Promoting Racial/Ethnic Equity in Psychosocial Treatment Outcomes for Child and Adolescent Anxiety and Depression.
Promoting Racial/Ethnic Equity in Psychosocial Treatment Outcomes for Child and Adolescent Anxiety and Depression.
复制标题
DOI：
10.1176/appi.prcp.20210044
复制
发表时间：
2022
影响因子：
--
通讯作者：
Lynch, Frances L
中科院分区：
文献类型：
--
作者：
Weersing, V Robin;Gonzalez, Araceli;Hatch, Brigit;Lynch, Frances L
焦虑和抑郁是最普遍和治疗最少的儿科心理健康问题。少数种族/族裔青年患焦虑和抑郁症的风险更大，负担更重，因为他们不太可能因这些情况获得适当的心理健康服务，也不太可能满足他们的需求。此外，针对青少年焦虑和抑郁的标准循证干预措施可能会对种族/少数民族青少年和社会经济地位较低的家庭产生影响。虽然迫切需要社区一级的干预措施来打击结构性种族主义和减少人口层面的风险，但许多年轻人将继续需要焦虑和抑郁的急性治疗服务，干预者必须了解如何将公平置于护理的最前沿。在本次综述中，我们采用卫生系统框架来检查儿科焦虑和抑郁症心理社会治疗中系统、干预、提供者和患者层面因素中的种族/民族差异。目前的证据差异的访问和焦虑和抑郁的青年心理干预的效果进行了总结，我们使用我们的工作在初级保健作为一个案例，适应干预，以减轻差距，增加公平。最后，我们建议在每个层次的卫生系统框架的差距行动目标，并提供干预这些机制，以改善种族/少数民族青年的成果的示例战略。少数种族/族裔青年患上焦虑和抑郁症的风险更大，因精神失常而承受的负担更重，因为他们不太可能因这些情况获得适当的精神保健服务，也不太可能满足他们的需求。增加获得焦虑和抑郁服务的机会对种族/族裔少数家庭至关重要。访问问题可能与服务的物理位置相关联（例如，初级保健或远程保健）或有语言、收入或资金障碍的人。服务环境和研究治疗方案经常要求少数民族/种族青年的家庭以可能与文化不兼容的方式（例如，父母很少参与治疗）或实际可行（即，在父母工作时间内每周举行一次会议）。在可能的情况下，干预的非必要方面应被释放，以符合患者的偏好和限制，并应采取对焦虑和抑郁有广泛影响和个性化目标选择的干预措施。
Anxiety and depression are the most prevalent and least treated pediatric mental health problems. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Further, standard evidence‐based interventions for youth anxiety and depression may show diminished effects with racial/ethnic minority youths and with families of lower socioeconomic status. While community‐level interventions to combat structural racism and reduce population‐level risk are sorely needed, many youths will continue to require acute treatment services for anxiety and depression and interventionists must understand how to bring equity to the forefront of care. In this review, we adopt a health system framework to examine racial/ethnic disparities in system‐, intervention‐, provider‐, and patient‐level factors for psychosocial treatment of pediatric anxiety and depression. Current evidence on disparities in access and in efficacy of psychosocial intervention for anxious and depressed youths is summarized, and we use our work in primary care as a case example of adapting an intervention to mitigate disparities and increase equity. We conclude with recommendations for disparity action targets at each level of the health system framework and provide example strategies for intervening on these mechanisms to improve the outcomes of racial/ethnic minority youths. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden from disorder as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Increasing access to services for anxiety and depression is of critical and immediate importance for racial/ethnic minority families. Issues of access may be associated with the physical location of services (e.g., primary care or telehealth) or with barriers of language, income, or financing. Both service settings and research treatment protocols frequently require families of ethnic/racial minority youths to fit themselves to the demands of care, in ways that may not be culturally compatible (e.g., little parent involvement in treatment) or practically feasible (i.e., weekly sessions during parent working hours). Whenever possible, non‐essential aspects of intervention should be freed to match patient preferences and constraints, and interventions for anxiety and depression should be adopted that have broad impacts and options for personalization of goals.