report using mental health care than their White counterparts, according to a new study of teenagers in Ontario.

The disparity was particularly marked for Black girls, who consistently used mental health services less than their White peers. The gap widened as their mental distress increased.

The study also found that Black boys were more likely to report initiating mental health care than their White peers but only when they perceived their mental distress as low. Once their distress increased to moderate levels, their access pattern resembled that of Black girls.

The findings were published on September 8 in CMAJ.

Gender Gap

“I have been working at the Centre for Addiction and Mental Health for the last 10 years and in the mental health and public health fields for a while, and I recognized that there is a lack of data on the mental health service use among racialized groups in Canada,” study author Mercedes Sobers, a PhD candidate in epidemiology at Dalla Lana School of Public Health, University of Toronto, Toronto, told Medscape Medical News.

“We know racialized groups face unique mental health challenges that are shaped by the experience of racialization, as well as their own cultural context. I wanted to make sure that data were available so that community groups could be informed and know how best to direct their advocacy efforts,” she added. Sobers is also research coordinator at the Centre for Addiction and Mental Health (CAMH).

The investigators used data from the Ontario Student Drug Use and Health Survey, a population-based survey of Ontario students in grades 7 through 12, which is conducted every 2 years by the CAMH.

The researchers analyzed data that were collected in 2015, 2017, and 2019 from students who identified as Black or White. They did not include data from 2020 because the stresses from the COVID-19 pandemic and the murder of George Floyd disproportionately amplified preexisting inequities and stressors for Black people, Sobers explained.

The analysis included data on 12,368 middle- and high-school students from 52 school boards in Ontario, including students from English and French schools in the public and Catholic systems from the Greater Toronto Region and Northern, Western, and Eastern Ontario.

The overall sample was 51.5% boys. Most Black (58.8%) and White (52.8%) students rated their mental health as “excellent” or “very good.” 

Black male students with low distress were nearly twice as likely as White male students to report initiating care (odds ratio [OR], 1.50). When their distress worsened to moderate levels, however, they became less than half as likely to access care than their White counterparts (OR, 0.41).

Black girls were less likely to access mental health services at all distress levels. The disparity widened as their distress increased; the OR of initiating care was 0.78 for participants with moderate distress and 0.60 for participants with serious distress.

In addition, Black girls consistently had poorer outcomes than all other groups. When they sought mental health care, they did not continue with that care to the same extent as White teens.

“This research really matters because it’s about real children who could be struggling with mental health issues but are not getting the support they need. To build a fair and healthy society, we need to make sure that our mental health system is working for everyone, not just certain groups,” Sobers said.

“These disparities are connected to the fear of trust, less representation, and systemic racism. Once Black students start accessing care, we see that they are not using it as frequently as White students, and this points to the possibility that even if they are able to access care, perhaps the care is not relevant to them,” she said.

Cause vs Correlation

Commenting on the findings for Medscape Medical News, Terry McQuaid, PsyD, a registered clinical psychologist in private practice in Richmond Hill, Ontario, said, “Overall, it is a good study, and I appreciate the positioning of its purpose, the findings, and the recommendations for the future.” McQuaid did not participate in the research.

The study has shortcomings, however. “The paper cites systemic racism and lack of cultural fit, but it didn’t seem to explicitly state how it measured racism, such as by the impact or benefits of provider representation,” said McQuaid. “If there were more or fewer Black clinicians, would the results change? It’s also a one-time survey that matches 30-day distress with 12-month use. In my view, then, it may be more accurate to describe the results as consistent with a correlation of factors, not caused by them.” 

The relative lack of Black therapists and counselors may be part of the reason why Black teens don’t seek mental health services. “There are very few Black, or Black-identified medical staff within the system, and so, in my view, when people don’t see people who look like them, they are not going to interact, and this is especially true for young people,” said McQuaid.

The trends for accessing care among boys are also noteworthy, she said. “The fact that Black boys interacted with the mental health system through the justice system or the corrections system is not a surprise. That’s common knowledge. When Black boys are struggling, they get perceived differently.”

No funding for this study was reported. Sobers and McQuaid reported no relevant financial relationships.