Barzilay Ran, Michel Nadine
Department of Child and Adolescent Psychiatry and Behavioral Science at Children's Hospital of Philadelphia (CHOP); with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of CHOP and Penn Medicine.
Department of Psychiatry, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Acad Child Adolesc Psychiatry. 2025 Mar;64(3):326-328. doi: 10.1016/j.jaac.2024.07.909. Epub 2024 Jul 26.
Increasing evidence suggests that, as in other medical fields, there are pronounced pediatric mental health disparities with greater burden among marginalized racial and ethnic youth. The reasons for these disparities are not fully understood. One way to explain pediatric mental health disparities is through the lens of environmental stress as a driver of mental health burden, given that marginalized populations are exposed to more structural and individual stress. Although traditionally stress has been linked to specific psychiatric disorders that fall under the umbrella of "stress-related disorders" such as acute/post-traumatic stress disorder or adjustment disorder, broader conceptual frameworks include depression (including suicidality) and anxiety as stress related. More recently, there has been growing recognition of the contribution of early life stressful exposures (ie, childhood adversity) to psychosis spectrum disorders. As such, recognition of the role of stress exposure in psychotic presentations and the fact that exposure to adverse social determinants of health and stressful environments is more common among youth of color can serve as a potential mechanism to explain pediatric disparities in psychosis risk.
越来越多的证据表明,与其他医学领域一样,儿科心理健康存在明显差异,边缘化种族和族裔的青少年负担更重。这些差异的原因尚未完全明了。鉴于边缘化人群面临更多的结构性和个体性压力,一种解释儿科心理健康差异的方式是通过环境压力这一视角,将其视为心理健康负担的驱动因素。虽然传统上压力一直与“与压力相关的障碍”范畴内的特定精神疾病相关联,如急性/创伤后应激障碍或适应障碍,但更广泛的概念框架将抑郁症(包括自杀倾向)和焦虑症也视为与压力相关。最近,人们越来越认识到早年应激暴露(即童年逆境)对精神病谱系障碍的影响。因此,认识到压力暴露在精神病表现中的作用,以及有色人种青少年更常见于暴露于不良健康社会决定因素和压力环境这一事实,可作为解释儿科精神病风险差异的潜在机制。