Exploring Mental Health Needs,Stressors,and Intervention Preferences Among Adolescents of Color: A Mixed Methods Study

Abstract

Purpose:

Examine mental health stressors and needs among adolescents of color and understand their preferences for community-based mental health interventions.

Methods:

This preliminary mixed methods study comprised a cross-sectional online survey and two in-person focus groups among high school students of color in California.

Results:

In total, 102 adolescents completed the survey and 16 adolescents participated in focus groups. Nearly a third of survey respondents exhibited moderate-to-severe depression (30.4%) and anxiety (28.4%) symptoms. Respondents’ mean score on the Flourishing scale was 42.5 (standard deviation = 7.2), indicating moderate psychological well-being. Over half (52.9%) reported that their social relationships are engaging and rewarding, and less than half (45.1%) reported that they lead a purposeful and meaningful life. More than half (58.8%) reported academic pressure and 37.3% reported financial insecurity as their greatest mental health stressor. Focus group results indicated themes around financial stress, planning for the future, and preferences for on-site school mental health programming with engaging activities.

Discussion:

This study highlights the prevalence of moderate-to-severe depression and anxiety symptoms among adolescents of color and emphasizes the need for youth-engaged mental health interventions delivered in community settings.

Introduction

Adolescent mental health is a growing concern in the United States.^1,2 In 2021, 17% (4.1 million) of youth aged 12–17 years experienced a major depressive episode in the past year and 12% (3 million) reported serious thoughts of suicide.³ Between 2010 and 2020, Asian, Black, and Latine/x adolescents saw large increases in suicide-related deaths,³ with the highest suicide death rate among American Indian/Alaska Native adolescents (22.9 per 100,000)—over three times the rate among Whites.⁴ However, fewer adolescents of color receive mental health services compared with White peers,^5,6 with disparities driven largely by structural determinants preventing marginalized populations from accessing care.⁷

Enhancing preventive mental health programming in community settings, such as schools,^8–10 can address structural, financial, and parental-related barriers to mental health care utilization.^11–13 However, efficacious and scalable community-based interventions for adolescents of color are lacking.^11,14 Factors contributing to this gap include lack of representation in mental health research, inadequate understanding of mental health needs, and limited efforts to optimize interventions for youth of color.^15,16

This mixed methods study aimed to inform development of a culturally relevant, community-based mental health intervention by examining (1) mental health stressors, needs, and challenges; (2) prevalence of depressive symptoms, anxiety, and positive mental well-being; and (3) mental health intervention preferences among a sample of adolescents of color.

Methods

Recruitment and data collection took place from December 2023 to February 2024 in a high school within the Twin Rivers Unified School District in Sacramento County, CA, a racially and ethnically diverse district (47.5% Latine/x; 19.5% Multiracial/Other, 14.6% Black, 11.9% Asian; 7.5% White). Inclusion criteria for survey and focus group activities included enrollment in grade 9–12 and ability to read and communicate in English.

We employed a concurrent mixed methods design,¹⁷ administering surveys and focus groups independently to collect and analyze data simultaneously. Participants completed a onetime online survey. Measures included standard screening instruments for depressive symptoms (Patient Health Questionnaire-9 questions 1–8),¹⁸ generalized anxiety disorder (GAD-7),¹⁹ and positive mental health (Flourishing Scale),²⁰ as well as self-reported mental health stressors, desired services, preferred service settings (school, clinic/hospital, home, online, other), attitudes toward preventive programs such as mindfulness, and sociodemographic data. Study staff contacted interested and eligible participants to schedule 1 h in-person focus groups (6–8 participants/group). Survey and focus group participants were entered into a raffle for a $35 and $50 Amazon gift card, respectively. A trained facilitator asked open-ended questions assessing mental health stressors and preferences for mental health programming and support around the design of mental health interventions.

Survey data were analyzed using SAS 9.4. Descriptive statistics characterized the study population according to sociodemographic and mental health measures. Associations between mental health and gender were analyzed using t-tests for continuous and chi-square tests for categorical measures. Focus group audio was transcribed and analyzed using a directed content analysis approach. A staff member developed a preliminary codebook by identifying common themes from the transcriptions and informed by the focus group guide (Supplementary Appendix S1). Two independent researchers then reviewed and refined this codebook through a collaborative process, applying and adjusting the codes to the transcripts to ensure consistency. All data were manually coded by two members of research team independently, with codes being directly applied to the transcripts. We opted for a manual coding approach to enhance our ability to maintain sensitivity to the contextual nuances and cultural subtleties in the data. Initial inter-rater agreement was 92.5%, with 100% consensus achieved through discussion of discrepancies.

Study procedures were approved by the Institutional Review Board of Boston University Medical Campus.

Results

Surveys were completed by 102 adolescents of color (mean age 15.8 years [standard deviation or SD = 1.4]; 51.0% female; 53.5% Latine/x, 23.8% Asian, 13.9% Black; 80.4% no parental college degree). Moderate-to-severe depression and anxiety symptoms were detected in 30.4% and 28.4% of respondents, respectively, and were comorbid in 23.5% of respondents. Participants had a mean score of 42.5 (SD = 7.2) on the Flourishing Scale, which ranges from 8 to 56, with higher scores indicating more positive psychological well-being. No differences by gender were found in depression, anxiety, or positive mental health score.

Academic pressure (58.8%) and financial insecurity (37.3%) were the top reported stressors across both genders, with childhood trauma selected by more females (28.8%) than males (10.2%; p = 0.0188). Individual counseling/therapy (29.4%) and educational resources (26.5%) were the most desired services, both selected by higher percentages of females than males (individual counseling/therapy: 42.3% vs. 16.3%, p = 0.0043; educational resources: 38.5% vs. 14.3%, p = 0.0061). School was the most common preferred setting to receive services (39.2%), with home preferred by more females than males (36.5% vs. 18.4%, p = 0.0405). Finally, nearly half (49.0%) were interested in learning more about preventive programs such as mindfulness training, with greater interest among females (61.5%) than males (36.7%; p = 0.0127). See Table 1 for additional descriptive statistics.

Table 1.

Sociodemographics and Mental Health Characteristics by Gender Among 102 9th–12th Grade Students of Color Participating in a Mixed Methods Study (2023)

	All	Male	Female	p-Value
Total	N = 102	N = 49	N = 52	p-Value
Gender
Male	49 (48.0%)	49 (100.0%)	0 (0.0%)
Female	52 (51.0%)	0 (0.0%)	52 (100.0%)
Non-binary	1 (1.0%)	0 (0.0%)	0 (0.0%)
Age, mean (SD)	15.8 (1.4)	15.6 (1.4)	16.0 (1.3)	0.2030
Grade
9th	37 (36.3%)	20 (40.8%)	17 (32.7%)	0.5407
10th	1 (1.0%)	1 (2.0%)	0 (0.0%)
11th	14 (13.7%)	7 (14.3%)	7 (13.5%)
12th	50 (49.0%)	21 (42.9%)	28 (53.8%)
Race/Ethnicity
Hispanic or Latine/x	54 (53.5%)	26 (54.2%)	28 (53.8%)	0.9241
Non-Hispanic Black	14 (13.9%)	6 (12.5%)	8 (15.4%)
Non-Hispanic Asian	24 (23.8%)	12 (25.0%)	12 (23.1%)
Non-Hispanic American Indian/Alaska Native	0 (0.0%)	0 (0.0%)	0 (0.0%)
Non-Hispanic White	3 (3.0%)	1 (2.1%)	1 (1.9%)
Non-Hispanic Other race	1 (1.0%)	1 (2.1%)	0 (0.0%)
Non-Hispanic Multiple races	5 (5.0%)	2 (4.2%)	3 (5.8%)
Parental education level
Grade school	29 (28.4%)	14 (28.6%)	15 (28.8%)	0.0169
High school diploma or GED	41 (40.2%)	18 (36.7%)	23 (44.2%)
Some college (no diploma)	12 (11.8%)	2 (4.1%)	10 (19.2%)
Associate’s degree	7 (6.9%)	6 (12.2%)	1 (1.9%)
Bachelor’s degree	7 (6.9%)	3 (6.1%)	3 (5.8%)
Master’s degree	5 (4.9%)	5 (10.2%)	0 (0.0%)
Doctorate degree	1 (1.0%)	1 (2.0%)	0 (0.0%)
PHQ scale, mean (SD)	7.4 (6.1)	7.0 (5.9)	7.8 (6.4)	0.5026
Minimal (0–4)	42 (41.2%)	21 (42.9%)	20 (38.5%)	0.5706
Mild (5–9)	29 (28.4%)	13 (26.5%)	16 (30.8%)
Moderate (10–14)	14 (13.7%)	9 (18.4%)	5 (9.6%)
Moderately severe (15–19)	12 (11.8%)	4 (8.2%)	8 (15.4%)
Severe (20–24)	5 (4.9%)	2 (4.1%)	3 (5.8%)
GAD scale, mean (SD)	6.3 (5.8)	5.3 (5.3)	7.2 (6.1)	0.1137
Minimal (0–4)	51 (50.0%)	27 (55.1%)	23 (44.2%)	0.3570
Mild (5–9)	22 (21.6%)	12 (24.5%)	10 (19.2%)
Moderate (10–14)	18 (17.6%)	6 (12.2%)	12 (23.1%)
Severe (15–21)	11 (10.8%)	4 (8.2%)	7 (13.5%)
PHQ and GAD scales both moderate to severe (10+)	24 (23.5%)	9 (18.4%)	15 (28.8%)	0.2162
Flourishing scale, mean (SD)	42.5 (7.2)	41.5 (7.6)	43.5 (6.7)	0.1656
Q1 agree/strongly agree	46 (45.1%)	17 (34.7%)	28 (53.8%)	0.0529
Q2 agree/strongly agree	54 (52.9%)	27 (55.1%)	27 (51.9%)	0.7489
Q3 agree/strongly agree	40 (39.2%)	21 (42.9%)	19 (36.5%)	0.5164
Q4 agree/strongly agree	56 (54.9%)	22 (44.9%)	34 (65.4%)	0.0384
Q5 agree/strongly agree	54 (52.9%)	24 (49.0%)	30 (57.7%)	0.3803
Q6 agree/strongly agree	55 (53.9%)	23 (46.9%)	32 (61.5%)	0.1409
Q7 agree/strongly agree	50 (49.0%)	20 (40.8%)	30 (57.7%)	0.0900
Q8 agree/strongly agree	49 (48.0%)	22 (44.9%)	27 (51.9%)	0.4802
Biggest source(s) of mental health stress^a
Financial insecurity	38 (37.3%)	16 (32.7%)	21 (40.4%)	0.4202
Food insecurity	17 (16.7%)	5 (10.2%)	12 (23.1%)	0.0840
Housing insecurity	9 (8.8%)	3 (6.1%)	6 (11.5%)	0.3397
Academic pressure	60 (58.8%)	27 (55.1%)	32 (61.5%)	0.5119
Community violence	7 (6.9%)	3 (6.1%)	3 (5.8%)	0.9402
Childhood trauma	21 (20.6%)	5 (10.2%)	15 (28.8%)	0.0188
Experiences of discrimination	7 (6.9%)	5 (10.2%)	2 (3.8%)	0.2086
Bullying	4 (3.9%)	3 (6.1%)	2 (1.9%)	0.2795
Other	15 (14.7%)	9 (18.4%)	6 (11.5%)	0.3348
Mental health services you would like to have but do not currently have access to^a
Individual counseling/therapy	30 (29.4%)	8 (16.3%)	22 (42.3%)	0.0043
Support group	13 (12.7%)	7 (14.3%)	5 (11.5%)	0.6803
Family therapy	18 (17.6%)	6 (12.2%)	12 (23.1%)	0.1551
School-based programs/workshops	17 (16.7%)	8 (16.3%)	9 (17.3%)	0.8952
Educational resources	27 (26.5%)	7 (14.3%)	20 (38.5%)	0.0061
Other	23 (22.5%)	14 (28.6%)	8 (15.4%)	0.1086
Preferred setting(s) to receive mental health services^a
School	40 (39.2%)	18 (36.7%)	22 (42.3%)	0.5671
Clinic/hospital	30 (29.4%)	11 (22.4%)	18 (34.6%)	0.1768
Community	15 (14.7%)	4 (8.2%)	11 (21.2%)	0.0665
Home	28 (27.5%)	9 (18.4%)	19 (36.5%)	0.0415
Online	25 (24.5%)	13 (26.5%)	12 (23.1%)	0.6877
Other	10 (9.8%)	6 (12.2%)	3 (5.8%)	0.2536
Familiar with mindfulness practice	42 (41.2%)	19 (38.8%)	22 (42.3%)	0.7179
Interest in learning more about mindfulness practice	50 (49.0%)	18 (36.7%)	32 (61.5%)	0.0127

Multiple responses allowed; thus, percentages may sum to >100%.

GAD, generalized anxiety disorder; GED, General Educational Development; PHQ, Patient Health Questionnaire; SD, standard deviation.

In total, 16 participants aged 14–18 years (56% female; 37% Latine/x; 75% Black) took part in one of two focus groups. Common stressors and preferences for mental health programming were identified and coded based on the focus group guide (Table 2). Themes around stressors included educational concerns, such as worries about grades and graduating, as well as personal stressors such as financial strain. Coping strategies included engaging in hobbies such as drawing or listening to music and health behaviors such as exercise and sleep. Participants expressed desire for resources including safe spaces on campus, hotlines, and rooms equipped with stress-relief tools. Preferences for mental health interventions included group-based modalities, peer support, and virtual sessions. Trusted messengers for mental health information included peers and teachers. Suggestions to engage adolescents in mental health intervention development included social media outreach and creating a comfortable environment for stress identification and peer support.

Table 2.

Focus Groups Themes Among 16 9th–12th Grade Students of Color Participating in a Mixed Methods Study (2023)

Themes	Illustrative quotes
Primary stressors
Education	“I’m a freshman. I’m just worried about graduating.” “I’m worried about going to college.”“I’m worried about getting good grades.”
Personal	“I have financial stress.”“Getting a job and a driver’s license.”“Doing chores around the house.”
Current stress coping mechanisms
Hobbies	“I listen to music.”“I like drawing.”“Playing instruments.”“I like to journal.”
Health behaviors	“Exercise”“I like to workout.”“I sleep when I’m stressed.”
Type of resource preferred to help deal with stressors
Safe space/services	“A building or room on campus.”“A hotline”“A room where you can go to escape kind of the stress of things” and have “stuff to fidget with. A rocker.”“Maybe like an email, that you can be like hey somethings going on, do you have any resources?”
Preferences for mental health intervention
Format and delivery	“Maybe once every couple of months there could be a [peer group] check-in.”“I would talk to someone on zoom.”“I wouldn’t want to be in a peer group.”“An app on your phone.”“Somewhere that’s a safe space [room on campus].”
Trusted messengers and sources	“Anyone that’s similar [to me]”“I would go to [teacher’s name]. They are understanding.”
Familiarity and attitudes toward mindfulness programs
	“Being aware.”“Being present.”“Being aware of yourself and everyone around you.”“A way to calm yourself down.”
Strategies to engage adolescents in intervention development
	“I would feel comfortable identifying stressors” [peers might experience]“Promote via social media.”“Engaging activities where everyone gets to participate.”“Something [a program] where people won’t be left out.”

Discussion

This preliminary mixed methods study revealed prevalent depressive and anxiety symptoms among adolescents of color, moderate psychological well-being, and academic pressure and financial insecurity as prominent stressors. Gender differences were observed in the reporting of childhood trauma, preferences for mental health services, and desired settings for receiving support.

Our study’s focus specifically on adolescents of color addresses gaps in the literature regarding the mental health needs and intervention preferences relevant for this population. By examining sources of mental health stressors, prevalence of symptoms, and preferences for interventions, this study provides unique insights into the needs and challenges faced by adolescents of color in accessing mental health support. Our findings are consistent with reports from nationally representative U.S. surveillance data indicating higher rates of depression and anxiety among marginalized youth.^21,22 The moderate levels of psychological well-being observed suggest that participants are managing their mental health but may benefit from strategies that promote resilience, coping skills, and social support. Future interventions could focus on these areas and be tailored to the needs identified in this study to enhance adolescent well-being.

This study adds depth by exploring preferences for mental health interventions and settings among adolescents of color, in line with the U.S. Surgeon General’s recent call to prioritize mental health research that elevates the voices of youth from historically underserved populations.²³ One notable finding is that nearly half of participants expressed interest in preventive programs such as mindfulness training, with higher interest among females than males (61.5% vs. 36.7%). This suggests that targeted mindfulness interventions may be a way to increase male engagement and enhance preventive service utilization across genders.

The results underscore the importance of developing engaging and accessible mental health interventions for adolescents of color in schools. Future research can explore how mindfulness training and other school-based preventive programs can be adapted or tailored for this vulnerable population.^9,24 Additionally, efforts to increase awareness and destigmatize mental health issues²⁵ among adolescents of color are needed to encourage help-seeking behaviors and promote overall well-being.

Footnotes

Authors’ Contributions

M.L.W. conceptualized the study and research methods, provided supervision, and developed the original article. S.A. oversaw data collection. A.G.S. and S.A. conducted formal analyses. All coauthors participated in drafting, reviewing, and editing of the article.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH).

Author Disclosure Statement

The authors declare that they have no conflicts of interest.

Funding Information

M.L.W., S.A., and A.G.S. are supported in part by the NIH National Institute of Diabetes and Digestive and Kidney Diseases Grant # R01DK120713.

Supplementary Material

Abbreviations Used

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Supplementary Material

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