Racial and gender disparities in suicide and mental health care utilization in a pediatric primary care setting

Purpose: We examined racial and gender disparities in the underrecognition of mental health disorders in adolescents and young adults as defined by a suicide-related diagnosis without a previous mental or behavioral health diagnosis. Methods: We employed a series of adjusted mixed multilevel logistic regression models to determine the odds of specific mental health diagnoses (anxiety, depression, and suicide-related) in a large, U.S. pediatric ambulatory  care group (ages 8e20 years) using Electronic Medical Record Data. Results: Using the reference group of White males, White females had 17% increased odds of having a suicide-related diagnosis (odds ratio (OR) 1.17, 95% confidence intervals (CI) 1.03, 1.34) and Black females had 48% increased odds of suicide-related diagnosis (OR 1.48, 95% CI 1.28, 1.71). Conversely, White females had 75% increased odds of recorded anxiety (OR 1.75, 95% CI 1.62, 1.89), Black males had 62% decreased odds of anxiety  (OR 0.38, 95% CI 0.33, 0.42), and Black females had 33% decreased odds of anxiety (OR 0.67, 95% CI 0.60, 0.74). White females had 81% increased odds of having recorded depression (OR 1.81, 95% CI 1.62, 2.04) and Black  females had 80% increased odds of underrecognized need for mental or behavioral health diagnosis services (OR 1.80, 95% CI 1.53, 2.13) as defined by a suicide-related diagnosis without a previous mental health diagnosis. Discussion: Black adolescents and young adult patients are either not accessing or identified as needing mental health services at the same rates as their White peers, and Black females are experiencing the most underrecognition of need for mental health services.