(73) Racial Disparities in Mental Health and Substance Use during the COVID-19 Pandemic

Background & Introduction: The COVID-19 pandemic exacerbated existing racial and ethnic disparities in the United States, particularly in health outcomes. Marginalized communities experienced disproportionate effects due to social determinants of health, including job insecurity, access to healthcare, and systemic discrimination (Obinna, 2021; Phiri et al., 2021). This study investigated how the pandemic affected mental health, alcohol use, drug use, and financial conditions across different racial and ethnic groups. We hypothesized that racial and ethnic disparities were associated with the negative effects of the pandemic. Data from the 2021 National Survey on Drug Use and Health (NSDUH) were used to assess differences among White, Black, Hispanic, and Asian populations, examining the health inequities intensified during the pandemic.

Methods: We extracted data from the 2021 National Survey on Drug Use and Health (NSDUH). The cross-sectional survey assessed participants’ consumption of alcohol, tobacco, illicit drugs, prescription drug misuse, mental health, and more. Four key outcomes were analyzed in this research: the effect of the COVID-19 pandemic on mental health, alcohol use, drug use, and financial condition. Participants reported these impacts on a graded scale. Our final study sample included 51,740 respondents who fully answered all questions of interest.

Race and ethnicity were the primary predictors (White, Black, Asian, Hispanic, and others), with additional covariates such as age, marital status, income, and health behaviors. Multivariable ordered logistic regressions were used to examine the association between race/ethnicity and the pandemic’s effects. We performed two sets of regression models, one without and one with interaction terms between age and race/ethnicity. The results were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). All models were weighted according to NSDUH guidelines, and statistical analyses were conducted using R software. The significance level for all tests was set at p < 0.05.

Results: The final study sample included 51,740 participants, with most individuals aged between 18 and 49 (62.97%), White (61.11%), and never married (54.69%). A majority of participants had an income above $50,000 and resided in metropolitan areas. Most participants reported not using cigarettes or marijuana, but alcohol use was common. Approximately 10.24% of participants reported fair or poor health, and over 90% did not misuse prescription or illicit drugs. Many participants reported that their mental health was affected by the pandemic, while alcohol and drug use levels largely remained unchanged. Nearly 60% of participants experienced some level of financial hardship due to the pandemic.

Multivariable logistic regression models showed significant racial and ethnic disparities. Black and Hispanic participants had lower odds of reporting poor mental health due to the pandemic, while Asian participants had higher odds compared to White participants. Age moderated this relationship, with older Black participants (50+) reporting worse mental health outcomes. Hispanic participants aged 30-49 were less likely to report poor mental health.

All minority groups had lower odds of reporting increased alcohol and drug use during the pandemic compared to White participants. However, all racial and ethnic minority groups faced significantly higher odds of experiencing deteriorating financial conditions, particularly Black participants and those categorized as “other.” The interaction between race/ethnicity and age further revealed complexities in the effects of the pandemic across different groups.

Conclusion & Discussion: Our findings emphasized the need for public health interventions specifically targeting racial and ethnic minority groups (Lee et al., 2023). Mental health support and financial relief are particularly necessary for older Black adults and Asian communities, who have borne disproportionate burdens during the pandemic (Chatters et al., 2020; Huang et al., 2023). These disparities reveal the systemic inequities in healthcare access and economic stability in the U.S., especially in times of crisis. To reduce these effects, policies must focus on promoting health equity and ensuring that minority groups receive tailored support during and beyond public health emergencies.

This study has several limitations. The cross-sectional design of the NSDUH dataset prevents us from establishing causality. Additionally, the self-reported nature of the data may introduce self-reported bias. The lack of state identifiers limits our ability to examine regional disparities, and the drug use measures combine illicit drug use with prescription misuse, lacking detailed differentiation. Further research is needed to address these limitations and explore long-term impacts.

References: Chatters, L. M., Taylor, H. O., & Taylor, R. J. (2020). Older Black Americans During COVID-19: Race and Age Double Jeopardy. Health education & behavior: the official publication of the Society for Public Health Education, 47(6), 855–860. https://doi.org/10.1177/1090198120965513
Huang, J. T., Krupenkin, M., Rothschild, D., & Lee Cunningham, J. (2023). The cost of anti-Asian racism during the COVID-19 pandemic. Nature human behaviour, 7(5), 682–695. https://doi.org/10.1038/s41562-022-01493-6
Lee, Y. H., Woods, C., Shelley, M., Arndt, S., Liu, C. T., & Chang, Y. C. (2023). Racial and Ethnic Disparities and Prevalence in Prescription Drug Misuse, Illicit Drug Use, and Combination of Both Behaviors in the United States. International journal of mental health and addiction, 1–17. Advance online publication. https://doi.org/10.1007/s11469-023-01084-0
Obinna D. N. (2021). Confronting Disparities: Race, Ethnicity, and Immigrant Status as Intersectional Determinants in the COVID-19 Era. Health education & behavior: the official publication of the Society for Public Health Education, 48(4), 397–403. https://doi.org/10.1177/10901981211011581
Phiri, P., Delanerolle, G., Al-Sudani, A., & Rathod, S. (2021). COVID-19 and Black, Asian, and Minority Ethnic Communities: A Complex Relationship Without Just Cause. JMIR public health and surveillance, 7(2), e22581. https://doi.org/10.2196/22581