We have known for some time that the physical effects of the pandemic are not evenly distributed across society.
For example, data from the UK and other countries has shown that there have been a disproportionate number of COVID-19 cases, hospitalizations and deaths among people who identify with an ethnic minority.
A study conducted in England during the first two waves of the pandemic found that even when factors such as pre-existing health conditions were taken into account, people of Pakistani and Bangladeshi backgrounds were more likely to die than those who identified as coming from a white background. background.
The reasons for this inequality are complex, but may be related to the clustering of multiple disadvantages, such as living in deprived areas, unemployment and household composition (for example, many people living together in one household).
In addition to physical health, we know that the pandemic has also exacerbated mental health problems. And this burden also appears not to be fairly distributed.
A recent study looked at the mental health toll of the pandemic among people from different ethnic groups in the US and UK. The researchers used data from 691,473 people who responded to the smartphone-based COVID symptoms study between January and June 2021.
They asked participants to report their symptoms of depression and anxiety in a questionnaire based on screening tools commonly used by doctors and researchers to identify people who may be in serious need.
Read more: We studied how COVID affects mental health and brain disorders up to two years after infection – here’s what we found
The researchers found that adults from ethnic minorities in both countries, compared with participants of white background, were more likely to have symptoms of depression and anxiety.
For example, black participants in the US were 16% more likely to screen positively for depression than white participants. Hispanic participants in the US were 23% more likely, and also 23% more likely, to show signs of anxiety compared to white participants. Similar results were seen for black and Asian participants in the UK.
These differences were not fully explained by pandemic-related issues, such as changes in people’s leisure activities. That means increased mental health symptoms cannot simply be explained by limitations caused by COVID. They probably reflect an amplification of existing inequalities and unmet needs when it comes to mental health in different communities.
Depression and anxiety were also more common in black health professionals, compared to white health professionals. This suggests that we need to examine the multitude of factors that influence people’s mental health.
It is likely that the results of this study underestimate even the degree of inequality in mental health needs. By design itself, using a smartphone app, there may have been some degree of digital exclusion or other barriers for people from different communities to participate, e.g. language or cultural factors.
The authors conclude that minority communities in both the US and UK have been disproportionately affected by the mental health burden of COVID.
The findings of this large study do not stand alone, but align with other emerging evidence. For example, a US study that compared data from before and during the pandemic found that the mental health of black, Hispanic and Asian respondents deteriorated compared to white respondents during the pandemic.
This study also found that poor mental health worsens for specific minority communities during times of social crises, such as for black adults after the George Floyd murder, and for Asian adults after the shooting of six Asian women in Atlanta.
Where to now?
The pandemic has brought into sharp focus the inequality that already exists in society. And so as we rebuild and reform, returning to “normal” is not an option.
We need to use the evidence we already have to adapt the way mental health is conceptualized, tailored and delivered to different communities. This may include ensuring that mental health awareness is embedded in all communities, emphasizing support for those in need alongside prevention, and placing services closer to communities in need.
It will also be important to diversify the mental health workforce and ensure that where mental health care is not standard free at the time of access, it is heavily subsidized to prevent cost from becoming a barrier to engagement.
Read more: Yes, there is structural racism in the UK – COVID-19 results prove it
These strategies are all informed by science. They will require continued investment if we are to work to improve mental health for some of the most disadvantaged members of our communities, both in and out of a pandemic.
At the same time, we must recognize that narrowing this gap is more than the right care. It is about a fundamental shift in the way we operate as a society and allocate resources to promote equality.