Some groups may face a disproportionate mental health impact during the COVID-19 pandemic. These include people of color, migrants, and people of various ethnic backgrounds. In this Special Feature, we dive deeper into the issue.
All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.
The fact that the current pandemic is affecting people’s mental health as much as their physical health is no secret.
In speaking to Medical News Today, people from all over the world have reported increased levels of stress and anxiety.
Based on the known psychological effects of other events that have left a deep mark on global communities in the past, researchers warn that the COVID-19 pandemic could have dire consequences for mental health.
For instance, a position paper in The Lancet Psychiatry in April argues that in the wake of the pandemic, the world may face an increase in anxiety and emotional distress, as well as other severe effects on mental health.
However, although the pandemic is mentally and emotionally affecting many people all over the world, past evidence suggests that it may affect certain communities more than others — particularly because they have reduced access to mental health services and other healthcare resources.
According to a 2008 study in the journal Health Affairs — which primarily discusses issues inherent to the United States — “[m]ental healthcare disparities, defined as unfair differences in access to or quality of care according to race and ethnicity, are quite common.”
“In general, minorities, particularly African Americans, have poorer health and health outcomes than do [white people],” its authors note.
Although “Hispanics and [black individuals] [have a] lower risk of having a psychiatric disorder as compared with their white counterparts, […] those who become ill tend to have more persistent disorders.”
But why do people of color and certain other ethnic groups experience more long-term effects on mental health? Also, how is this pandemic affecting their mental health, and what should decision makers do to support these communities?
We are considering these questions as part of a series of features looking at the disproportionate impact the current pandemic is having on certain groups and on issues of society-wide importance.
For this feature, we spoke to people of diverse ethnic backgrounds in the U.S., asking them about their experiences with mental health and mental healthcare.
We also looked at existing data about mental health burdens and access to healthcare for different communities in the U.S.
To begin with, past research has shown that African American, Native Hawaiian, Hispanic, and Asian individuals have higher rates of post-traumatic stress disorder (PTSD) than white individuals.
Since some specialists have already expressed concern that the current pandemic may increase the risk of PTSD in the general population, it may be that it affects people of color and those from diverse ethnic groups even more significantly.
When asked about the impact that the current pandemic has had on their mental health, one person of color told MNT: “I live with PTSD, depression, and anxiety, and I’ve had both positive and negative experiences with mental health during this time.”
“I feel I’ve been relatively lucky compared [with] many other [people of color] I know, in that I have a job that allows me to work from home, so I can keep a full-time income without taking the health risk of leaving home,” they said, adding:
“I know many others don’t have the same opportunities. For example, they work in service industries where they’ve had their hours cut, or lost their jobs altogether, or they have to put themselves at risk by continuing to perform tasks that don’t allow for physical distancing.”
Data from the Centers for Disease Control and Prevention (CDC), albeit incomplete, suggest that of all confirmed cases of COVID-19 in the U.S., 27% have been in black or African American individuals and 14.2% have been in people who describe their background as “multiple” or “other.”
People of diverse ethnicities also account for a large proportion of the workforce deemed “essential” during the pandemic, which means that they are more at risk of contracting SARS-CoV-2, the new coronavirus.
In fact, according to the CDC, Hispanic people form 53% of the agricultural workforce in the U.S., while black and African American individuals make up 30% of nurses.
The aforementioned respondent said that their family members also fall into this category.
“I have many family members working in healthcare, and they don’t have the option of staying home — which then means they have to then stay away from me and other family members to avoid passing on the risk of contracting the virus,” they told MNT.
The significant exposure of people of color to the coronavirus is likely to leave a lasting mark on their mental health: A recent study from China shows that many COVID-19 survivors face traumatic stress in the aftermath of local outbreaks.
The fact that people of color and certain other ethnic groups may face a more severe and longer lasting mental health impact than white populations is, in part, explained by the fact that they are often unable to access appropriate mental healthcare.
According to the American Psychological Association (APA), a large number of people in the U.S. who identify as a person of color or as belonging to a minority ethnic group experience a significant degree of marginalization and discrimination. This is a top risk factor for poor mental health outcomes in the long-term.
The APA explain that this is because discrimination and marginalization can hinder socioeconomic growth as well as access to appropriate healthcare, including formal mental health support.
Reports from 2001 found that even when these people do access formal mental healthcare, people of color are faced with bias from health professionals, who sometimes fall short in providing the right form of intervention for them.
However, discrimination has also taken on another aspect during the COVID-19 pandemic. Because the original epicenter of the SARS-CoV-2 outbreak was a city in China, people of Asian descent all around the world have started reporting an increase in racism and xenophobic violence.
The nongovernmental human rights organization Human Rights Watch (HRW) have recently issued a statement expressing their concern about the rise in anti-Asian discrimination.
“Racism and physical attacks on Asians and people of Asian descent have spread with the COVID-19 pandemic, and government leaders need to act decisively to address the trend,” says John Sifton, HRW advocacy director for Asia.
In speaking to MNT, a U.S. citizen who identifies as Chinese and Asian American expressed deep concern about this intensification of racism:
“May is actually Asian and Pacific Islander American Heritage Month, which is usually a time for us to celebrate the achievements we’ve made as a community. Instead, [it] has been an increasingly stressful time for the Asian community. Many of us have been reminded that despite being the ‘model minority,’ the title can be taken away from us and the underlying racism that we want to think we’ve moved past can come back instantly.”
Specialists have long recognized the fact that racism, discrimination, and xenophobia are particularly harmful to mental health.
In a 2018 position statement, the Royal College of Psychiatrists in the United Kingdom point out “that racism and racial discrimination is one of many factors [that] can have a significant, negative impact on a person’s life chances and mental health.”
“We are particularly concerned about the disproportionate impact on people from black, Asian, and minority ethnic communities,” they emphasize.
Besides systemic biases, discrimination, and financial barriers, another significant obstacle that sometimes stands in the way of people’s access to healthcare is language.
For example, a 2015 study in Health and Social Care in the Community found that “[l]anguage and concerns about services’ cultural and religious appropriateness” prevent a significant number of people from diverse ethnic backgrounds from receiving much-needed formal support.
In a teleconference from April 24, 2020 — sponsored by the Robert Wood Johnson Foundation, a public health philanthropy based in Princeton, NJ — Prof. Margarita Alegría, chief of the Disparities Research Unit at Massachusetts General Hospital in Boston, argued that language barriers can be an issue for people belonging to minority groups.
“Many linguistic minorities, especially Latinos, will not have suitable resources to really access mental healthcare and substance abuse [resources] — we already know that,” she said, after warning about the pandemic’s likely impact on the mental health of people from diverse ethnic backgrounds.
The feedback that MNT received from contributors outlines similar concerns. One person, who identifies as Hispanic and Mexican American, expressed worries about family members who may not be able to access support and accurate health information due to language barriers.
“Getting resources in Spanish at the beginning of this pandemic was tough, so I had to scavenge the internet to find reliable sources to share with my Spanish-speaking family members,” this person told us.
The gap to mental healthcare and formal social support grows even wider for those with an undocumented status.
“[Staying] at home under irritability and frustration might lead to domestic violence and child maltreatment, but people who are undocumented […] may not report [instances of domestic abuse] for fear of deportation,” Prof. Alegría warned.
“We also know that some people are not even willing to go and seek medical care because [they are] worried about the Public Charge.”
This rule indicates that the authorities can deny a person a U.S. visa or U.S. citizenship if it becomes apparent that they have accessed public health benefits while staying in the country.
Worries surrounding undocumented status also came across clearly in the response from our contributor.
“My parents have had to continue working and can’t control who they’re exposed to at work,” this person said. “That has left me uneasy about their health. They can’t telework because of their circumstance either; they’re also undocumented and have blue collar jobs.”
Stigma surrounding mental health issues in culturally homogeneous groups can also stop people from seeking the support they need.
A 2017 study in the Rand Health Quarterly, for instance, found that levels of self-stigma were particularly high among Asian American and Latino participants.
“For Asian American [people], stigma appears to figure most prominently in their beliefs about the level of functioning and status of individuals with mental health problems,” the study authors write.
For Latino respondents, the level of self-stigmatization appeared to depend on whether or not the researchers conducted the interviews in English or Spanish.
The contributors who reached out to MNT also consistently expressed the burden of mental health stigma in their respective communities.
“Personally, I know I can access mental health support, but I often put it as a last priority,” said the contributor who identifies as Chinese and Asian American.
They added: “I know that a lot of the Asian community has never put mental health as a priority because it’s been seen as being weak to seek help. Asians are also split into so many different subgroups, and there are definitely certain groups that are less privileged and have less access to mental health resources (i.e., the East Asian communities).”
The respondent who identifies as Hispanic and Mexican American made a similar point about their own community:
“Many of my family in the U.S. lacks easy access to mental health support from lack of financial stability. [Mental health issues have] also been stereotyped as a sign of weakness that […] further deters them from seeking any help.”
“I wish there [were] a bigger push for mental health support at a lower cost for communities my parents are in and others throughout the U.S,” they said.
“I also wish there could be a greater focus to change the mindsets of the poorer communities from thinking that mental health is a further sign of weakness as they strive to be resilient through their socioeconomic challenges,” they added.
As with all complex healthcare issues, there is no easy answer when it comes to redressing the disparities in access to formal support for people of color and those from other diverse ethnic backgrounds.
Nevertheless, where there is a will, there is a way. Both researchers and members of the public have been outlining some viable ways forward, and some employers are already making an effort to step up to the challenge.
“I feel fortunate to work where I do — a place that has provided formal opportunities for me to see to my well-being through designating company holidays, offering a therapy benefit, [and] eliminating logistical stresses that I know [other people of color] face,” one respondent told us.
“For example, I don’t have to use [paid time off] or go unpaid to take any kind of break during my workday, and I don’t ‘get to’ use [paid time off] to care for my children while school is happening at home,” they said, explaining their employer’s contribution in offsetting the mental health impact of the pandemic.
However, changes must be systemic in order to redress the balance for all communities in the U.S.
In her talk for the Robert Wood Johnson Foundation, Prof. Alegría argued that the best way of ramping up mental health support for certain ethnic groups is both by looking at social research and by actively listening to the communities that require that support.
“Making sure that we integrate social science disciplines to understand what’s needed in each local context” is the way to go, she said.
Additionally, “[c]reating mobile teams, crisis intervention units, and especially liaison services that can operate within the community clinics” during and after the pandemic could help address those disparities, in Prof. Alegría’s opinion.
To address institutionalized racism, she went on, decision makers should focus on policy innovation with people of color and diverse communities as their focus.
To bridge the gap between undocumented migrants and access to mental healthcare through nonprofit organizations, she advised “actually [having] community health workers that are trained by licensed clinicians that can actually offer help in terms of mental health, providing support, providing evidence-based treatment, […] so that people out in the community can receive mental healthcare and substance abuse care actually in their language [from] people that they trust.”
“[We can do it] […] directly through community-based organizations that they trust. If you ask people in the community, they can tell you who are the people, the leaders they trust, and they can also tell you [which] are the community-based organizations where they feel they’re safe.”
– Prof. Margarita Alegría
Such initiatives would formalize the efforts that people from diverse communities have been making for years to help bring support to their peers.
“Online, I’m […] connected to many communities where sharing openly about mental health is the norm,” one contributor told MNT. “Since these communities have been building since long before this moment, I think it’s helped to now have support systems already in place, so I don’t feel alone when my anxiety or depression is triggered by the stress and isolation.”
“I’m a millennial, and many of my [people of color] peers are breaking away from our families’ traditional shame around mental health to facilitate sharing openly across digital spaces. So in many ways, it’s been difficult to go into physical isolation, but on the other hand, we’ve been working on this muscle of supporting each other through virtual spaces since we were teenagers,” they added.
Recently, the World Health Organization (WHO) called for a global commitment to ramping up mental health support.
According to Dr. Tedros Adhanom Ghebreyesus, the WHO director general, “[t]he impact of the pandemic on people’s mental health is already extremely concerning.”
He has made it clear that the time to shift harmful mindsets and invest in concerted action to safeguard everyone’s well-being is now: “A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”