Literature review: Disparities in depression care for racial and ethnic minoritized youth - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice J Mood Anxiety Disord . 2026 Apr 1;14:100176. doi: 10.1016/j.xjmad.2026.100176 Search in PMC Search in PubMed View in NLM Catalog Add to search Literature review: Disparities in depression care for racial and ethnic minoritized youth ☆ Vanessa C D’Souza Vanessa C D’Souza a Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN, USA b Alberta Health Services and Recovery, Alberta, Canada Find articles by Vanessa C D’Souza a, b, 1, 2 , Monica J Taylor-Desir Monica J Taylor-Desir a Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN, USA Find articles by Monica J Taylor-Desir a, ⁎, 1, 2, 3 , Andrés J Pumariega Andrés J Pumariega c University of Florida, Department of Psychiatry, College of Medicine, Gainesville, FL, USA Find articles by Andrés J Pumariega c, 3 Author information Article notes Copyright and License information a Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN, USA b Alberta Health Services and Recovery, Alberta, Canada c University of Florida, Department of Psychiatry, College of Medicine, Gainesville, FL, USA ⁎ Correspondence to: 200 1st SW, Rochester, MN, USA [email protected] 1 contributed equally to this work 2 The authors thank Stephen Strakowski, M.D.,of the University of Texas at Austin Dell School of Medicine and Indiana University School of Medicine; Lori Solmonson, Mayo Clinic for their help with analyses and manuscript preparation. 3 Drs. Taylor-Desir and Pumariega are members of the National Network of Depression Centers. Received 2025 Sep 9; Revised 2026 Mar 26; Accepted 2026 Mar 31; Collection date 2026 Jun. © 2026 The Authors. Published by Elsevier Inc. on behalf of Anxiety and Depression Association of America. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). PMC Copyright notice PMCID: PMC13091293 PMID: 42006562 Abstract Objective The aims of this paper are to review the current literature on racial and ethnic disparities in depression care for children and adolescents and identify strategies to provide culturally responsive care that eliminates disparities in depression care for youth. Our tertiary aim is to highlight gaps in the current literature. Methods A systematic search of studies from January 1990 to July 2024 utilized the following databases: APA PsycInfo, EBM Reviews-Cochrane Register of Controlled Trials, EMB-Reviews, Cochrane Database of Systematic Reviews, and OVID Medline. Inclusion criteria encompassed various categories: ethnic and racial disparities in populations and clinical care, culturally informed interventions, and barriers to addressing access to care. Exclusion criteria include: articles not focused on depression care, articles without measurements of depressive symptoms, and partially completed studies. Results 1403 abstracts were screened, with 24 articles meeting inclusion criteria. Barriers identified for youth include perceived stigma, historical barriers, and access to care. Among African Americans, Latinx, and Asian Americans sociocultural factors contribute to barriers for depression care and treatment utilization. Interventions identified included community-based programs and parental education with a culturally informed approach. Conclusion The majority of the included studies were cross sectional studies which limits causal inference. Family and community-based interventions along with parental education were most effective in overcoming racial and ethnic disparities. There is an ongoing need to shift future studies to address the knowledge gaps around depression care for youth including improved strategies for early identification of depression, and effectiveness of interventions in diverse populations of youth. Keywords: Racial/ethnic disparities, Depression care, Minoritized youth, Barriers Highlights • Barriers identified were perceived stigma, historical barriers, and access to care. • Community and school-based programs are key interventions to address disparities in depression care. • Parental education is needed to overcome disparities in depression care. • Future studies need to carefully consider patient populations included. Introduction Approximately 3% of youth worldwide are reported to have a depressive disorder [1] . Depressive disorders in children and adolescents lead to an elevated risk of suicide, school failure, substance use, and social isolation. The prevalence of depression in children and adolescents, individuals who are 18 years old and younger, is increasing. By the age of 18, as many as 20% of youth in the United States (U.S.) will have experienced at least one episode of major depression. [2] . The most recent American Academy of Child and Adolescent Psychiatry (AACAP) clinical practice guideline for depressive disorders in youth was published by Walter et al. (2023). This guideline integrates expert consensus on diagnostic assessment with empirically supported recommendations for treatment [2] . The principal components of the guideline are summarized in Fig. 1 . Despite alignment with recommendations from the United States Preventive Services Task Force, substantial challenges persist in the early identification of depressive disorders among youth, particularly those aged 11 years old and younger. Moreover, these treatment recommendations are predominantly derived from randomized controlled trials with limited inclusion of minoritized populations, thereby perpetuating disparities in depression care among racially and ethnically diverse youth. Ensuring adequate and culturally responsive care for children and adolescents with depression remains a challenge, especially among racial and ethnic minority youth. Fig. 1. Open in a new tab An outline of current practice parameter for depression care. AACAP has recognized the concerns about disparities in psychiatric care which led to the development of a practice parameter for cultural competence in child and adolescent psychiatric practice in 2013. Thirteen principles are recommended for clinicians to implement in their practice, including identifying barriers, using the language children and their family are proficient in, being cognizant of cultural bias and applying knowledge of cultural differences in symptomatic presentation [3] . This practice parameter has facilitated clinicians addressing disparities in care for racial and ethnic minoritized youth, but implementation can be challenging [4] . The practice parameter assists clinicians in decision making but does not define standards of care. The rapidly changing demographic of the U.S., where European American children and adolescents are no longer the majority (as of 2022), presents clinicians and health systems with an urgent need to address the existent racial and ethnic disparities in pediatric depression care [5] . Previous key studies for youth with depression that were included in the AACAP practice guideline for depressive disorders did not initially focus on the impact of race and ethnicity on depression care. For example, demographics were often categorized as White and non-White populations. For example, in the Treatment for Adolescents with Depression Study (TADS) [6] , gender, racial or ethnic majority-minority status (White versus non-White) did not show statistical significance in depression care, implying that the same treatment approaches can be used broadly in adolescents. Over time, it has become more apparent how current racial and ethnic health service disparities for minoritized youth are unjust, inequitable and in need of remediation. The prevalence of psychiatric disorders including depression are all influenced by health service disparities including access to care, quality of care, stigma, and treatment recommendations [7] , [8] . Historically, Black youth had lower rates of suicide and suicide attempts. However, the prevalence of suicide attempts among Black youth has notably increased in the most recent years, and related to disparities in health services [9] . Both Black and Hispanic youth often report higher rates of suicidal ideation compared to White youth [9] , [10] . This emphasizes the importance of recognizing the variance of symptom presentation for depressive disorders by race and ethnicity, and psychosocial factors impacting the severity and prognosis of the depressive disorder. The aim of this review is to outline the existing literature on racial and ethnic disparities in depression care for children and adolescents. Our secondary aim, based on the findings of available literature, is to identify strategies to overcome barriers and provide responsive care that reduces or eliminates these disparities in depression care for youth. Our tertiary aim is to highlight gaps in the current literature that need to be addressed in future studies. Methods Search strategy This systematic literature review utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines ( Fig. 2 ) [11] . The electronic search targeted empirical, peer-reviewed journal articles published between January 1990 and July 2024, in the following databases: the following databases: APA PsycInfo, EBM Reviews-Cochrane Register of Controlled Trials, EMB-Reviews, Cochrane Database of Systematic Reviews, OVID Medline. The search was conducted from January 1990 to July 2024. Search terms included “depression”, “antidepressants”, “healthcare disparities”, “alternative medicines”, and “culturally adapt”. Initially the search was conducted for racial and ethnic disparities in depression care across the life span. Fig. 2. Open in a new tab PRISMA diagram. Inclusion & exclusion criteria Inclusion criteria for the identified articles included the various categories: ethnic/racial disparities in populations and clinical care, depression treatment, culturally informed interventions, subjects included in the study were 24 years old and younger, and barriers to addressing access to care and interventions to address them. Exclusion criteria for articles consisted of: not focusing on depression care, lack of objective measurements of depressive symptoms, perinatal depression, the abstract referred generically to depressive symptoms or diagnosis, and the study was a published abstract from conference presentations or a partially completed study. This approach with our search strategy allowed variance to incorporate as many articles as possible. Data extraction & synthesis of results Title and abstract screening, full-text review, and extraction were completed using a web-based software, Covidence. Initially, all titles/abstracts were screened by authors using the exclusion and inclusion criteria discussed above. Full-text articles were retrieved and reviewed by two authors independently. If there was any disagreement during this process regarding including the study and categorization of the study, consensus was achieved with a third reviewer. Studies that met inclusion criteria based on full-text review underwent data extraction by two authors independently with the use of a standardized data extraction grid. Data extraction consisted of further analysis of each study including: study population, geographic location, research design, area of depression care (e.g. Identification, barriers to care, and interventions), objective depression measures used, main outcome findings, and limitations of the study. Data extraction was contingent on information provided by each study. During data extraction, if a consensus was needed on a particular study, the third investigator reviewed the data extraction grid. Results Study selection A total of 1403 abstracts of studies were screened, and from these five (5) were identified as duplicates. Of these, 320 studies passed the initial title and abstract screening, and only 24 of these studies focused on depression care for children and adolescents and were selected for data extraction, as outlined in Fig. 2 . The studies selected included a number of methodologies: cross sectional studies, randomized controlled trials, case control studies, qualitative research studies, and a non-randomized experimental study. All participants in the included studies self-reported race and ethnicity. The terminology used to describe racial and ethnic groups reflects the language employed in the original studies, ensuring alignment with the authors’ categorizations and data collection methods. Characteristics of the included studies are described in Table 1 . We will discuss the abstracts identified below by area of depression care. Table 1. Overview of included studies. Area of depression care Authors Publication year Study design Population description Measurement of depression Summary of findings Identification Algeria et al. [12] 2012 Cross sectional study Adolescents, 13–17 years old, (n = 904), and their parents. Race/ethnicity were self-reported and included non-Latinx white, Latinx and non-Latinx black. Modified version of Composite International Diagnostic Interview Mental Health Service Use This study highlights concerns about parents of minority race and ethnicity being less likely than other parents to identify disorders/concerns in children. Non-Latinx blacks who met criteria for depressive disorder not were less likely to use services (47.9%) than Latinx (71.1%) or non-Latinx white (72.1%) counterparts. Therefore, schools are critical in early detection for mental health in adolescents, especially for non-Latinx black. Guo et al. [13] 2017 Randomized controlled trial Students in grade 7 and 8 from 13 elementary schools in the same school district (n = 2494). Race and ethnicity included were Asian American, Latinx, Non-Hispanic White and Black. Patient Health Questionnaire-9 modified for adolescents (PHQ-9 A) Depression screening was successful in identifying students with mental health needs who may be overlooked by routine routes of referral. Specifically, Asian American students were less likely to be referred to school based mental health services for depression than Latinx students. Caregivers of students who were referred by PHQ-A screening only were less likely to provide consent to treatment relative to caregivers of students referred by routine methods. Velez- Grau et al. [14] 2023 Cross sectional study Latinx and Black youth age 13–17 years old (n = 61) PHQ-9 A Perceived burdensomeness was significantly associated with increased persistent depressive disorder among Latinx and Black youths. Thwarted belongingness was not significantly associated with persistent depressive disorder in adolescents. Identification Calzada et al. [15] 2024 Cross sectional study Mother-child pairs (n = 749). Mother's identified as Mexican or Dominican and the child (average age was 4–5 years old) was enrolled in school. Participants were from predominantly immigrant communities. Behavior Assessment System for Children-Second Edition (BASC-2) Within each ethnic group (Mexican and Dominican), English-speaking children had higher scores than Spanish-speaking children on teacher-rated social skills and on emotion knowledge. Mother- and teacher-rated withdrawn behavior (when children were 4 or 5 years old) was the most consistent predictor of internalizing problems over time including depression. Park et al. [16] 2024 Cross sectional study Asian American adolescents in grades 7–12 (n = 689). It was a stratified sample of 80 high schools and 52 middle schools across the United States. Center for Epidemiological Studies–Depression (CES-D) Asian American students who perceived higher levels of prejudice from their peers reported significantly lower levels of school belonging. Asian American students also reported higher levels of perceived prejudice. from teachers which impacted school belonging. There is a significant association between school belonging and adolescent depressive symptoms. Barriers Angold et al. [17] 2002 Cross sectional study Age 9–17 years old (n = 920) that self identified as African American, White, and other. Child and Adolescent Psychiatric Assessment, Parent or caregiver completed Child and Adolescent Impact Assessment White youth had a higher rate of depressive disorders and were slightly more likely to use specialty mental health services compared to African Americans (6.1% vs 6.2%, respectively). Identified a large gap between the use of mental health services and need for services. Chandra et al. [18] 2009 Case control study Participants consisted of adolescents (13–18 years old) interested in the study (n = 324), with parent consent from seven healthcare organizations in Los Angeles and Washington DC. Racial and ethnic backgrounds included Latino, African American, and White. Diagnostic Interview Schedule for Children Depression Module Latinx and African American adolescents had lower average scores on antidepressant knowledge (p < .01) and counseling knowledge compared to white adolescents (p < .01). Parent antidepressant knowledge had an impact on treatment for adolescents as they reported turning to them for advice. Adolescent knowledge about medication and counseling were associated with a willingness to seek active treatment. Barriers Breland-Noble et al. [19] 2010 Qualitative research study American adolescents ages 11–17 years old (n = 28), who self identify as Black/African American (non-Latinx). Children's Depression Rating Scale (CDRS), K-SADS-PL, Suicide Ideation Questionanneire-Jr Derived 5 themes describing African American adolescents’ experience of depression and suggested mechanisms for improving African American youth treatment engagement: adolescent pluralism in depression management, triggers and outcomes, impressions of treatment, trust and frustration, and recommendations. Rose et al. [20] 2011 Cross sectional study Adolescents ages 12–17 years old (n = 108) and their caregivers participated in the study. Adolescents self identified as African American, mixed race, Latino, or American Indian. Approximately 54% of the sample was female. Reynolds Adolescent Depression Scale 2nd edition (RADS-2) Approximately 77% of the adolescents who reported mild to severe depressive symptoms perceived a need for treatment from a psychiatrist, counselor, or both. There was a statistically significant association and relation between perceived stigma, particularly self-stigma, and depression severity. Barriers Caporino et al. [21] 2014 Cross sectional study Female high school students, approximately half of (n = 36) self-identified as Hispanic, with the remaining (n = 31) self-identifying as non-Hispanic White. RADS-2 Both Hispanic and non-Hispanic White adolescents favor psychological treatments over pharmacotherapy. Among Hispanic participants, overall ratings of treatment acceptability were significantly higher for bicultural adolescents than Hispanic adolescents immersed predominantly in non-Hispanic culture. Villodas et al. [22] 2019 Cross sectional study Teachers ( n = 157) from regular education classrooms at 17 elementary schools in a large, diverse school district anonymously nominated the boy (n = 157) and girl (n = 156) in their class whom they considered the best candidate for prevention services provided by the university-based services research center conducting the study during the 1994–95 academic school year. Children's symptom Inventory, fourth edition, which included 10 items for depression Black students were four times more likely to be nominated than White or Latinx students for prevention services, and ten times more likely than Asian-American students. It was found that externalizing problems and symptoms of inattention and major depression significantly predicted teachers' services nominations. Barriers Assari et al. [23] 2020 Cross sectional study Non-Hispanic White or African American 8–11 years old (n = 7067) from the Adolescent Brain Cognitive Development study with data on suicide attempts. Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) The protective effects of parent education and marital status against depressed mood and suicidal attempts are diminished for African American adolescents compared to White adolescents. Bond et al. [24] 2024 Cross sectional study Undergraduate students, 18–24 years old experiencing suicidal thoughts and behaviors (n = 4198). Individuals self-identified as White, Black/African American, Asian American/Asian, Hispanic/Latinx, Other (Native Hawaiian/Pacific Islander, Middle Eastern/Arab/Arab American, American Indian/Alaskan Native, and other). PHQ-9 Black/African Americans were 56% less likely to report formal help-seeking intentions including mental health professionals, general practitioners. Hispanic/Latinos were 30% less likely to have informal help-seeking intentions including family members or friends. Asian American/Asian students were 28% more likely to have formal help-seeking intentions but do not actively engage in formal mental health seeking behaviors. Barriers Mora Ringle et al. [25] 2024 Cross sectional study 11–17 years old experiencing depression (n = 211). Participants self-identified as White, Latin/Hispanic, Asian, African American, more than one race and, other. Mood and feelings questionnaire- short (13-item measure that assesses levels of depression in adolescents) Adolescent responses resulted in 13 access barriers, with parent-related barriers to accessing mental health services emerged at the forefront of this study. Intervention Richardson et al. [26] 2003 Cross sectional study Youth aged 5–18 years old and were continuously enrolled in Medicaid in Washington State from July 1, 1997 to December 31, 1998, (n = 192, 441). Youth were categorized as being white, Hispanic, black, Native American, Asian/Pacific Islander, other, or unknown based on parents responses. ICD-9 code for a depressive disorder, antidepressant use Mental health specialty visits With the exception of Native Americans, youth in racial and ethnic minority groups were less likely to a depression diagnosis present when compared with white youth. In addition, Native American and Hispanic youth were less likely to have received any form of treatment including antidepressant use or mental health visit, 6 months after receiving a diagnosis of a depressive disorder. Intervention Alexandre et al. [27] 2009 Cross sectional study Adolescents 12–17 years old with a major depressive episode within the past year (n = 1169) who were either White or Hispainic. Modified version of the World Health Organization Composite International Diagnostic Interview-Short Form (CIDI-SF) For white adolescents, the odds of receiving adequate care for depression increased with age. White adolescents were 1.55 times more likely than Hispanic youth to receive adequate treatment for a depressive disorder, which could be related to how presentation and interpretation of symptoms differs according to race and ethnicity. Ngo et al. [28] 2009 Randomized controlled trial Self-identified Black, Latinx or White age 13–21 years old youth had endorsed "stem items" for major depression or dysthymia from the 12-month Composite International Diagnostic Interview (n = 325). To diagnose depression, the CIDI was used at base- line; the CES-D was administered only at the six-month follow-up. Black youth in the intervention group who participated in the Youth Partners in Care quality experienced significant reductions in depressive symptoms and had higher rates of use of specialty mental health care at the six-month follow-up. Among Latinx youths, the intervention was associated with significantly greater satisfaction with care. Thomas et al. [29] 2011 Cross sectional study Adolescents, aged 13–19 years old, attending public high school in a southeast town in Texas (n = 1694). Adolescents self identified as African American (31%), Hispanic (38%), and White (31%). CES-D White students were found to have scored 1.84 points higher on the CES-D compared to Hispanic students. It appeared that having access to a school-based mental health clinic did not appear to alleviate ethnic disparity on indicators of accessing and using needed care. It was found that referral sources (parents/ teachers/ counselors) and health care providers interpret depressive symptoms differently depending on an adolescent’s race and ethnicity. Intervention Johnson et al. [30] 2012 Non-randomized experimental study African Adolescent males (13–19 years old) who attended an appointment at a large, university-affiliated, public hospital-based adolescent primary care reproductive health clinic in the southeastern region of the United States (n = 49). CES-D Primary care and reproductive health-care settings are viable settings for the identification of depressive symptoms, particularly among low-income, African American male adolescents.The use of the CES-D with African American adolescents may serve as a first-stage screening device that allows for the identification of depressive mood disorder. Breland-Noble et al. [31] 2015 Qualitative research study Socioeconomically diverse group of participants with depression between the ages of 11–17 years old (n = 28),who self-identify as Black/African American (non-Latinx) from the southeastern United States. CDRS Religion and spirituality play a key role in African American adolescents’ experiences of depression. It is surmised that these factors may be important for improving treatment seeking behaviors and reducing racial mental health disparities in this population of youth. Intervention Weersing et al. [32] 2017 Randomized controlled trial Youth 8.0–16.9 years of age (n = 185) were recruited from 9 pediatric clinics in San Diego, California (n = 4), and the Pittsburgh, Pennsylvania, metropolitan area (n = 5). The primary outcome was clinically significant improvement on the Clinical Global Impression–Improvement scale. Secondary outcomes included the Pediatric Anxiety Rating Scale, CDRS–Revised, and functioning. In this randomized clinical trial, 56.8% of youths in pediatric-based behavioral treatment were clinically improved compared with 28.2% of youths provided with assisted referral, a significant difference. Effects were significantly stronger for Hispanic youths, with 76.5% of those in behavioral treatment improving compared with 7.1% of referred youths. Thus, a pediatric-based brief behavioral treatment for anxiety and depression can have superior benefits compared to usual assisted referral to outpatient mental health care and may address ethnic disparities in outcomes. Pina-Watson et al.31 2019 Cross sectional study Mexican-descent adolescents, 14–20 years old, from a high school located in the Rio Grande Valley region of South Texas (n = 524). The modified version of the CESD-20 Intergenerational acculturative conflict is positively related to depressive symptoms among Mexican-descent adolescents. However, traditional cultural value of familismo may protect against the association of intergenerational acculturative stress on depressive symptoms. As there was no relationship between intergenerational acculturative conflict and depressive symptoms for Mexican descent adolescents who endorsed higher familismo values. Zhang et al. [33] 2021 Cross sectional study Adolescents aged 12–17 years old (n = 4380) from across all 50 states and the District of Columbia, who had a major depressive episode in the past year and received psychotropic prescriptions. Adolescents identified as:African American, non-Hispanic White, Hispanic, Asian American, or 2 or more races. National Comorbidity Survey–Youth derived from the World Health Organization Composite International Diagnostic Interview–Short Form On average, about one sixth of youth experienced a past year MDE, with the highest percentage among youth of two or more races (18.26%) and the lowest proportion among African American youth (12.57%). Among depressed youth who also used specialty mental health services, Caucasian youth (44%) and youth of two or more races (38%) were much more likely to receive psychotropic medications than their counterparts of other racial/ethnic groups. Intervention Siciliano et al. [28] 2024 Cross sectional study Adolescents (ages 12–18 years old) enrolled in the adolescent partial hospital program between January 1, 2019, and April 28, 2023 (n = 1237). PHQ-9 Regarding ethnic and racial identity, most patients were non- Hispanic/Latino (92%) and White (84%), with 12% of the sample identified as Black or African American, 2.3% Asian, 2.3% American Indian/Alaska Native, and 2.0% as multiple racial identities. There was a significant main effect of treatment days since enrollment, where there was a reduction in PHQ-9 scores from the moderately severe (scores of 15–19) to the moderate (scores 10–14) during partial hospital program treatment. Open in a new tab Identification A total of five (5) studies were focused on the identification of racially/ethnically diverse children and youth, or factors contributing to their identification. Sample sizes varied widely from close to 4200 total participants to as low as 61 participants. Below we review some of the main findings. Alegria et al. [12] found that Non-Latinx Black youth with low severity internalized disorders, including major depressive episode and dysthymia, were less likely to be identified/encouraged to seek services compared to Non-Latinx White youth with the same characteristics. Non-Latinx Black youth who met internalizing disorder criteria but were not encouraged to seek services were less likely to use services (47.9%) than Latinx (71.1%) or Non-Latinx White (72.1%) counterparts. They were also less likely to use specialty mental health care, and more likely to use schools, human services, complementary services and services in the justice system [12] . Guo et al. [13] found that depression screening was successful in identifying students who were overlooked by routine routes of referral. They found that Asian American students are less likely to be referred to school based mental health programs (SBMPHs) than Latinx students (OR=.31). This disparity was nonexistent when controlling for indicators of academic functioning. Students that attended a school that conducted universal screening resulted in a 1.63 increase in likelihood of referral to mental health services relative to attending schools without universal screening [13] . More recently, Velez-Grau et al. [14] found perceived burdensomeness was significantly associated with increased identification of persistent depressive disorder among Latinx and Black youth, which could be considered a risk factor. In a study of Mexican and Dominican origin children ages 4–5 years of age, Calzada et al. [15] found that mother and teacher ratings of withdrawn behavior was the most consistent predictor of internalizing problems over time, including depression. Park et al. [16] found that among Asian American middle and high school students, low levels of school belonging were associated with depressive symptoms. Barriers A total of nine (9) studies focused on barriers to access to depression care. Sample sizes ranged widely from over 7000 to about 40 participants (latter in qualitative studies). In general, the consensus was that there is a low level of utilization of mental health specialty care among minoritized populations of children and adolescents. Two studies examined structural factors such as insurance and specialty access. Alexandre et al. [27] examining service utilization by Hispanic versus White youth, found that having Medicaid or State Children’s Health Insurance Program increased the likelihood of receiving mental health services for both Hispanic and White youth. The authors also commented on how Hispanic mistrust of the traditional care system may have also contributed to services disparities [27] . Angold et al. [17] found that White youth were identified as having a higher rate of depressive disorders, with White youth being slightly more likely to receive specialty mental health services. However, White and Black youth were equally likely to receive services in SBMHPs [17] . Various studies examined attitudinal barriers, including stigma, and health literacy factors as barriers. Chandra et al. [18] examined mental health literacy across youth and parents. They found that Latinx and African American adolescents had less knowledge about antidepressants and counseling than White teens, and 52% of Latinx and African American parents were aware of the efficacy of antidepressants in the areas of sleep, energy, and appetite compared to 90% of White parents. They also found that treatment knowledge is a key predictor of treatment seeking [18] . One small study, using qualitative methodology, showed that African American youth demonstrated a lack of willingness to label depression in others and recognize symptoms of depression in themselves, as well as reluctance to accept depression as a medical illness [19] . Rose et al. [20] found that 77% of Black adolescents characterized as being mildly or severely depressed perceived the need for mental health care from a psychiatrist, counselor or both, but found a statistically significant association between perceived stigma, particularly self-stigma, and depression severity. Thomas et al. [29] found Black youth were as likely as White youth to disclose depressive symptoms to an adult but substantially less likely to receive treatment from a health care professional, while Mora Ringle et al. [25] identified 13 access barriers, finding parent related barriers emerging in the forefront. They found Asian adolescents endorsed the highest number of barriers to accessing mental health services [25] , [29] . Assari et al. [23] found the protective effects of parental education and marital status against depressive mood and suicidal ideation are diminished for African American youth as compared to White youth. One study examined acceptability of treatment modality as a barrier, and found that both Hispanic and non-Hispanic White youth favored psychological treatments over pharmacotherapy, with overall ratings of treatment acceptability among Hispanics being higher in more acculturated/ bicultural youth than less acculturated youth [21] . Interventions A total of ten (10) studies focused on interventions for depression care including utilization of specialty mental health services, SBMHP, pastoral and spiritual counseling, incorporating cultural values in treatment, and initiation of pharmacotherapy. Zhang et al. [33] found that adolescents identifying with two or more races (43%) and White youth (40%) were substantially more likely to use specialty mental health services than racially and ethnically minoritized youth (22–30%), with these differences primarily observed in outpatient rather than inpatient settings. [33] . Alexandre et al. [27] , examining service utilization by Hispanic versus White youth, found that 34% of all youth received adequate mental health care in the past year, as compared to 27% of Hispanic youth, with White youth being 1.55 times more likely to receive mental health care compared to Hispanic youth. Thomas et al. [29] found that White students were more likely than their Hispanic counterparts to have received a prior diagnosis of depression. White female adolescents were over four times more likely to report a previous diagnosis of depression when compared to Black female adolescents and nearly three times more likely than Hispanic adolescents [29] . Having access to a SBMHP did not reduce disparity in access or use of care. They concluded that referral sources (parents, teachers, counselors) and health care providers interpreted depressive symptoms differently depending on the youth's race and ethnicity. Non-Latino Black youth with internalizing disorders who were not encouraged by teachers or other adults to seek care were less likely to use specialty mental health services and more likely to utilize human services, school-based supports, and justice system services. [12] . The preferred use of pastoral and spiritual counseling to address mental health concerns has been observed in several racial and ethnic communities. According to Alexandre et al. [27] , Hispanic youth tend to rely more on pastoral and family counseling, decreasing their likelihood of accessing clinically-oriented mental health care, including antidepressant use and repeated visits to specialty mental health providers. A small study of African-American youth noted that religion may serve as a facilitator of care seeking behavior, providing messages of self-care for emotional concerns. In addition, African-American youth identified varying experiences and mixed messages from adults and faith leaders which contributed to youth ambivalence to help seeking within the faith community [31] . Non-religious cultural values may also play an important role in treatment acceptability. Familismo is a traditional Latinx value set which places the needs of the family, nuclear or extended above oneself. High levels of familismo are noted as a protective factor in Mexican-descent adolescents experiencing conflict with caregivers around intergenerational acculturative differences. Harnessing these values in treatment interventions can prevent intergenerational acculturative conflict from contributing to depressive symptoms [34] . Hispanic and non-Hispanic White adolescents are similar in their preference for psychotherapy over pharmacotherapy. Pharmacotherapy is preferred when paired with psychotherapy. Bicultural adolescents, as determined by the Bidimensional Acculturation Scale for Hispanics, rated CBT and family therapy plus pharmacotherapy more acceptable than Hispanic adolescents immersed in a primarily non-Hispanic culture [21] . Racial and ethnic identification in themselves are also associated with treatment selection and experience. Racial and ethnic disparities occur not only when depressed youth and families initiate specialty mental health services but also at the initiation of psychotropic medication. White youth (44%) and youth of two or more races (38%) were much more likely to receive psychotropic medications than their counterparts of other racial and ethnic groups (22–30%) after controlling for confounding factors [33] . Improvements in the quality of depression treatment for youths in primary care settings can improve depression outcomes and rates of use of psychotherapy and counseling in Black and Latino youth [28] . Latinx and Black youth with persistent depressive disorder were more likely to endorse beliefs about being a burden to others. Mental health practitioners may want to consider focusing on the adolescents’ ability to contribute to others, and caregivers’ ability to recognize the contribution of their children, which may reduce feelings of burdensomeness [14] . Brief behavioral therapy showed a stronger response in Hispanic youth as compared to non-Hispanic White youth (X 2 = 14.90, p < .001) [32] . Discussion This scoping review identified approaches for identification of depressive disorders, barriers to identification and treatment, and interventions for depressive disorders for children and adolescents with racial and ethnic disparities. The majority of the studies identified in this review were cross sectional studies. Cross sectional studies can study multiple outcomes and exposures, are effective in generating a hypothesis, and providing a foundation for future in-depth studies. By contrast, cross sectional studies make causal inferences and interpretation of associations difficult [35] . There were a few randomized control studies on specific therapies and pharmacologic treatments included in this review. Nevertheless, the studies identified in this review do contribute some insights that are applicable to effective depression care for ethnically and racially minoritized children and youth. The effectiveness of systematic screening and/or assessment tools for the identification of depression was an overall finding in many of these studies, even ones that focused on barriers to depression care, which is often missed in practice with ethnically and racially minoritized youth. Screening and assessment tools studied included: utilizing the patient health questionnaire (PHQ), Center for Epidemiologic Studies Depression Scale (CES-D), Reynolds Adolescent Depression Scale, Children’s Symptom Inventory, Mood and Feelings Questionnaire, Composite International Diagnostic Interview, Children’s Depression Rating Scale, Diagnostic Interview Schedule for Children - depression module, Kiddie Schedule for Affective Disorders and Schizophrenia, and international classification of disease diagnostic criteria (Refer to Table 1 ). Systematic screening and assessment of depression reduces diagnostic bias and facilitates timely referral and access of mental health care, which are often challenges in ethically and racially minoritized populations. Barriers to depression care identified in this review included various social determinants of health which may cause delay in seeking care until symptoms are more severe potentially due to negative experiences with previous services or symptoms. Socioeconomic status, insurance coverage, employment status of caregivers, language barriers, as well as caregivers’ perceptions of child impairment may create challenges in accessing care [24] . Other barriers were identified in the identified studies which can be readily addressed by systems of care, such as mental health literacy around modalities for depression treatment such as antidepressants [13] , [25] , perceived prejudice [27] , stigma (self and other) [29] , barriers to youth and family belonging and engagement [15] , [20] , [27] , [31] , and differences in symptomatic expression [17] , [22] , [25] , [26] , [28] . The educational system was identified as an important setting in seven (7) of the studies identified, even ones addressing barriers to care. Schools may be the best setting in identifying emerging mental health problems such as depression, which impair the functioning of children and adolescents. Alegria et al. [12] study supports previous evidence of how teachers may have different expectations of behavior of Black youth and may minimize internalizing symptoms, which may present a barrier to care in the educational system. Park et al. [16] emphasized that SBMHP’s should include supports for educators and students by fostering mental health literacy and developing a safe school community that is accepting and welcoming for all students as to reduce stigma. This includes culturally responsive mental health services and programs that target both prevention and treatment of depression [27] . Other studies examined barriers within schools that may interfere with effective identification and referral, such as bias around externalizing symptoms [22] and stigma [20] . Once depression care is accessed by a young person disparities remain within various treatment options. In this review, for example, African-American and Latinx youth had significantly less experience with antidepressants [19] . This disparity may be due to clinician bias in treatment choice but various racial and ethnic populations have significant preference on the types of care preferred to address mental health. Several articles looked at the role of acculturation, cultural identification and their impact on treatment selection and acceptability. For example, Black/African American college students were 56% less likely to report formal help-seeking intentions and 58% less likely to report informal help-seeking intentions when compared to White college students and Asian American college students were 28% more likely to have formal help-seeking intentions [36] . More studies are needed to examine these associations and how this knowledge may be used to reduce disparities in treatment planning. One study identified the role that spirituality and religion play in African Americans’ experiences with depression, so integrating spirituality into depression care as well as outreach to pastoral leaders for involvement in identification and treatment support might be promising approaches [34] . The findings of our literature review are consistent with the recommendations from many guidelines and standards documents on cultural competence and effectiveness developed over the past 25 years for mental health in general and child mental health. These include: the Cultural Competence Standards in Managed Care Mental Health Services: Four Underserved/Underrepresented Racial/Ethnic Groups (1999), the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health (2000), the 2001 Surgeon General report on culture, race, and ethnicity in mental health, the American Psychiatric Association Cultural Formulation, and the American Academy of Child and Adolescent Psychiatry 2013 Cultural Competence practice parameter. These are in the context of increases in immigrant populations, a more multicultural society, and a global syndemic of Covid-19 and racism [5] , [37] , [38] , [39] . In fact, many of these called for systematic objective assessment of psychiatric symptomatology so as to reduce diagnostic bias. The relatively small number of studies on depression care in ethnically and racially minoritized youth during this time period, particularly including systematic assessment, stand in stark contrast with the numerous policy statements and guidelines that emphasized the importance of practices to reduce mental health care disparities. Our systematic review had a number of inherent limitations. Identified articles that met criteria spanned the past 22 years even though the time period of eligibility was the last 34 years. However, the search terms selected, which were focused on depression care, may have created an unintended limitation in articles identified. An example is the epidemiological study by Cuffe et al. [40] , utilizing the 20 item CES-D, which was not included in the 1403 abstracts screened. This early study showed African-American adolescents endorsed higher levels of depression and were significantly undertreated [40] . However, this article did not list any of the search terms used as outlined in the methodology including depression, in the title, abstract, or keywords, thus being excluded from the review. Much as with Cuffe et al., other studies may have identified significant findings around racial and ethnic disparities in depression care where the major focus of the manuscript was not on depression or depression care, or addressed disparities around psychiatric disorders more broadly [40] . The only way to find such articles would be using methodology that could review the content of articles and not just abstracts, titles and keywords, such as machine learning or large language model methods. Another inherent limitation that was intentional, was the inclusion only of studies that used objective measures of depressive symptomatology. This limitation is important if we are to identify literature that includes measurable outcomes, which is rapidly becoming the standard for depression care. 2 Conclusion Though this literature review has limitations, it does point to many areas and som e concrete next steps for research and policy to better address racial and ethnic disparities in depression care for children and adolescents. Overall, focusing on increasing access to specialty mental health care in itself creates a large structural barrier for pediatric populations in general and subsequently ethnically and racially minoritized children in particular. This is an important goal to address disparities, but it is challenging given the shortage of child and adolescent psychiatrists and other child mental health professionals, with a high percentage who are not accepting commercial insurance or Medicaid. There has been some focus both in the literature and service policy on the development of pediatric mental health access programs that utilize a collaborative care model, where child psychiatrists and other mental health professionals provide consultation and support to pediatric primary care providers delivering entry level care [30] , [41] . This is a promising approach which should be promoted, in combination with systematic screening and assessment, but also evaluated in terms of its potential for reducing mental health disparities and depression related disparities for children and youth. In addition, further development of SBMHPs and “drop-in” clinics for mental health in partnership with community agencies, places of worship and adolescent-focused community programs can facilitate access to care. It is important that these services also focus on their cultural acceptability and awareness, mental health literacy, and stigma reduction by the front-line primary care providers and community partners involved, as well as advocacy within the field to adequately reimburse mental health services provided by culturally competent providers. This focus does not exclude the need to both study and address broader societal and structural barriers, such as adequate funding for children's mental health services in general and for outreach services to underserved ethnically and racially minoritized communities, especially for psychological interventions that are acceptable to these communities. Other structural barriers that impact depression care and deserve further attention in research include family socioeconomic status related factors including: caregivers’ time flexibility, social support, parenting skills, and communication efficacy with service providers [31] . Research on the effects of youth and family cultural orientation and beliefs about mental health, differences in treatment acceptability and treatment consent, and initiation of treatment are all important to address the more subtle aspects of cultural adaptation for treatment [14] . Studies that address community attitudes and stigma, with the goal of improving communication regarding depression in diverse communities, are also important to effectively address barriers to care. Studies have focused primarily on African American, Latino, and Asian American youth and families, and more are needed, but more studies are needed including American Indian, bi-racial/bi-cultural adolescents (the fastest growing population group), and rural underserved White populations. Our literature review included studies that utilized various screening and diagnostic tools for depression. The development and evaluation of the validity of measures of depression in racial and ethnic populations is critical for effective identification. For example, reliability and validity of the CES-D has been tested in the African American population, while the PHQ9-A has shown good specificity and sensitivity in Latino and Asian American students [15] , [22] . This work can then result in expanded and more effective regular depression screening, both in primary care and other community settings. Above all, it is important that studies use standard conventions for racial and ethnic identification and adequate sample recruitment and racial/ ethnic sub-analyses that can ensure representation in studies (especially intervention studies), reflecting the racial and ethnic makeup of our American population. Blending different groups as “non-White” or inadequate samples that under-power the representation of different groups should not be acceptable, and adequate funding should be provided to ensure that research findings are specifically relevant to diverse populations of children and youth, especially in studies addressing the efficacy and effectiveness of interventions. Some landmark studies unfortunately did not include adequate recruitment of ethnically and racially minoritized populations and/or failed to conduct racial/ ethnic sub-analyses, thus leaving a gap in our evidence-base [6] . Psychiatry, specifically child and adolescent psychiatry, is well positioned to lead the way with significantly more research in this important area, and to normalize reporting on treatment disparities within general studies. We also need further development of practice parameters and guidelines based on such research, and collaborative work on clinical interventions with ethnically and racially minoritized children, adolescents and families to reduce disparities in depression care in what is now the largest segment of our national population of youth. Disclosure Drs. D’Souza, Taylor-Desir, and Pumariega have reported no biomedical financial interests or potential conflicts of interest. Funding This project was funded by the National Network of Depression Centers Diversity, Equity and Inclusion Task Group. Declaration of Competing Interest Disclosure: Drs. D’Souza, Taylor-Desir, and Pumariega have reported no biomedical financial interests or potential conflicts of interest. Footnotes ☆ A version of this study was presented at the American Psychiatric Association Annual Meeting; May 4–8, 2024; New York, New York. References 1. World Health Organization. Adolescent mental health. Published February 2022. 〈https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health〉 . Accessed on September 1, 2024. 2. Walter H.J., Abright A.R., Bukstein O.G., et al. Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders. J Am Acad Child Adolesc Psychiatry. 2023;62(5):479–502. doi: 10.1016/j.jaac.2022.10.001. [ DOI ] [ PubMed ] [ Google Scholar ] 3. Pumariega A.J., Rothe E., Mian A., et al. Practice parameter for cultural competence in child and adolescent psychiatric practice. J Am Acad Child Adolesc Psychiatry. 2013;52(10):1101–1115. doi: 10.1016/j.jaac.2013.06.019. [ DOI ] [ PubMed ] [ Google Scholar ] 4. Rosselló J., Bernal G. The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. J Consult Clin Psychol. 1999;67(5):734–745. doi: 10.1037//0022-006x.67.5.734. [ DOI ] [ PubMed ] [ Google Scholar ] 5. US Census. 2023 national population projections tables: main series. 2023. 〈https://www.census.gov/data/tables/2023/demo/popproj/2023-summary-tables.html〉 Accessed September 19, 2024. 6. Curry J., Rohde P., Simons A., et al. Predictors and moderators of acute outcome in the treatment for adolescents with depression study (TADS) J Am Acad Child Adolesc Psychiatry. 2006;45(12):1427–1439. doi: 10.1097/01.chi.0000240838.78984.e2. [ DOI ] [ PubMed ] [ Google Scholar ] 7. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley B.D., Stith A.Y., Nelson A.R., editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC) National Academies Press (US); 2003. [ PubMed ] [ Google Scholar ] 8. Alegria M., Vallas M., Pumariega A.J. Racial and ethnic disparities in pediatric mental health. Child Adolesc Psychiatr Clin N Am. 2010;(4):759–774. doi: 10.1016/j.chc.2010.07.001. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 9. Meza J.I., Patel K., Bath E. Black youth suicide crisis: prevalence rates, review of risk and protective factors, and current evidence-based practices. Focus (Am Psychiatr Publ) 2022;20(2):197–203. doi: 10.1176/appi.focus.20210034. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 10. Zayas L.H., Pilat A.M. Suicidal behavior inLatinas: explanatory cultural factors and implications for intervention. Suicide Life Threat Behav. 2008;38(3):334–342. doi: 10.1521/suli.2008.38.3.334. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 11. Moher D., Liberati A., Tetzlaff J., Altman D.G. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009;6(7) doi: 10.1371/journal.pmed.1000097. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 12. Alegria M., Lin J.Y., Green J.G., Sampson N.A., Gruber M.J., Kessler R.C. Role of referrals in mental health service disparities for racial and ethnic minority youth. J Am Acad Child Adolesc Psychiatry. 2012;51(7):703–711.e2. doi: 10.1016/j.jaac.2012.05.005. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Guo S., Kim J.J., Bear L., Lau A.S. Does depression screening in schools reduce adolescent racial/ethnic disparities in accessing treatment? J Clin Child Adolesc Psychol. 2017;46(4):523–536. doi: 10.1080/15374416.2016.1270826. [ DOI ] [ PubMed ] [ Google Scholar ] 14. Velez-Grau C., Mufson L., Byansi W., Lindsey M.A. The association between interpersonal factors, barriers to mental health help-seeking behaviors, and persistent depression disorder among Latinx and Black youths. Psychiatry Res Commun. 2023;3(2) [ Google Scholar ] 15. Calzada E.J., Huang K.-Y., Ursache A., Sevillano L., Kim N. Early social emotional competencies as predictors of internalizing problems in Latinx children. J Appl Dev Psychol. 2024;91:1–12. [ Google Scholar ] 16. Park S.Y., Park Y., Lee J. Long-term effects of the school context on depressive symptoms among Asian Americans. Am J Orthopsychiatry. 2024 doi: 10.1037/ort0000753. Published online June 6, Published online June 6, [ DOI ] [ PubMed ] [ Google Scholar ] 17. Angold A., Erkanli A., Farmer E.M., et al. Psychiatric disorder, impairment, and service use in rural African American and White youth. Arch Gen Psychiatry. 2002;59(10):893–901. doi: 10.1001/archpsyc.59.10.893. [ DOI ] [ PubMed ] [ Google Scholar ] 18. Chandra A., Scott M.M., Jaycox L.H., Meredith L.S., Tanielian T., Burnam A. Racial/ethnic differences in teen and parent perspectives toward depression treatment. J Adolesc Health. 2009;44(6):546–553. doi: 10.1016/j.jadohealth.2008.10.137. [ DOI ] [ PubMed ] [ Google Scholar ] 19. Breland-Noble A.M., Burriss A., Poole H.K. AAKOMA PROJECT adult advisory board. engaging depressed African American adolescents in treatment: lessons from the AAKOMA PROJECT. J Clin Psychol. 2010;66(8):868–879. doi: 10.1002/jclp.20708. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 20. Rose T., Joe S., Lindsey M. Perceived stigma and depression among black adolescents in outpatient treatment. Child Youth Serv Rev. 2011;33(1):161–166. doi: 10.1016/j.childyouth.2010.08.029. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 21. Caporino N.E., Chen J.I., Karver M.S. Preliminary examination of ethnic group differences in adolescent girls' attitudes toward depression treatments. Cult Divers Ethn Minor Psychol. 2014;20(1):37–42. doi: 10.1037/a0033467. [ DOI ] [ PubMed ] [ Google Scholar ] 22. Villodas M.T., Pfiffner L.J., Moses J.O., Hartung C., McBurnett K. The roles of student gender, race, and psychopathology in teachers' identification of students for services. Child Youth Serv Rev. 2019;107 [ Google Scholar ] 23. Assari S., Boyce S., Bazargan M., Caldwell C.H. African Americans' diminished returns of parental education on adolescents' depression and suicide in the adolescent brain cognitive development (ABCD) study. Eur J Invest Health Psychol Educ. 2020;10(2):656–668. doi: 10.3390/ejihpe10020048. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 24. Bond K.L., Turner L.W., Love H.A., Leeper J., Stellefson M., Chaney B.H. Factors associated with intentions to seek formal and informal mental health help among college students with suicidal thoughts and behaviors. J Am Coll Health. 2024 doi: 10.1080/07448481.2024.23629. (Published online) [ DOI ] [ PubMed ] [ Google Scholar ] 25. Mora Ringle V.A., Sung J.Y., Roulston C.A., Schleider J.L. Mixed-methods examination of adolescent-reported barriers to accessing mental health services. J Adolesc Health. 2024;74(2):268–276. doi: 10.1016/j.jadohealth.2023.08.034. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 26. Richardson L.P., DiGiuseppe D., Garrison M., Christakis D.A. Depression in medicaid-covered youth: differences by race and ethnicity. Arch Pediatr Adolesc Med. 2003;157(10):984–989. doi: 10.1001/archpedi.157.10.984. [ DOI ] [ PubMed ] [ Google Scholar ] 27. Alexandre P.K., Martins S.S., Richard P. Disparities in adequate mental health care for past-year major depressive episodes among Caucasian and Hispanic youths. Psychiatr Serv. 2009;60(10):1365–1371. doi: 10.1176/ps.2009.60.10.1365. [ DOI ] [ PubMed ] [ Google Scholar ] 28. Ngo V.K., Asarnow J.R., Lange J., et al. Outcomes for youths from racial-ethnic minority groups in a quality improvement intervention for depression treatment. Psychiatr Serv. 2009;60(10):1357–1364. doi: 10.1176/ps.2009.60.10.1357. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 29. Thomas J.F., Temple J.R., Perez N., Rupp R. Ethnic and gender disparities in needed adolescent mental health care. J Health Care Poor Under. 2011;22(1):101–110. doi: 10.1353/hpu.2011.0029. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 30. Johnson K., Kelch-Oliver K., Smith C.O., Green S.E., Wallace T.M., Kottke M., et al. Depression screenings during routine visits in a reproductive healthcare setting: identifying depressive symptoms in African American adolescent males. Psychology. 2012;3(10):870. [ Google Scholar ] 31. Breland-Noble A.M., Wong M.J., Childers T., Hankerson S., Sotomayor J. Spirituality and religious coping in African American youth with depressive illness. Ment Health Relig Cult. 2015;18(5):330–341. doi: 10.1080/13674676.2015.1056120. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 32. Weersing V.R., Brent D.A., Rozenman M.S., et al. Brief behavioral therapy for pediatric anxiety and depression in primary care: a randomized clinical trial. JAMA Psychiatry. 2017;74(6):571–578. doi: 10.1001/jamapsychiatry.2017.0429. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 33. Zhang S., Cain D.S., Liao M. Racial/Ethnic disparities in the decision points of mental health service use and psychotropic medication receipt among depressed youth. Youth Soc. 2021;53(4):610–635. [ Google Scholar ] 34. Pina-Watson B., Gonzalez I.M., Manzo G. Mexican-descent adolescent resilience through familismo in the context of intergenerational acculturation conflict on depressive symptoms. Transl Issues Psychol Sci. 2019;5(4):326–334. [ Google Scholar ] 35. Four Racial Ethnic Panels. Center for Mental Health Services. Cultural Competence Standards in Managed Care Mental Health Services: Four Underserved/Underrepresented Racial/Ethnic Groups. U.S. Department of Health and Human Services; 1999:68 pages. 36. Asarnow J., Rozenman M., Wiblin J., Zeltzer L. Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: a meta-analysis. JAMA Pedia. 2015;169(10):929–937. doi: 10.1001/jamapediatrics.2015.1141. [ DOI ] [ PubMed ] [ Google Scholar ] 37. The Federal Register. Office of minority health: national standards on culturally and linguistically appropriate services. Federal Register. December 22, 2000. Accessed October1,2024. 〈https://www.federalregister.gov/documents/2000/12/22/00-32685/office-of-minority-health-national-standards-on-culturally-and-linguistically-appropriate-services〉 . 38. U.S. Department of Health and Human Services. Mental health: culture, race, and ethnicity—A supplement to mental health: a report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; 2001. [ PubMed ] 39. Lewis-Fernández R., Aggarwal N.K., Hinton L., Hinton D.E., Kirmayer L.J., editors. DSM-5® Handbook on the Cultural Formulation Interview. American Psychiatric Publishing, Inc; 2016. [ Google Scholar ] 40. Cuffe S.P., Waller J.L., Cuccaro M.L., Pumariega A.J., Garrison C.Z. Race and gender differences in the treatment of psychiatric disorders in young adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34(11) doi: 10.1097/00004583-199511000-00021. 1536-15. [ DOI ] [ PubMed ] [ Google Scholar ] 41. Cinko C., Thrasher A., Sawyer C., Kramer K., West S., Harris E. Using the project ECHO model to increase pediatric primary care provider confidence to independently treat adolescent depression. Acad Psychiatry. 2023;47:360–367. doi: 10.1007/s40596-023-01800-x. 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