A blog featuring research, resources and people who are diligently working to improve minority health and eliminate health disparities.
A blog featuring research, resources and people who are diligently working to improve minority health and eliminate health disparities.
By Xinzhi Zhang, M.D., Ph.D.
Program Director, Division of Scientific Programs
National Institute on Minority Health and Health Disparities
Too many stories point to the troubled minds and mental struggles of our youth with the tragic event in Parkland, Florida being one of the latest. Even more saddening, these children’s cries for help are often misunderstood or ignored.
Suicide is the second leading cause of death for children between the ages of 10–24 years old, accounting for 17.6% of deaths in this age group 1 The American Academy of Pediatrics recently updated their guidelines to include universal screening for adolescent depression (youth 12 years of age and older).2 According to the 2016 National Survey on Drug Use and Health, one in eight youth ages 12–17 years old has had a major depressive episode in the past year, with 70% of them having severe impairment.3,4
For young Asian Americans and Pacific Islanders (AAPIs), the suicide rates are also bleak. AAPI adolescent females (15-19 years old) have a higher rate of suicide deaths (21.9%) compared to non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. AAPI males aged 15–19 years have comparable or higher rates of suicide deaths (27.1%) when compared to all other racial and ethnic groups.1
The Model Minority Myth is a stereotype that portrays all Asian Americans as academically gifted and successful. This myth wrongly portrays AAPIs as a prosperous group who have secured economic and educational success, have fewer health problems than the overall population, and do not need public assistance. In reality, AAPIs are a very heterogenous group with immigration from more than 30 different countries and ethnic groups, hundreds of languages and unique dialects, and varying degrees of economic and academic success.
In the U.S., only half of adolescents with depression are diagnosed,5 and among them, approximately 60% do not receive appropriate treatment.4 This situation is amplified in the AAPI community due to stigma and cultural barriers.
Many AAPIs face multiple challenges, including lack of health insurance, limited English proficiency, difficulty of acculturation and lower socioeconomic status. Less than half of AAPIs would seek help for their emotional or mental health concerns than their white counterparts.6 AAPIs tend to dismiss, psychosomaticize, deny or neglect their depressive symptoms for different reasons, such as different conceptualizations of mental health and illness or avoiding family shame.
These reasons have prevented many AAPIs from seeking mental health counseling or medication. Parental expectations in academic excellence, cultural/family obligations, identity conflicts, societal unconscious bias, and discrimination are some of the daily challenges confronting AAPI youth and young adults.
Parental warmth, family cohesion, and strong intergenerational relationships can help AAPI adolescents in expressing experiences with bullying and minimizing internalizing issues with immigrant parents, teachers, or the education system.7 It is critical for the AAPI community to continually strengthen family/parenting skills, build resiliency, and reduce risks for adolescent anxiety and depression. Safe, supportive, and nurturing relationships are important to children. Strong and positive self-esteem is extremely vital and can be associated with reduced risk of depression.
There is an urgent need to improve the mental well-being of future AAPI generations. Learning how to cope with various stressors that life throws at them, work productively and fruitfully, and contribute to their community and society are key for the younger AAPI generations to actualize the great potential that lies within them. It is equally important to reduce the stigma about mental health among the AAPI community and encourage seeking help and counseling when needed. We have a lot of work to do.
Parents, teachers and friends need to know the signs of anxiety and depression, and “act early.” The Centers for Disease Control and Prevention (CDC) offers several suggestions on their Children’s Mental Health website. I highlight a few below.
- Being very afraid when away from parents (separation anxiety)
- Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)
- Being very afraid of school and other places where there are people (social anxiety)
- Being very worried about the future and about bad things happening (general anxiety)
- Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)
- Feeling sad, hopeless, or irritable a lot of the time
- Not wanting to do or enjoy doing fun things
- Changes in eating patterns – eating a lot more or a lot less than usual
- Changes in sleep patterns – sleeping a lot more or a lot less than normal
- Changes in energy – being tired and sluggish or tense and restless a lot of the time
- Having a hard time paying attention
- Feeling worthless, useless, or guilty
- Self-injury and self-destructive behavior
- Heron M. Deaths: Leading Causes for 2015. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2017;66(5):1-76.
- Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D, Glad-Pc Steering G. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics. 2018.
- Federal Interagency Forum on Child and Family Statistics. America’s Children: Key National Indicators of Well-Being. 2017.
- National Institute of Mental Health. Major Depression. Bethesda, MD. See: https://www.nimh.nih.gov/health/statistics/major-depression.shtml: National Institutes of Health;2017.
- Kessler RC, Avenevoli S, Ries Merikangas K. Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry. 2001;49(12):1002-1014.
- Spencer MS, Chen JA, Gee GC, Fabian CG, Takeuchi DT. Discrimination and Mental Health-Related Service Use in a National Study of Asian Americans. Am J Public Health. 2010;100(12):2410-2417.
- Wyatt LC, Ung T, Park R, Kwon SC, Trinh-Shevrin C. Risk Factors of Suicide and Depression among Asian American, Native Hawaiian, and Pacific Islander Youth: A Systematic Literature Review. J Health Care Poor U. 2015;26(2):191-237.
- National Institute of Mental Health (NIMH):
- The Substance Abuse and Mental Health Services Administration (SAMHSA): https://www.samhsa.gov/behavioral-health-equity/aanhpi
- Behavioral Health Treatment Services Locator
- Asian American Health Initiative:
By Eliseo J. Pérez-Stable, M.D.
Director, National Institute on Minority Health and Health Disparities
Each year in April, the Office of Minority Health at the U.S. Department of Health and Human Services (HHS) leads our sister HHS agencies in commemorating National Minority Health Month. This year’s theme, “Partnering for Health Equity,” is a sustainable message which we not only recognize this month but also put into practice all year long through our research, training, and outreach programs and activities.
Over the last two and a half years, I have been leading this Institute in research to improve minority health and reduce health disparities in the U.S., as well as help guide other NIH Institutes and Centers on these issues. Our country is often described as a melting pot—representing people from all over the world. However, our research does not reflect the culture. We are continually trying to raise the bar.
NIMHD’s commitment to funding multi-faceted minority health and health disparities research—and supporting underrepresented minority researchers—continues to address the gaps in access to high-quality health care, inclusion in research, and advancing knowledge of issues which affect minorities. Our work in these areas, along with other NIH Institutes and Centers, aims to improve the health of our nation, which is reflected in the health of all populations.
National Minority Health Month provides not only a platform for our mission, but it is also a chance for us to raise the flag for health equity together with our stakeholders, including researchers, public health advocates, and community leaders. NIMHD has the esteemed honor of developing, shaping, and influencing the science of minority health and health disparities. In doing so, we are moving toward touching the lives of those burdened by health disparities. The objective this month is to join forces in efforts to improve access to high-quality health care and advance the health of everyone—through research which reflects the populations we serve.
Through our research collaborations across NIH and externally, we are addressing diseases that disproportionately impact health disparity populations, such as HIV/AIDS, cancer, diabetes, and cardiovascular disease.
Supporting efforts like the NIH All of Us Research Program is one way that we can help address these health problems. The All of Us Research Program is a historic effort to engage one million or more people in research. This program will allow us to gather information to improve our ability to treat and prevent disease based on individual differences in lifestyle, environment, and genetics. These and other factors, known as the social determinants of health, are essential to understanding the complexity of disease and identifying the most effective prevention and treatment strategies. NIMHD joins this effort to promote inclusion of populations historically underrepresented in biomedical research.
Through partnerships like the NIH Minority Health and Health Disparities Strategic Plan, which is currently under development, we look forward to designing specific goals to address innovative research approaches, training to build the next generation of researchers in minority health and health disparities, capacity-building for research institutions focusing their efforts on minority health and health disparities, and inclusion of diverse populations in research studies. We also aim to build upon the community of scholars, advocates, and others interested in promoting health equity.
NIMHD also partners with other NIH Institutes and Centers to enhance diversity in our biomedical workforce. For example, NIMHD actively participates with the NIH Medical Research Scholars Program (MRSP). MRSP is a year-long research enrichment program designed to attract medical, dental, and veterinary students with strong research interests to NIH. The goal of our partnership is to introduce the MRSP to students from diverse racial and ethnic backgrounds and encourage them to consider biomedical research careers.
Our partnerships with external groups provide opportunities to promote health in communities across the nation.
We collaborate with the Omega Psi Phi fraternity on a program called Brother You’re On My Mind (BYOMM). Encompassing workshops, community events, media engagement, and our BYOMM toolkit (which can be found on our website) allows us to help start conversations about mental health in African American men. NIMHD is proud to support this endeavor to help bring awareness of the mental health challenges associated with stress and depression.
We also partner with the GENYOUth Foundation on their program, Fuel Up to Play 60 en Español that is designed to educate Latino students, parents, and communities about the importance of healthy eating and physical activity, create healthier school environments, empower students to choose more healthy foods, and encourage students to be active for at least 60 minutes everyday.
Collaboration and partnership are at the core of NIMHD’s mission, and we look forward to continuing our efforts with NIH Institutes and Centers, HHS agencies, and our external stakeholders as we work together to advance health equity for all populations.
This is the first in a series of guest NIMHD Insights blog posts where NIH Institute and Center (IC) Directors highlight initiatives, resources and funding opportunities relevant to minority health and health disparities research and training at their Institutes. The goal of this guest blog series is to link NIMHD stakeholders to minority health and health disparities-related information and opportunities across NIH.
The inaugural post is from the National Institute of General Medical Sciences (NIGMS). With a $2.6 billion budget, NIGMS supports basic research that increases understanding of biological processes and lays the foundation for advances in disease diagnosis, treatment and prevention.
By Jon R. Lorsch, Ph.D.
Director, National Institute of General Medical Sciences
During my tenure at the Johns Hopkins School of Medicine, one of my proudest achievements was launching a summer research program for Baltimore-area high school students. Many of the students came from groups underrepresented in the biomedical sciences. Most had never been exposed to a career in science.
At NIGMS, I help impact the careers of students and researchers nationwide. Two of the Institute’s five divisions are dedicated to developing a robust, highly skilled, geographically widespread, and inclusive biomedical research workforce.
The Division of Training, Workforce Development, and Diversity offers a suite of programs to science students and scientists already in the workforce. These include:
- Maximizing Access to Research Careers Undergraduate Student Training in Academic Research (MARC U-STAR) awards, which provide support for undergraduate students from underrepresented backgrounds to gain skills and prepare for high-caliber, doctoral-level training. The program supports the final 2 years of undergraduate training for honors students majoring in biomedical sciences with an interest in pursuing a postgraduate degree.
- The Research Initiative for Scientific Enhancement (RISE) program, which aims to help reduce the existing gap between underrepresented and well-represented students in completing doctoral degrees. The program provides grants to institutions with a commitment and history of developing students from underrepresented populations so they can strengthen academic preparation, research training, and professional skills development.
- Building Infrastructure Leading to Diversity (BUILD) grant awards, which help undergraduate institutions engage and retain biomedical research students from diverse backgrounds. (NIGMS manages this NIH Common Fund program.)
The Division for Research Capacity Building focuses on states that historically haven’t received significant levels of NIH research funding. Its programs include:
- Institutional Development Award (IDeA), which supports faculty development and research infrastructure enhancement.
- Native American Research Centers for Health (NARCH) program, which supports partnerships between American Indian/Alaska Native organizations and biomedical research-intensive institutions.
- Science Education Partnership Awards (SEPA), which use innovative education programs to engage students in pre-kindergarten through 12th grade.
- Support of Competitive Research (SCORE) awards, which increase the competitiveness of faculty at institutions with a mission to serve underrepresented students.
NIGMS also participates in NIH-wide programs to enhance the diversity of the NIH-Funded Workforce and to provide research supplements to promote diversity in health-related research.
Through the efforts listed above, NIGMS aims to train and retain an inclusive and diverse workforce. This will in turn maximize opportunities to advance biomedical science, improve our nation’s health, and maintain its global competitiveness.
If you have questions or comments, feel free to reach out to me or the NIGMS staff listed as contacts for our various programs.