Hello, my name is Dr. Sarah Vincent, and I'm pleased to moderate this talk by Dr. Rashaun I. Lane, Black Mental Health During the COVID-19 Pandemic, What Does the Data Say? We do want to acknowledge the funders for this project, and it is a collaboration between the American Psychiatric Association and the SAMHSA African American Behavioral Center of Excellence at Morehouse School of Medicine. Funding for the Striving for Excellence series was made possible by grant number H79FG000591 from SAMHSA of the U.S. Department of Health and Human Services. The contents are those of the author and do not necessarily represent the official views of nor un-endorsement by SAMHSA, HHS, or the U.S. Government. The American Psychiatric Association is accredited by the Accreditation Council for Continuing Medical Education, the ACCME, to provide continuing medical education for physicians. The APA designates this live event for a maximum of one AMA PRA Category 1 credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity. How to download handouts, so you can use the handouts area of the attendee control panel from your desktop, and in Instant Join Viewer, you can click the page symbol to display the handouts area. And for the Q&A, which we hope that many of you will participate in, just use the questions area of the attendee control panel. And if you're using Instant Join Webinar, click the question symbol to display the questions area. And Dr. Lane has no financial relationships or conflicts of interest to report. Now I will introduce you to Dr. Rashawn Lane. So Dr. Rashawn Lane is a behavioral scientist in CDC's Division of Heart Disease and Stroke Prevention. She specializes in applying behavioral and social research to apply health equity principles in public health programs. He is a subject matter expert in mental health and chronic comorbidities, including heart failure and hypertension. Rashawn specializes in medical sociology and has responded to multiple public health emergencies, including the 2014 to 2016 West Africa Ebola epidemic, Hurricane Irma and Maria, and the current COVID-19 pandemic. Most recently, she's worked on developing health equity indicators and interventions in cardiovascular disease and designing equitable evaluation frameworks for structural interventions. In CDC's COVID-19 response, she served as a team lead for the monitoring and evaluation and the minority and rural health teams and a subject matter expert for the social behavioral health team. And I will add that Dr. Rashawn not only did this and provided this service during COVID-19, but she wrote her dissertation and finished her PhD while she was doing it. So just an extraordinary person that we have sort of sharing her time and her expertise with us today. And she received that doctorate from the University of California, San Francisco. Great. Well, thank you so much, Dr. Vincent, for that introduction and welcome everyone who's attending to today's session. I'm excited to talk about mental health during the COVID-19 pandemic. As we all know, this is something of concern and an area that we're monitoring here at the CDC. So excited to share a few studies with you today. I'm going to start off by talking a little bit about centering Black voices and thinking about how we conduct research, how we need to think about the epidemic and conjoining forces of mental health and other chronic diseases. And then I'll talk about a few studies from our public health research primarily here at the CDC. And then lastly, we'll come back and talk to some of the addressing root problems in society and thinking about how that impacts mental health as a whole. Next slide. So this first slide here you'll see was the first study that we published on mental health at the CDC last year during the COVID-19 pandemic. I'm going to go into more details about the study, but what we first saw in the summer of last year was that about 40% of US adults that were surveyed were struggling with some form of mental health or substance use. And this morbidity and mortality weekly report was published about a year ago and really started to sound the alarms of some of what we knew we were seeing within healthcare systems, but also what we were seeing at a population level in public health. Next slide. So first I want to talk a little bit about, we understand that the COVID-19 pandemic is one of the worst pandemics that we've seen in almost a century, but we have other pandemics that are coexisting. And so longstanding social, economic, and health inequities have placed many racial and ethnic minority groups at increased risk for SARS-CoV-2 infection, especially considering those who have more severe illness and are dying from COVID-19 that are based on systemic inequities and social determinants of health. And these include racial and ethnic minority discrimination that we've seen throughout the pandemic, including increases in anti-Asian stigma and violence, challenges in accessing healthcare during the pandemic. But we also recognize that there has been, there continues to be challenges in accessing quality housing, their interconnected relationships between poverty, those who are at specific occupation and essential workers who have had higher risk of COVID-19 infections. And the COVID-19 pandemic really amplified these pre-existing social conditions that we saw that are largely impacted by our societal structures, include the systemic racism that we observe and are amplified by social injustices. And so as we witnessed public health emergencies such as COVID-19, we often see that symptoms of mental health disorders, including anxiety and depressive disorders, increase. And population mental health has observed an adverse impact during this pandemic, but also in others such as hurricanes and other natural disasters that we've seen. And so one of the things that we've been focusing on here at the CDC is to think about these potential stresses, not only as is the illness that are caused by the COVID-19 pandemic, but how do we start to mitigate these strategies that are being added in addition to thinking about what we saw early in the pandemic where individuals had to quarantine and we had increased stay at home orders, but that we're also thinking about the general life influences. And so I'm going to share a little bit more about what we need to think about from a more structural lens, and then I'll go into the data. Next slide. Next slide. So over the last year, since the beginning of the pandemic, we've heard this prevailing discourse about we're all in this together and thinking about the COVID-19 pandemic has created this equalizer and that it's possible that everyone can be impacted and could contract the virus. However, this narrative quickly was shown to be an inaccurate reality for Black lives and other Brown indigenous persons in the United States, as we saw increased COVID in these communities. And what we witnessed here is that these longstanding health and social inequities have placed many from minoritized groups at increased risk of dying from COVID-19. And what we've come to know as social determinants of health or conditions where people live, learn, work, and play has affected the quality of life for Black communities. So that's historically and currently these factors are preventing us from having equitable opportunities for economic, physical, and emotional health. Next slide. So I want to turn to thinking about where we were a little bit over a year ago. And there's a CBS News story that I'm not going to play today, but the link is posted here on this slide and hope you are able to access it after today's presentation to think about where we were. And we were at a time where individuals were protesting police sanctioned violence in the streets for many weeks last summer after the death of George Floyd and Breonna Taylor amongst others. And at that time, they were reporting that Black Americans, about 41% had symptoms of anxiety or depression. And when we think about the racial injustice that occurred during COVID-19, the ongoing racial trauma that Black communities experience and face, we were wondering specifically at the CDC, what are some of the ways that we can account for not only population health, but first person accounts? And so I want to share some ways we can think about that. In the clip that you'll hopefully be able to access later, the individual shares some of her feelings of fear and anxiety from racial trauma and how that's having an adverse impact on her mental health. And what really resonated from that clip is she says that, I know that I should not live in fear, but I do. And for many Black and brown communities that lived experience of being a minoritized member of the United States is this constant fear that has been ongoing since the COVID-19 pandemic and has escalated such. So this constant state of crisis that Black communities face created this perfect storm for mental health disorders, including anxiety, depression, suicidal ideation that we've watched over the past year plus. And moreover, these experiences have amplified the historical legacy of oppression in America and just thinking about the constant everyday experiences of racism that individuals experience through various institutions. Next slide. So bringing this a little bit closer to thinking about how it's connected to mental health, we know that racial trauma, also known as race-based traumatic stress, is a cumulative effect of racism that exacerbates mental and physical health disparities in the United States. And racial trauma is associated with feelings of anxiety, depression, as well as physical health issues. And extensive research explains how racism is a physical stressor to the body, which includes increases in allostatic load and cortisol, which can lead to poorer physical and mental health. Studies by researchers, including David Williams, have talked about these increases in ostatic load that are associated with cardiovascular disease, metabolic disorders, and reduced immunity of poor mental health. And these health outcomes often align with the underlying conditions that are for those individuals who are at higher risk for COVID-19. And studies that demonstrate that the physiological effects of racism on cortisol levels can contain little discussion often of racism itself or the social hierarchies that promotes its effects. However, we do know that research effectively illustrates that there are ways that the decaying infrastructure leads to specific bodily illness and provides this relatively less detail in our data about structural-level intervention. So while we know about its effect on the body, we also need to combine it in thinking about how these interventions can be addressed at complex social problems. And so one of the ways that we can think about this is just thinking about ways that we can collect data that also speaks to qualitative or participatory-based research in order to connect first-persons accounts of lived experiences of racial trauma to some of the scientific, more quantitative research that we conduct. And so in some of the quotes that you see here on this slide, the first by a study conducted looking at maternal health by Dr. Armani Allen and colleagues, one of the participants is talking about the experiences that she's having within the healthcare system and is noting that it's the skin that you're in. And this quote highlights how an African-American woman is verbalizing and trying to capture the inescapable sense of pervasive awareness and being a Black woman in America and through these focus groups has experienced this chronic bias. And the next quote that's highlighted here highlights that a participant who is discussing how mental illness is stigmatized and that this compounding effect of double discrimination from being both Black and having a mental illness is having a particularly challenging impact on his life and thinking about how he is valued and how Black people in particular experience discrimination in everyday life and fear of experiencing double discrimination from again having this mental health stigma provoke the challenges of carrying racial discrimination. And so here they say, first off, they see a Black person and they think angry, lazy, complaining, and stupid. Then the Black person says, yeah, I also have bipolar and they add crazy, unfit, dangerous, and incompetent to the list. I know it's stigma, but who wants that? And just thinking about how we can really focus on centering individuals' voices in our data is something I wanted to contextualize before I started to jumping into numbers and odds ratios so that we can continue to go back to that individuals are having these lived experiences. Next slide. And so we know, again, that what we understand of health in general and Rudolf Virchow, who is one of the founders of thinking about social medicine, eloquently describes that one of our biggest defects in thinking about disease is defects in society. And these structural inequities that we often think of around systemic disadvantages of one social group in comparison to others and how we think about race, ethnicity, gender, gender identity, class, sexual orientation, amongst other domains, are often known as isms. And so what we're going to talk about more later at the end of this presentation is just thinking about the types of racism of how that's internalized, institutionalized, and personally mediated to think about how that spans across the lifespan. And so, for example, we know that data shows that housing and practices of racial segregation that leads to historical redlining that was implemented after Jim Crow and into the civil rights era has demonstrated that there is this continuous link across the lifespan from utero to older adult that understands how we can connect social and environmental conditions to mental health. And one framework, next slide, that examines this is the Social Determinants of Health Framework by Compton and Chim, and here they highlight how these compounded effects of racial trauma that I described with thinking about the legacy of slavery and Jim Crow segregation really impact the current social determinants of health as their housing practices, unequal criminal justice, quality of education, and in our case of the work that many of us do here on this call, thinking about health and healthcare access. And so thinking about this multilevel approach of incorporating a life course perspective can help us in thinking about mental health as we move forward, and again, Compton and Chim do a really good job of describing about how public health policies and social norms create this unequal and unjust distribution of opportunity for social determinants of health, and that these have inequitable distribution of resources and opportunities that are pervasive in nature, and that ultimately does impact the way that we understand adverse mental health and psychological stress. Next slide. So now I want to point our attention back in thinking about where we are in the COVID-19 pandemic. And so we know that Black Americans in the United States have had varied responses to the public health crisis, and these have both short- and long-term consequences for their overall health and well-being. So at the beginning of the pandemic, the increased fear and anxiety, helplessness created disruptions to our daily life and thinking about where we were in implementing mitigation strategies. It just that anxiety around thinking about COVID-19 illness and social isolation has created increased interrupted connectiveness in communities, but also caused increases in emotional distress. And so I'm gonna now talk about a few different studies that share and highlight some of those differences and disparities in black mental health. Next slide. So the first study is from the COVID-19 Outbreak Public Evaluation Initiative. And this study is a cross-sectional study. And the study that I mentioned earlier, which I'm gonna share some of the findings from, was a study amongst 5,412 U.S. adults that were surveyed in June of last year. And then there was also a cohort of an additional 1,400 individuals who were included in a longitudinal analysis and have been included. We're actually just finishing up wave seven of this initiative. And so in order to look at specific mental and behavioral health elements, we looked at symptoms of anxiety disorder, symptoms of depressive disorder, as well as symptoms of trauma or stress or disorder using the impact event scale. We also looked at if individuals had increased substance use to cope with stress or emotions from the COVID-19 outbreak. And then asked a question about suicidal ideation in the previous 30 days. And this study uses a panel study using the FallTRX survey provider, which collects information based on a non-probability quota sampling and weights data by age, gender, and race in order to meet quotas that are based on the 2010 U.S. census data, which will be updated to the 2020 data that we have. And some participants are invited to participate in the survey. And for this one in particular, it was out for about a week. Next slide. So overall, what this study showed is that mental health, substance use, and suicidal ideation last year, earlier in the pandemic, had increased in comparison to pre-pandemic levels. And so the prevalence of symptoms of anxiety were approximately three times those that were reported in the same quarter of 2019. So 25% to 0.5 versus 8%. And the prevalence of depressive disorders were approximately four times those as reported at the same time period in 2019. So 24 versus 6%. And suicidal ideation similarly was elevated approximately twice as many respondents reported. So it's seriously considered suicide in the past 30 days in the United States in comparison to the previous time period in which we had data for that question, which was in 2019. And that was 10% versus 4%. Next slide. And so this report, again, presents the wave three findings to look at mental health, substance use, and suicidal ideation amongst adults over 18. And as I mentioned previously, about 41% said that they had at least one adverse mental health condition. But we also saw that individuals who reported symptoms of anxiety or depressive disorder were about 30% amongst those who reported symptoms of trauma or stress-related disorder, and about 26.3%. And then 13.3% reported increasing or starting substances to cope with COVID-19 stressors. Next slide. And what we really wanna focus on for the purpose of today's conversation is that there were some racial-ethnic disparity differences. So I wanna point you to the race-ethnicity side on the screen and highlight that non-Hispanic Black individuals reported about 30% of individuals reported symptoms of anxiety or depressive disorder, whereas 18% reported starting or using substances to cope with stress, and about 15.1% reported suicidal ideation. And only Hispanic individuals were higher in comparison to other racial-ethnic groups, and you'll see those statistics on the right side, where in about 40% reported symptoms of anxiety and depression, and a similar, a little bit higher reported suicidal ideation at 18.6. But what we've seen consistently in this study and a follow-up study and other studies is that particularly for non-Hispanic Black and Hispanics, we've seen high adverse mental health during the COVID-19 pandemic versus pre-pandemic rates and higher than their non-Hispanic white counterparts in the U.S., and so we are seeing some disturbing trends that have continued throughout the pandemic. Next slide. So we wanted to see if some of these trends were continuing, so we conducted an additional survey about six months after the pandemic started to see if we were continuing to see adverse mental health in the fall of 2020. Next slide. So similar methodologies, and what we did see is that we actually saw some increases in the main mental health symptoms and outcomes that we looked at, including anxiety and depression, TSRD, substance use, suicidal ideation, and this was important for us because there were some questions that, because we saw an increase in the early waves of the pandemic that adverse mental health would decline over time. However, that's not what we have seen, and it's not what we've seen when we look at Black Americans in the United States. Next slide. So this follow-up study from the COPE Initiative, again, does highlight in the blue bar, you'll see for Black non-Hispanic individuals still had pretty high rates of depression, anxiety, higher than normal rates of suicidal ideation, trauma, stress-related disorder, and over 50% had at least one of these mental health conditions. And so definitely concerning numbers. As you'll see, there were also, again, really high adverse mental health amongst the individuals who identified as Hispanic. Next slide. And I wanted to highlight, I'm not gonna go into detail on the prevalence ratios presented here, but that there were higher prevalence of these mental health conditions when we looked by specific other social demographic characteristics, such as age, sexual orientation, caregiver status, and disability, for example. Just to highlight the intersectional nature is that while we didn't present these findings by race and other characteristics and that individuals do, or Black Americans do fall into multiple categories. And just to think about how that impacts younger African-Americans, individuals who were essential workers, for example, or unpaid caregivers or have a disability, that there are conjoining demographics that impact Black Americans. Next slide. So some of the implications from this work just highlights that there is a persistence of high prevalence of adverse mental and behavioral health that continued on through the fall and actually through the winter as well. And this contradicts some of the notions that adverse mental health during a pandemic are transient and that they did not continue forward. But then also highlights that there's a need continued for monitoring of adverse mental behavioral health, especially in thinking about racial ethnic communities, especially as we think about our public health data systems that are available to collect national data. Next slide. So here, I want to highlight a study by McKnight Ely et al on racial and ethnic disparities and the prevalence of stress and worry in mental health conditions. And similarly, they also found that Black, not Hispanic, and those who have identified as Hispanic or Latino had higher rates of various mental health, either stress or related conditions. And this study specifically also looked at social determinants of health, which I'll highlight on the next slide. But what we see here is that African-Americans did have higher rates in comparison to other counterpoints, counter parts in thinking about stigma and discrimination from the spreading of COVID-19. The study was conducted also last summer of 2020, challenges and stress and worry of thinking about the death of a loved one, feeling isolated and alone, higher levels of thinking about workplace exposure, and then just thinking about the stress that comes from worrying about getting sick from COVID-19 was higher amongst Black individuals in this study. Next slide. And then this highlights what I spoke to earlier about thinking about social determinants of health, thinking specifically about economic resources of housing instability and our inability to pay for rent. This is particularly important as we think about changes and eviction notices and challenges that we've seen with individuals who are experiencing homelessness during the pandemic, but also issues such as food insecurity. And so we did see higher levels of Black saying that they are worried about not having enough food or getting the needed services or concerns about losing their jobs. And again, this was a snapshot of data, but it's important just to contextualize that in addition to mental health challenges that Black Americans are experiencing, they're also experiencing stress and worry from other social determinants of health. Next slide. So now I wanna just point our attention to think through how we experience and understand mental health through emergency department visits. And particularly for many minoritized communities, emergency departments can be a particularly important point of care of getting primary care specifically and unfortunately for mental health. And unfortunately for mental health care services. So many African-Americans receive mental health care through schools and other community-based programs. And as those declined last year due to stay at home orders, we have been looking at emergency department data to see if we've seen increases in our mental health visits over the past year. And so we have some analysis from previous surveys to look at this, such as the National Survey of Drug Use and Health that SAMHSA and others provide regularly data. However, ED data also provides us with ways to think about how individuals have either avoided routine care and then maybe turn to later returning to emergency departments to receive services. Next slide. And so the main question that I was interested in wanting to share some preliminary data is, did emergency department needs for mental health concerns increase during the pandemic and specifically thinking about this from a racial ethnic disparities lens. Next slide. And the National Syndrome and Surveillance Program, or NSSP, is a network of developed and maintained by the CDC, state and local health departments, data departments, and academic and private sector partners. And here we collect electronic health worker data in real time. And so NSSP includes emergency department visit data in a subset of hospitals in 47 states, all but Hawaii, South Dakota, and Wyoming. And so it represents about 73% of ED visits and we're continuing to add additional EDs into our dataset so that we're able to report pretty accurately on ED visits. And so for the purpose of this work, we define mental health related ED visits using a composite variable derived from NSSP Developmental Health Syndrome. And we query a chief complaint and discharge diagnosis data to look at diagnosis codes that are related to mental health. And so mental health syndrome queries focus on conditions that are likely to result in ED visits after and during a disaster. So for example, thinking about stress, anxiety, acute PTSD, panic disorders. Next slide. And so our interest here is that we were interested in looking at if the number of mental health visits has decreased in 2020. And so looking at this, we did see that visits decreased sharply in March of 2020 through the earlier weeks of April. And this is coinciding with the rights for implementation of community mitigation efforts in order to prevent COVID-19 transmission early in the pandemic. And decreases in overall ED visits occurred for the same visits. And then beginning in mid April, mental health related ED visits increased steadily through October 2020, but did remain lower than 2019. And anecdotally, which you won't see here, but hopefully you'll see in a coming publication is that what we are starting to see is that we do see declines in ED mental health visits during the peaks of the COVID-19 pandemic, such as our current Delta wave. But in the weeks subsequent of our peaks, we're seeing that we do see increases in mental health ED visits. So I think there's some alarming trends and just some need to increase our infrastructure and availability of mental health resources after we see spikes in the COVID-19 pandemic. And we saw that in the way that we experienced last winter. And then we're seeing that now during the current Delta. Next slide. So looking at this here, what we wanted to really focus on is what trends we were seeing over time. And so we looked at three pandemic periods, thinking about 2019 comparisons to 2020 to 2021 by race ethnicity. And you'll see at the very bottom, we have Asian on Hispanic. The second line from the top includes Hispanic and then black is the third line. And what we really wanted to focus on here is that the trends have stayed pretty stable for these individuals. And what you can't see because the ED visits are lower for those who are non-white is that while it's been pretty stable, it has continued to stay stable. So the particular mental health outcomes that we have been looking at have stayed stable and have not declined at areas where we've seen for individuals who are white, non-Hispanic that throughout the pandemic, we do see declines after particular ways of the pandemic or increases in cases, but for other racial ethnic minority groups is continued to stay pretty stable. So there are some concerns that it's not declining. Our mental health concerns are not declining for racial ethnic minorities. Next slide. And so here what we have, it looks like we have two visuals, but what you would see here are some of the ED visit data by race ethnicity. And so, well, again, we are noting here that it's pretty much staying stable for Hispanic and non-Hispanic black in comparison to dips that we're seeing amongst individuals who identify as white. So, we've seen some lower during the mid-pandemic that we saw declines, but it's staying pretty stable for both Blacks and Hispanics. Next slide. So, some of the limitations of our NSSP data is that individuals, this doesn't represent, of course, all individuals in the United States, so it's a limited sample of the population, but that we do have some idea of what we're seeing as far as mental health concerns. And so, previous reports of mean weekly data from ED visits show that we are seeing, we typically see declines throughout the pandemic, but for racial ethnic minorities or specifically for Hispanics and Black individuals, we're seeing a pretty steady wave of concerns around mental health. And so, the definitions around mental health, we're continuing to focus in and look at other disorders that often is challenging because of we don't have enough data for smaller disorders like tick or eating disorders, often for racial ethnic populations to look at particular disorders. But for anxiety, depression, trauma, stress-related disorders, bipolar, schizophrenia, we're usually able to collect enough data to provide a nationally representative sample for racial ethnic minorities. And so, we're increasing our access to that data so that we're able to report that on a regular and ongoing basis. Next slide. So, I want to just highlight that and acknowledge, so of the studies that I shared with you today, many of them were conducted last year, and there really hasn't been a huge outpouring of data that looks at specifically Black mental health. There's been studies that have included, of course, individuals who are Black, but there's just an increasing need to think about and acknowledge the stress that Black individuals are experiencing throughout the pandemic, and that this really warrants additional funding, resources, monitoring of Black mental health. And that includes strengthening our public health resources to monitor our trends throughout the pandemic, but also thinking about mental health care and social services that need to be provided. And then lastly, and importantly, just thinking about the various positive and healthy coping strategies and medical treatment options that should be available throughout the pandemic, as we see we are not out of our wave of the pandemic now. So, next slide. Where to start? So, I want to leave you with a few nuggets of how I like to think about how social justice and mental health are related. And I think it's important, as we're thinking about racial trauma throughout the pandemic, is that we are naming racism and racial trauma, and that we continue to monitor mental health amongst Black individuals. And this is important, not only in thinking about the mental health outcomes that I noted, but also in measuring racism and other structural inequities that have been mentioned earlier around social determinants of health, such as those highlighted in the McNeely et al study. And then importantly, what we need to really be moving forward to is just thinking about, as Compton and Shim discussed, and thinking about the social determinants of mental health, is that there's just a need to think about more societal-level interventions that really shifts from thinking about the biological determinants of health to other social, ecological factors that we can focus on. And this would look like thinking about other systemic factors, such as voting rights, safe housing, redlining, fair living wage practices, that all contribute to social determinants of mental health. Next slide. And in order to really shift our discourse and how we think about this in mental health practice, but then also in public health, is really naming racism as a public health problem. And if we think about the language that is used and how we talk about the problems in the Black community, it's important that we shift what we're talking about in medical discourse, not only as a biological issue. Next slide. And so this leads us to a lot of the work that is done by scholars in our field, such as Kamara Jones, who talks about naming of racism, and that it's important that we're not just talking about race, but we're really talking about the root structures that are creating inequities. And it's important, as I mentioned earlier, that we have challenges often in collecting data at a national level, that we are collecting sufficient data to look at specific racial ethnic groups, such as African Americans and other smaller groups, such as Native Hawaiians or Native Americans in the United States, but that we're also thinking about the intersections of these isms that are listed here on this slide in acknowledging and examining intersectionality and understanding root problems. Next slide. So I'm going to not talk extensively about the theoretical framework, but did want to just note that this is a framework that we've used within the COVID-19 response at CDC to think about how racial trauma affects the different chronic stressors, immune susceptibility, and then thinking about how infection and presentation of COVID-19 is impacted. And you'll see some biometric outcomes that are listed here, but do want to point to some of the surveillance measures that we've been increasing in our work at CDC of collecting different measures around racial trauma, as well as some of the social determinants of health data to really provide a fuller picture of how these different factors intersect in thinking about racial trauma and COVID-19. Next slide. So I'm going to leave you just thinking that with all that I shared today around some of the disparities and challenges of Black mental health during the COVID-19 pandemic that we have to think of this from a structural violence lens. And so medical anthropologists and sociologists, for example, that study socially constructed patterns of disease really point to how population groups and economies create structural agendas for politics and economics change and how these systems create systemic inequities. And so some of the work that structural violence, such as individuals like Paul Farmer has pointed to, it highlights that neither culture or a pure individual will is at fault, but we really need to think through the historical given processes and forces that constrain individual agency. And so to that end, we know that this isn't just an individual issue, but that it's really systemic issues that deal with our current medical institutions, medical education, and how we treat, how we learn within our institutions of medicine. And one way that we can think of through this is also about interrogating ourselves in public health and medical communities of thinking about structural competency that's needed to expand our approaches and providing medical care specifically and thinking about mental health. And so I really want to just push all of our work in thinking about how to be more social justice oriented as we're looking at mental health and providing better access to health care, thinking about different modalities of research that can be conducted and really thinking about how we address these social determinants in clinical practice. And before I leave you today, next slide, I will just share that we do have some resources available on our CDC website that includes the hotlines here. Next slide. And lastly, we'll just say thank you for today's presentation. You do have the opportunity to submit questions at this time, and I'm happy to answer any questions about the data that's shared or any other questions that you have. Dr. Lane, thank you so much for that talk, for doing the work in the first place, because it is such important work and doing it the way that you have, as you mentioned, centering the voice of the people who you're trying to research and understand. And also, thank you for sharing it with us tonight. As someone who has had experience responding to things on a broad scale that have impacted entire populations, like the Ebola epidemic and dealing with the aftermath of major disasters, as you went into this, you certainly had some experience, but this has been its own kind of collective trauma for people. As you did this work, what part of it surprised you the most? Sure. You know, I think what you just noted from collective trauma, that it's just not one impact. And while it never is, I think that this pandemic has really brought to the forefront just the multiple layers of pandemics that we're encountering. So, not just COVID-19, but mental health and systemic injustice and education and thinking about violence and just the challenges that communities are continuing to face. And then, where we're seeing that in mental health outcomes. And particularly, I think, as we're looking long-term at these impacts and are not seeing declines in adverse mental health, specifically in Black communities, I think that that's surprising. You know, oftentimes, we think that it's only, you know, this post-traumatic event, this traumatic event that we'll see an uptick in mental health for a shorter period of time and that it will normalize. But I think this extended length of community trauma or collective trauma is particularly concerning because of the longevity of the pandemic. And something else for, you know, the researchers out there. When you mentioned being intentional about centering the voice of Black people, if you're doing research on Black people or things that are impacting them, can you provide some examples or ideas about how people go about doing that? Yes, definitely. I think there are many ways. I think, one, even just in thinking about who's at the table in designing research. And, you know, I think we often, there's been this increase in wanting to look at issues such as structural racism and, you know, calls for NFRPs from NIH and other funders. And I think it's just important that as we're doing this research, just to acknowledge that there are researchers who have been doing research on racism for decades and to make sure that they're at the table. But also, in just thinking about various designs. So, we often think about either survey data or clinic data in conducting RCTs or cohort studies, but that there is extreme value in thinking about how to do more community participatory research where we're actually including the voices of those who are in communities and designing that research. And so, I would say that's really important of thinking about both those who are researchers who are at the table who should be representative of communities that we're engaging, but then also engaging actual members of the community. And then I think when we think about more quantitative research, I would also just encourage us often, you'll see that there is a critique of making sure that we have comparison groups that are white and just thinking about how that in itself is embedded in hierarchies of whiteness. And so, that it's important that we can also just look at mental health and other outcomes just within a particular community and that that in itself can help to eliminate some of the bias that we see in how we integrate our and understand science. Thank you for that. And I think one of the nice things about this series is that we're hearing from people from a variety of disciplines. And I'm just curious about your perspective as someone with public health expertise and who's been at the CDC, what you see as the role of psychiatrists or mental health professionals in terms of addressing some of these broader issues, right? Of course, there's the treatment provision aspect of it. And there are things that we can do better as a field, certainly when it comes to that. But what would you like to see the clinicians, the medical administrators, the medical school faculty and teachers who you've shared this with, what would you like to see them do with this information? Sure, you know, I think there's some particular, you know, direct impact of just requesting, you know, more services, which I know I'm preaching to the choir for those who work and care about mental health and who are in psychiatry that this is the work that you all do. But I think even at the CDC, where we acknowledge and understand that there are mental health impacts, there's just this continual need. And, you know, I say that as someone who primarily works in cardiovascular disease, but that, you know, there are these comorbidities. And I think continuing to highlight and push that mental health is a challenge during the COVID-19 pandemic in particular, something that as a public health practitioner, that we continually need to, you know, hear a voice that there are these multiple pandemics and need support from clinicians to continue to say what you're seeing in the field. Because I think while we would love to have the best public health data systems to be able to point to this, I think that clinicians are our voices and eyes and ears in the field to tell us what's going on on a day-to-day level. Thank you for that. And, you know, as they're trying to implement these things and do this work, one of the things that may come up are that, you know, they don't feel prepared or as if they have the knowledge base to do this. And so if you have someone who, you know, this wasn't covered in their residency or their postdoc or what have you, what are some resources that you recommend, you know, be it podcasts, documentaries, books for folks? I know you mentioned researchers you believe should be at the table and who have expertise and has done this work for decades, but for people who are not familiar with that, where are some places that you would recommend they start? Sure. I think, you know, for some of the race equity work, there's been an increase in like there's a site race, racial equity tool sets, a toolkit that is really useful in just thinking about that work. Structuralcompetency.org provides more of the perspective of thinking about structural competency within clinical settings. But I do think just on a day-to-day level of thinking about, you know, some of the more up-to-date data that we have at the CDC, there's definitely the, our MNWRs are regularly useful reports and understanding what we're seeing during the COVID-19 pandemic. There's also been a study that's been going on for I think since last spring as well called the Household Pulse Survey. That's a really easy way to look at a dashboard of data that uses Power BI as its main tool. And so that also provides regular snapshots of data from a weekly basis of mental health. And so I think that that's a great way to get access. One of my favorite tools is just TED Talks. So I think I missed it, mentioned Kamara Jones. David Williams also has a great TED Talk. Dorothy Roberts talks about challenges with like race-based medicine and had TED Talks. So I think even just avenues such as those are really easy ways to understand some of these interconnections between health inequity and mental health. Fantastic. Dr. Lane, thank you again for your work in this area, not just what you've done, but the way that you have done it and for sharing with us tonight. Thank you. And in order to claim credit as an attendee for your CME, follow the instructions below. Email thelearningcenteratpsych.org with any questions.

Black Mental Health

COVID-19 Pandemic

Data

Anxiety

Depression

Substance Use

Social Determinants of Health

Structural Inequities

Community Engagement