RISE looks at recent headlines concerning social determinants of health (SDoH).

The toll of COVID-19 on pediatric mental health

Mental health claim lines for young people age 13-18 approximately doubled in 2020, according to a study conducted by FAIR Health, a nonprofit organization that aims to provide transparency in health care costs and health insurance information. While mental health claims increased significantly, medical claims decreased by more than 50 percent due to widespread restrictions on nonemergency medical care and patient avoidance of in-person appointments amid the pandemic.

Diagnoses found to increase substantially in 2020 when compared to the same period in 2019 include intentional self-harm, generalized anxiety disorder, major depressive disorder, adjustment disorders, and overdoses and substance use disorders.

Similar patterns in increased mental health claims were found among individuals age 19-22, though less severely.

Other key findings include:

  • Females age 13-18 accounted for 66 percent of mental health claim lines in January and February 2020 and increased steadily to 71 percent by November, whereas males accounted for 29 percent
  • Claim lines for intentional self-harm as a percentage of all medical claim lines for individuals age 13-18 increased by more than 90 percent in March 2020 when compared to March 2019, by almost 100 percent in April 2020 compared to April 2019, and an increase of more than 89 percent in a single month from July to August 2020
  • Females age 13-18 were two and a half to five times more likely to be treated for intentional self-harm than males age 13-18
  • The extent of intentional self-harm varied by region, with self-harm claim lines in the Northeast increasing more than 300 percent among individuals age 13-18 in August 2020 compared to August 2019
  • Claim lines for overdoses, which encompass drugs and alcohol and may include suicide attempts and fatalities, for individuals age 13-18 increased by almost 95 percent in March 2020 and 119 percent in April 2020 when compared to the same months in 2019
  • In the 13-18 age group, mental health conditions were the sixth most common reason for emergency room visits in 2020

Wake Forest medical school health equity curriculum found to improve understanding of SDoH

To better address gaps in health equity curricula and develop a stronger understanding of SDoH, Wake Forest School of Medicine implemented a “longitudinal health equity curriculum,” according to JAMA Network Open. In conjunction with the curriculum, Wake Forest conducted a cohort study to evaluate the impact of the program on students’ self-reported knowledge of SDoH as well as their confidence working with underserved populations.

The curriculum, open to third-year medical students, was based on three domains, including education, community, and organization, and consisted of a health equity simulation and a series of nine modules that exposed students to different SDoH.

The curriculum improved knowledge and confidence in SDoH by eight points on a 32-point scale. Due to the ongoing success of the program, Wake Forest has made the curriculum a requirement for all third-year medical students.

AMA announces fellowship to address health equity

The American Medical Association (AMA) announced last week a new initiative with the Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine to empower physicians to advance health equity and address barriers to health care in vulnerable communities.

The annual Medical Justice in Advocacy post-doctoral fellowship program will connect 10 physicians across the country with health equity experts to gain knowledge, skills, and solutions to tackle root causes of inequity.

“Our goal of ensuring that all people have the conditions to achieve optimal health requires that physicians be equipped with the consciousness, tools, and resources needed to confront racism and other forms of oppression in our health and other social systems, such as housing and education,” said AMA’s Chief Health Equity Officer Aletha Maybank, M.D., M.P.H, in the announcement. “Through the creation of this fellowship, we have the opportunity to use collective leadership, knowledge, and experience to push upstream and train physician leaders how to effectively advocate for the policies and laws that advance equity and justice. These fellows, working collaboratively with others, will become a force of change within their own communities and help drive the future of medicine.”

The first fellowship will run from September 2021 to November 2022 and is open to eligible physicians and residents with an interest in health equity. Participants will receive a $15,000 stipend and will be eligible for up to 28 CME credit hours. The application deadline is Wednesday March 31. You can apply or learn more about the fellowship here.