In order to reverse the trend in youth and adolescent suicide rates, we need to implement effective interventions to prevent depression. Though that remains a challenge for the population as a whole, there are vulnerable subgroups – including socioeconomically disadvantaged, sexual minority, and racial and ethnic minority youth – for whom it is not clear that common preventive interventions are effective. There is a reason we don’t know this: we’re not doing enough to find out.
Last week, Dr. Donna Holland Barnes discussed the horrific upward trend of suicide rates among very young Black males, ages 5-11. We know that one of the key strategies in preventing youth depression and depression symptoms–often precursors to suicidal ideation–is to use early interventions that help to develop resilience, coping and communication skills, and capacity for emotional expression. Dr. Barnes notes that there are some excellent programs for introducing coping mechanisms but, unfortunately, funding and access limit their implementation in schools.
“Health disparities” or “health inequalities” refer to the differences that affect disadvantaged groups more than advantaged groups; these differences include access to, quality of, and outcomes from health care. These inequities are compounded by the disproportionate occurrence of depression and depression symptoms among disadvantaged youth. Addressing these disparities, particularly in mental health, is a priority for SAMHSA, the National Institutes of Health, and other leading health organizations.
Let’s take a step back to understand why we have not developed more effective solutions to address the disparities. According to a recent study, the lack of research targeting the most affected populations emerges as a glaring reason. The failure of the scientific community to include relevant research participants (i.e., representatives of these vulnerable groups) and inadequate sample sizes results in a shortage of data. The success in recruiting research participants may be, in part, attributable to the lack of diversity among researchers, and even more so among the select group of researchers who receive funding for mental health research. But steps can be taken to achieve “scientific equity.”
Ways to accomplish scientific equity
In “Toward Scientific Equity for the Prevention of Depression and Depressive Symptoms in Vulnerable Youth,” the authors present several strategies to promote scientific equity relative to mental health disparities:
- Make the pool of research participants more diverse and greater in number
- Utilize synthesized data collected across research projects to increase sample sizes
- Perform research on implementation of interventions among diverse groups to better understand context and effectiveness
- Adopt and implement policies that facilitate wide distribution of evidence-based interventions
- Promote diversity in the fields of research.
These strategies call for the involvement of a wide variety of stakeholders: government agencies, academic and clinical institutions, leaders from diverse communities, educators and school administrators, professional and advocacy organizations, families and people with lived experience, and concerned citizens.
Programs with potential
There are some preventive programs that have been designed specifically for particular vulnerable subgroups, so we know that it’s possible to do. A few examples are Strong African American Families Intervention (for African-American youth); Familias Unidas Preventive Intervention (for Hispanic youth); Bridges to High School Program (for Mexican-American youth); and the Trevor Project Lifeguard Workshop (for LGBTQ youth). While these are promising, more needs to be done to advance suicide prevention for all young people.
The development, distribution, and implementation of programs that work for different ages and different groups of people will help stem the rising tide of youth suicide. It will take concerted efforts to make this happen; several agencies are already taking steps to eliminate mental health care disparities. Addressing scientific inequity will help.
- What is your school district doing about depression and suicide prevention? What would you want to be done?
- What strategies do you believe will help the most in erasing health disparities?
- What will you do to support the effort to eliminate health disparities?