Crooks has published a paper, titled “The Impact of COVID-19 Among Black Girls: A Social-Ecological Perspective,” in the Journal of Pediatric Psychology, reporting on the findings of a qualitative study that featured interviews with 25 Black girls—ages 9 to 18—from December 2020 to April 2021. Most participants reported significant psychological and physical consequences, including depression and anxiety, disrupted eating, distorted body image, and changes in self-esteem.
“Black girls are a very vulnerable and unprotected population, especially within the context of COVID,” Crooks says. “I thought it was a really critical question to be asking youth: How has this impacted their perceptions of self?”
Black girls are particularly vulnerable because they enter puberty and develop secondary sex characteristics earlier than their non-Black peers, according to the paper, causing them to suffer from “adultification” and “sexualization by society.” This can lead to elevated sexual and mental health risks.
Crooks found that only two of the girls in the study received any formal sexual education during the pandemic, as schools opted to delay teaching sex education during online learning due to the sensitive nature of the topic.
“Missing such a critical component of education was alarming to me,” she says. “This is a critical period in their life. Just because the world stops, doesn’t mean their bodies stop growing and evolving.”
Social media also played an outsized role in the girls’ lives as they found themselves isolated from peers during quarantine. Some girls struggled with body image issues and eating disorders, Crooks says.
“They were sitting in their houses watching TV, or they were on social media sites like Instagram or Tik Tok, so they were constantly exposed to overly-sexualized, unrealistic expectations for what their bodies are supposed to look like,” Crooks says.
Conversely, a majority of the participants said the isolation and reduction in peer interactions allowed them to engage in emotional healing and self-discovery, independent from peer pressure.
The pandemic also intersected with the Black Lives Matters movement. As the participants increasingly turned to media in lieu of social interactions, they saw mistreatment of Black people by police, including the murders of Breonna Taylor and George Floyd, nationally broadcasted. These messages led to mixed feelings among the participants.
“A lot of what the girls talked about was feeling empowered to be Black and having a sense of pride within their identities,” Crooks says. “On the other hand, there was fear that came with color of their skin – fear of being harmed themselves, or their fathers, brothers or other family members being hurt. There was this constant fear and threat to Black families.”
Crooks says her research shows the need for more school-based programming to bridge the gap in sexual health education in schools, as well as the need for family interventions to instill protective strategies in Black girls to help them be prepared to handle threatening situations.
July is Minority Mental Health Awareness Month and this year’s focus is particularly relevant. Minority populations have had significant stressors this year. The coronavirus pandemic, the national focus on race and systemic racism, and the economic fallout from an unstable economy have created a storm of emotions and concerns.
In 2017, 10.5% (3.5 million) of young adults age 18 to 25 had serious thoughts of suicide including 8.3% of non-Hispanic blacks and 9.2% of Hispanics.
In 2017, 7.5% (2.5 million) of young adults age 18 to 25 had a serious mental illness including 7.6% of non-Hispanic Asians, 5.7% of Hispanics and 4.6% of non-Hispanic blacks.
Feelings of anxiety and other signs of stress may become more pronounced during a global pandemic.
People in some racial and ethnic minority groups may respond more strongly to the stress of a pandemic or crisis.
Because of the vast gaps in health equity and access, many minority populations have trouble finding high-quality mental health care providers and/or a means of getting to a provider to receive care. The pandemic has created a unique situation that can actually be a benefit for some people who have trouble finding good care or getting to an office. Because so many healthcare appointments are now virtual, that could remove one barrier to receiving care, but is wholly dependent on access to reliable technology to be able to connect virtually.
Increased access also depends on changing much deeper levels of the healthcare system. Many mental health providers are overwhelmed with the increased demand for their services during the pandemic. And many providers choose to skirt the often tedious and time consuming insurance process and have opted not to accept insurance and are private pay only. Those two issues can actually create even steeper burdens for those already marginalized by the healthcare system.
MentalHealth.gov offers resources to help families, individuals, educators, and faith and community leaders to begin conversations around mental health among minority populations. Talking about mental health in a normalized and compassionate way can help reduce some of the stigma around mental health issues. People who feel like they can ask for help are often able to then take the steps to get the help they need. If they feel like they are not alone and they are not the only ones who might be struggling, then they will find that getting help is less of a burden. If they feel supported by their community, they feel less need to hide or even deny what they are feeling and experiencing.
Although July calls attention to minority mental health, the issue is one that needs constant attention, but particularly during this time of tremendous and chronic upheaval.
Mental health issues affect millions of families in the United States, and families struggling with the issue often have a hard time finding the right care to help tehir loved ones.
This month, the National Alliance on Mental Illness (NAMI) focuses the spotlight on Minority Mental Health Awareness Month by talking about the discrepancies minorities dealing with mental health issues face and the complex web those who care about them must navigate to get help.
Minority Mental Health Awareness Month highlights the struggle of minorities living with a highly treatable, but often stigmatized illness. Mental health is just as important as physical health to achieve a balanced, healthy life, and the Office of Minority Health notes that mental illness impacts minorities at a greater rate than whites.
Minorities who live with mental illness often face barriers to care that, throughout the nation, can often prevent them from getting tratment of any kind. Depending on the community in which they live, access to high-quality mental health care can be hard to find. With the best teaching hospitals and clinics often located in big cities and psychiatrists and mental health counselors scattered throughout regions, gaining access to help is tough. According to NAMI, language barriers, cultural bias, and resources that don’t fill the need for care also get in the way of people getting essential treatment.
Even in the best situations—if someone has access to care and the insurance to pay for it—some minorities find a rigid cultural stigma against mental health issues. The stigma can be so complex and overwhelming, that it’s enough to keep someone from getting the help they need. If someone has the determination to find proper care, continuing with it can be a lonely struggle, so good support and follow through is especially necessary.
As a nurse, you can help in a couple of ways. With your direct, hands-on caregiving of patients, you can help assess if the patient might have mental health issues underlying their other health concerns. Sometimes, it’s obvious. Erratic or harmful behavior is an obvious warning sign, but more subtle signs can easily be brushed aside: a patient who comes in routinely for aches and pains but nothing is physically wrong, a new mom who mentions her struggle to care for her newborn, the young man who says he can’t sleep for days and then sleeps for three days in a row, or an elderly patient who feels a sense of hopelessness and loneliness after a health change.
All these smaller signs are red flags that something isn’t right and that your patient may be struggling with some form of mental illness. Because there are so many different types of mental illness and so much variation in severity, a front-line nurse can bring in the mental health team for an assessment. They can continue to advocate for the patients to understand the issues they are facing, whether it is lack of care, inability to access care, a cultural belief in mental illness as a personal flaw or weakness, or family that is not supportive or understanding. Communicate what a kind of positive impact mental health treatment can have on their lives and well being.
Showing compassion for patients and a cultural understanding of why they may be reluctant to be diagnosed with a mental illness can have a lasting, positive impact on your patients as well. Let them know they are not alone and that your team can help them find help. They may still refuse, but an open attitude might bring them back.
Understanding the challenges of mental health care with minority populations is important. These complex issues can prevent someone with very treatable forms of things like depression, anxiety, or obsessive-compulsive disorder from growing into a worse problem. Earlier treatment makes a big difference, helps people live better lives, and can prevent a mild form of illness from developing into a more complex and harder-to-treat condition.
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