The Role of Pediatricians in Addressing the Mental Health Crisis among Low-Income Youth in the United States

Abstract

In 2023, one in five adolescents in the United States (U.S.) experienced a mental illness. Among the biological, environmental, and social factors that shape youth mental health outcomes, socioeconomic status is especially influential, as youth from low-income families suffer from significantly worse mental health outcomes than their higher socioeconomic peers. The literature attributes this disparity to the dual stigma associated with poverty and mental illnesses, which deters low-income youth and families from seeking mental health care. This thesis explores trust building as a pathway to dismantle stigma and strengthen the relationship between care providers and patients in medical settings. Specifically, this thesis argues that pediatricians, often the first and most consistent health professionals for youth, should adopt a more expansive role in addressing this mental health crisis by adopting trust-building practices in patient interactions. A survey conducted for this thesis of 79 practicing pediatricians across 25 U.S. states found that the majority believe that it is their responsibility to diagnose and treat mental illnesses in patients. Additionally, the more frequently participants used nine different trust-building practices in the past year, the more prepared they felt to address mental illnesses. Nevertheless, pediatricians’ ability to implement trust-building practices is constrained by a variety of challenges, including time, lack of reimbursement, and lack of mental health competency training in medical schools. Given the promise of trust-building practices to reduce stigma and improve access to care, this thesis proposes policies that maximize pediatricians’ capacity to fulfill this expanded role and advance the mental well-being of vulnerable American youth.