Mental health and the coronavirus research bite #6: a brief review of protective factors for positive mental health among children and young people of colour

Abstract

A brief review of protective factors for positive mental health among children and young people of colour

There is growing recognition that the coronavirus pandemic may be exacerbating existing inequalities that already pose risks to people of colour in the UK, meaning that children and young people of colour may be disproportionately affected by the pandemic. Careful consideration of the impact on the mental health and wellbeing of children and young people colour is vital to inform efforts to support positive outcomes and resilience.

This research bite draws on the literature about protective factors to support positive mental health or wellbeing among children and young people of colour. It highlights that studies have found particular protective factors that may lead to positive mental health outcomes in the context of adversity, while recognising the critical need to address the very real risks that people of colour and other minoritised groups face due to social inequalities, discrimination, and systemic racism.

Full text

1
Mental health and the coronavirus
research bite #6: a brief review of
protective factors for positive mental
health among children and young
people of colour
The question: what do we know from
research about protective factors
to support positive mental health or
wellbeing among children and young
people of colour?
In this research bite we draw on the literature
about protective factors, which refer to
activities, experiences and actions that can
increase wellbeing, reduce the negative eects
of stressors, and reduce the risk of mental health
diculties. Although the primary focus is on
protective factors among children and young
people of colour, we also reect on evidence
relating to children and young people from
other minoritised backgrounds.
As the United Kingdom (UK) and countries
around the world are tackling the challenge of
the coronavirus (COVID-19) pandemic, there is
growing recognition that the pandemic may be
exacerbating existing inequalities that already
pose risks to people of colour.1 The pandemic has
occurred in a context where pre-existing health
inequalities inuence access to health care.
Research nds that racism and systemic racism
confer a negative inuence not only on health
outcomes, but also on access to education,
housing and employment for young people of
colour and their families.2-5 Several publications
have reported increased risk of exposure to,
and death resulting from, the coronavirus for
people of colour, particularly for people of Black
African and Black Caribbean, Indian, Pakistani,
Bangladeshi and Filipino ethnic backgrounds.a, 5-8
These dierences mean that in the UK, children
and young people from the above backgrounds
may be disproportionately aected by the
coronavirus pandemic and its impact on
mental health. As well as being more likely to
experience the loss or illness of a loved one,
structural inequalities mean that children and
young people who are Pakistani, Bangladeshi
or Black are also more likely to be from lower
socio-economic backgrounds and may have
decreased access to online learning and spaces
to study during school closures and increased
stress at home.9 These could in turn increase
the potential detrimental psychological impact
of the pandemic on them. People of colour
may also be at greater risk of exposure to the
coronavirus due to occupational factors (e.g.
jobs in healthcare and public transport) and
other factors.9 Therefore, it is particularly
important that children and young people of
colour have access to support with their mental
health and wellbeing at this time, and that this
support is tailored to meet their needs.
March 2021
About this series
We are aware that parents, carers and those working with young people might have many
questions about how to support children and young people’s mental health and wellbeing
during the coronavirus pandemic. We know that it can be hard to nd evidence about the best
ways to tackle some of these challenges. The Evidence Based Practice Unit (a collaboration
between the Anna Freud Centre and UCL) is producing a series of ‘research bites’ based on
very rapid reviews of existing research. These are not thorough or extensive reviews, rather
they aim to oer concise and timely insights on some topical issues.
a. Further details about COVID-19 related deaths by ethnic group in England and Wales can be found at:
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/
coronaviruscovid19relateddeathsbyethnicgroupenglandandwales/2march2020to15may2020

2
Beyond the pandemic, a range of studies have
shown that there are specic risk factors that
are experienced by children and young people
of colour. For example, people from some
minoritised ethnic groups experience worse
mental health outcomes.10 Belonging to a
minoritised ethnic group in and of itself is not a
risk factor for worse mental health outcomes, it is
the structural inequalities and structural racism
that children and young people from minoritised
ethnic groups are exposed to that is the risk
factor for worse mental health outcomes. It is
well documented, for instance, that children and
young people of colour face racial discrimination,
racial proling and racist microaggressions that
can have negative eects on mental health and
other types of outcomes.1, 2,11
In this context of exposure to increased risk,
careful consideration of the factors that may
increase the likelihood of positive outcomes for
children and young people of colour is vital. There
may be some protective factors for children
and young people of colour that could aord
them some protection in the context of new
stressors and existing ones. Protective factors
are important as they refer to those factors that
enable children and young people to bounce back
and adapt positively from risks, described as
resilience. Protective factors lie at the individual
level (such as having high self-esteem), the family
level (such as having a close relationship with
parents and carers), and at the wider community
level (such as access to community groups and
extracurricular activities). Protective factors
can reduce the likelihood of poor mental health
outcomes or poor mental wellbeing.12
In this research bite our main focus is children
and young people of colour, but papers make
reference to other minoritised groups so these
are also referenced.
How did we answer this question?
To answer our question, we conducted a rapid
review of the research evidence, looking for
key studies of protective factors for positive
mental health and wellbeing for children and
young people of colour. Because this was a
rapid search, we only looked for key papers
published after the year 2000 and used a
small number of search terms. Conducting a
literature search in this way is less rigorous
than conducting a systematic review, but it
helps locate relevant evidence quickly. Due
to a lack of research carried out in the UK on
this question, we have included research from
other contexts, such as the United States (US),
where relevant research has been carried out.
We recognise that while we are attempting to
draw out protective factors for applicability in
the UK context, protective factors are highly
context-specific and may depend on specific
stressors which are only present in particular
environments and may only be relevant to
some people of colour but not others. As such,
it should not be assumed that the protective
factors described here are relevant to all
children and young people of colour in all
places. Instead, drawing from these studies,
we highlight protective factors that have been
supported by scientific research in specific
contexts and propose that further research is
needed in the UK context.
In addition, we note the importance of
understanding the lived experience of what
helps with wellbeing and mental health for
children and young people of colour in the UK
context, and we emphasise that it is important
to conduct qualitative research to understand
what works for whom, in addition to drawing
on current literature.
Finally, we recognise the vital need to address
the very real risks that children and young
people of colour, as well as other mintoritised
groups in the UK, face due to social inequalities,
discrimination and systemic and structural
racism. However, in writing this, we are aiming
to shine a light on how children and young
people of colour may have access to or draw
on dierent protective factors. Understanding
these protective factors is important to support
mental health and reduce the risk of mental
health diculties during this challenging time.

3
In this research bite, we have focused on
studies that include samples of children and
young people aged 0-18 years old, while
keeping in mind that definitions of young
people often use a higher upper age bracket.
What did we nd out?
There are complexities when it comes to
understanding the mental health of children
and young people of colour in the UK. The
available data is limited for several reasons.
Firstly, there is a lack of breakdown of young
people’s experience of mental health problems
by ethnic group.13 Secondly, there has been
limited research investigating protective factors
for children and young people of colour in the
UK. Finally, there is an important need for
researchers to make research both accessible
and meaningful for children and young people
of colour, and to take proactive steps to widen
participation in research projects.14
There are many inuences on the mental health
of children and young people of colour. Factors
include social and economic inequalities,
exposure to racism and discrimination and
mental health stigma.15,16 For example, research
nds that experiencing racial discrimination
is linked with low self-esteem and symptoms
of anxiety and depression.17 In terms of young
people’s access to specialist mental health
support, studies of referrals to child and
adolescent mental health services (CAMHS)
in the UK have shown an association between
route to services and ethnicity. Young people
of colour were found to be less likely to access
CAMHS through voluntary routes. Instead, they
were more likely to be referred through school,
social care services or youth justice.18,19
On the other hand, self-report studies in the
UK suggest that during adolescence, young
people of colour report, on average, better
mental health outcomes than their White British
peers.20 Reasons for this self-reported increased
resilience are not clear. One explanation could be
that self-report measures do not appropriately
conceptualise and capture the mental health
of young people of colour. That being said,
researchers have found associations with
protective factors including parental care, family
connectedness, cultural integration (measured
by ethnic diversity of friendships), and frequency
of attendance at a place of worship.21-23
In this research bite, we dene and describe in
detail the protective factors linked with children
and young people of colour which have been
found to be associated with better wellbeing
and mental health outcomes. Many of these
factors are found to increase wellbeing in the
general child and adolescent population, but
some are specic to children and young people
of colour in relation to specic risks they may
experience, such as racial discrimination.
a) Racial and ethnic identity
Racial and ethnic identity have been studied
both separately and together.24 In this research
bite, we have chosen to discuss racial and ethnic
identity together. Some research suggests that
this can be a helpful approach and denes racial
and ethnic identity as “the beliefs and attitudes
that individuals have about their ethnic–racial
group memberships, as well as the processes
by which these beliefs and attitudes develop
over time.” (see Umaña-Taylor et al., 2014 p.23)
Development over time is important in this
denition, as a young person’s thoughts and
feelings towards their ethnic or racial group
membership may vary through childhood
and adolescence. Racial and ethnic identity is
complex and can include identication with
other peers, as well as identication with a set of
values or behaviours associated with a particular
ethnic group.25

4
A range of studies have found that racial and
ethnic identity can serve as a protective factor,
and if these connections are lost, it can lead an
individual to feel isolated. A strong ethnic or
racial identity has been found to be associated
with outcomes including higher educational
attainment,26 increased self-esteem,27
increased self-ecacy (belief in one’s ability to
achieve goals within the environment),28 and
increased wellbeing.29 Researchers have also
suggested that ethnic identity can serve to
protect individuals from the eects of negative
stereotypes and discrimination by providing a
larger frame of reference with which to identify.30
There is also some evidence from studies with
African American families in the United States
(US) which link stronger messages that support
ethnic or racial identity (between parents, carers
and their children) with reduced symptoms of
anxiety in children.31 A recent meta-analysis
brought together a range of research which
found that cultural socialisation has a positive
role on self-perceptions and wellbeing in African
American young people in the US.32
b) Cultural connection and language
Some studies with young people have found
that cultural knowledge, language and
participation in traditional activities specic
to one’s culture are associated with improved
psychosocial functioning for specic minoritised
ethnic groups, such as aboriginal young people
in the Australian context and Native American
young people in the US.33 In the context of
the coronavirus pandemic, some projects in
the US have successfully brought together
young people and older adults from specic
minoritised ethnic communities for the purpose
of fostering resilience and mutual support.34
c) Religious identity and religiosity
Similar to the concept of ethnic identity,
religious identity and religiosity can provide a
shared experience and sense of community. This
protective factor broadly refers to the shared
experiences and sense of membership and
community which run alongside the presence
of spiritual beliefs. For adolescents who are
religious, spiritual or practice a particular faith,
religious identity has been linked with increased
wellbeing regardless of ethnic background.35
When looking at this protective factor in relation
to young people of colour, frequent attendance
at a place of worship and religious social support
were found to be associated with better
psychological wellbeing for Black young people
in the US.20,36 Religion is thought to inuence
mental health by providing social support, a
sense of meaning and coherence and positive
coping. Spirituality is thought to inuence
outcomes of wellbeing, mental health, resilience
and reduced substance abuse.37
It is important to recognise that religion
and religiosity are not always protective for
young people and that sometimes religious
expectation and religious norms can be a
source of risk, and can impact mental health
negatively,38 for example, if a child is a religious
minority in a school. Studies have also reported
hostile treatment of young people from
lesbian, gay, bisexual, trans, non-binary, and
queer (LGBTQ+) groups in particular religious
contexts,39 and for some traditions, religious
and spiritual beliefs can be a barrier to families
accessing mental health services.4 0,41
d) Psychological empowerment, positive self-
esteem and positive self-perceptions
These factors are found to be protective
for the general population in relation to
wellbeing.42-44 However, it is important to
consider these factors in reference to children
and young people of colour. Psychological
empowerment refers to young people gaining
a sense of control over their lives and decisions
and adopting a critical understanding of
their environment.45 Studies have found that
adolescents with more empowerment reported
better and more caring relationships with adults
and peers, and there is also some evidence
of increased academic attainment.46 Positive
self-esteem and positive self-perceptions have
been found to help young people of colour to be
resilient in the context of risk.47 However, some
studies have found that although higher self-
esteem helped to reduce the risk of depression
for Hispanic adolescents, this eect was not
sustained for Black adolescents.b,48
b. It is impor tant to note that somet imes a factor has been found to be protective because a young person is in a high-stress
environment (e.g. increased risk of crime), versus a fac tor that is protective because it directly links with race or ethnicity.

5
e) Relationships with parents, carers and family
members
Research has traditionally focussed on the
role of relationships with parents and carers,
nding for example that parental monitoring is
particularly important for adolescents growing
up in neighbourhoods which have high levels
of community violence.47 Recent research
examines the role of wider families members,
such as aunts, cousins, and grandparents, in
helping young people build family resilience and
enhance child wellbeing.49,50
f) Social support
Social support refers to supportive relationships
around the child or young person, including adults
outside of the family, teachers and community
leaders. There is mixed evidence for the eects
of social support for children and young people
of colour. Social support can promote wellbeing
and can reduce the risk of depression, but this is
not always the case and cannot be generalised
for all groups.51 Some studies have found that
in the context of witnessing violence or being a
victim of violence, social support protects African
American boys against depression.52 Another
study found that teacher-student relationships
reduced behavioural diculties and the risk of
depression for African American boys.53,
What are the implications?
Many protective factors are common across
ethnic groups, but some appear to emerge as
relevant to minoritised groups in particular
contexts. We have primarily found research
from America and Australia, indicating that
further research is needed to understand
their relevance to the UK context. Many of the
factors we identified suggest that promoting
a young person’s identity and self-belief, high
levels of family support, religious belief and
religious identity and social cohesion could
help to protect young people against some
of the adverse outcomes associated with the
consequences of the coronavirus pandemic.
In identifying these protective factors, we do
not intend to detract from the critical need
to address the very real risks that people of
colour face due to ingrained social inequalities,
discrimination and systemic racism. These need
to be tackled without question. In conducting this
research, we are attempting to bring attention
to the fact that children and young people of
colour may have access to or draw on a range of
dierent protective factors, and that families,
professionals and mental health services may
be able to support young people of colour to
access these protective factors. Like adults,
young people are unique with multiple aspects
to their identities (including race and ethnicity),
and therefore an intersectional approach to
understanding lived experience is crucial.54,55
It is widely agreed by mental health
researchers and policymakers that
coronavirus and lockdown pose a serious
threat to young people’s general wellbeing.
Further, the impact of coronavirus and
lockdown is especially relevant to children
and young people of colour who have
been disproportionately aected by the
pandemic. Therefore, it is important to
understand what helps protect children
and young people of colour from adverse
eects on their mental health. In the UK
context, while there is a lot of literature
about what protects White populations
from mental health problems, there is
limited knowledge about what protects
children and young people of colour.

6
As researchers, we are taking steps to do better
in tackling structural racism and inequalities,
not only in what we research, but also in how
we carry out our research and acknowledge
sources of privilege that we may bring to the
research process. Moving forward, we aim to
ensure the views of young people are central
to how we carry out research and that young
people from all backgrounds are represented in
this. As such, we have launched a new special
interest research group on youth mental health
and racism that aims to bring together dierent
academic and community-lead organisations.
In so doing, the research group will aim to
amplify the voices of those working in this area.
The group will also work with young people of
colour to understand how researchers can make
research more accessible and meaningful, from
participating in studies to hearing about the
results and being included in eorts for research
to inform policy change and intervention design.
This research bite highlights that some
protective factors may be equally prominent
across young people from a range of
racial and ethnic backgrounds, while other
protective factors are more specic. One of
the implications of this is not only examining
protective factors individually, but also
examining protective factors around the young
person at multiple levels: individual, home,
school, friendships and society. Therefore, the
study of protective factors can benet from
taking a wider, social ecological approach that
examines levels of support and protection
within the wider socio-ecology around the
young person.56,57
In addition, we would like to bring attention
to the value of structural competencyc in the
process of conducting research with children
and young people of colour. This means being
able to look not only at the causes of mental
health symptoms or outcomes in isolation, but
to understand how symptoms or outcomes at
the individual level may be the result of decisions
made at the social and political level of planning
and policy. It is crucial that consideration of the
structural determinants of health outcomes and
existing social and economic inequalities is an
integral aspect of research eorts going forward.
c. Struc tural competency has be en dened by Met zl and Hansen (2014 p.126) as ‘the trained abil ity to discern how a host of issues
dened clinically as symptoms, attitudes, or diseases (e.g., depression, trauma) also represent the downstream i mplications
of a number of upstream decisions about such matters as health care and food deliver y systems, zoning laws , urban and rural
infrastructures, medicalization, or even about the very de nitions of illness and health’.58

7
Take-away messages
Our review of the literature has found that
there is lack of research into protective factors
linked to wellbeing and the risk of mental health
diculties for children and young people of
colour in the UK context, particularly when
compared with the US context. There are a
number of important issues that have been
less well explored within the literature in the UK
context, including the following:
»Protective factors to support mental
wellbeing and reduce risk for children and
young people of colour.
»Protective factors that are specic to
young people of colour in the context of the
pandemic, for example, what helps young
people with recovery from grief and loss in
the context of the coronavirus.
»The lived experience of racism and social
inequalities for children and families of colour.
»The meaning of ethnic and racial identity to
children and young people of colour in the UK.
»Protective factors that children and young
people of colour report to nd helpful in
relation to racism and social inequalities.
»Understanding the reasons for the
inequalities in access to and use of mental
health services for people of colour, and how
to make mental health services more inclusive
of children and young people of colour and
their families.18
»What types of mental health care and
support may be favoured by children and
young people of colour, and how to make
sure that that support is sensitive to the
needs of children and young people of colour
and their families.1
»The eects of systemic racism on children
and young people of colour and their
families and the importance of structural
competence in the UK context.
Protective factors are highly context-specic
and may depend on the specic stressors that
are present in particular local contexts. As
such, we would like to note that it should not
be assumed that the protective factors here
are relevant to all young people of colour in all
places. Further research is needed in the UK
context to understand the factors that young
people of colour, as well as young people from
other minoritised groups, nd helpful to their
mental health during the coronavirus pandemic.
There is an urgent need to address gaps in the
research that limit our understanding of the
experience of specic minoritised groups.
Note on our use of language
This research bite discusses protective factors
for positive mental health or wellbeing among
children and young people of colour. We have
referred to children and young people of colour
as a broad category. However, we recognise
there are diculties with this categorisation,
and we recognise too that people from other
minoritised groups may also experience racial
and ethnic discrimination. Where possible,
we have further specied racial and ethnic
groups according to the terms given in the
source literature. The term ‘minoritised’ is used
to recognise that being a minority is shaped
by processes of power and is dependent on
context.59 We have discussed as a team as to
how to carefully and consciously use language in
addressing issues relating to race and ethnicity.
If you have any feedback on our use of language
that would help us rene our approach, please
get in touch at ebpu@annafreud.org. This
reects an ongoing area of enquiry and concern
for us. Please see Our commitment to equity,
diversity and taking an anti-racist stance: https://
www.ucl.ac.uk/evidence-based-practice-
unit/sites/evidence-based-practice-unit/
les/ebpu_equity_and_diversity_statement_
august_2020_0.pdf

8
References
1. Cénat JM. How to provide anti-racist mental health
care. Lancet Psychiatr y. 2020 Nov 1;7(11):929–31.
2. Stanley J, Harris R, Cormack D, Waa A, Edwards R.
The impact of racism on the future health of adults:
protocol for a prospective cohort study. BMC Public
Health. 2019 Mar 28;19(1):346.
3. Williams DR, Mohammed SA. Racism and Health
I: Pathways and Scientic Evidence. American
Behavioral Scientist. 2013 Aug 1;57(8):1152–73.
4. World Health Organisation Commission on
Social Determinants of Health. Closing the Gap in
a Generation: Health Equity Through Action on the
Social Determinants of Health: Commission on Social
Determinants of Health Final Report. World Health
Organization; 2008. World Health Organisation.
5. Platt L, Warwick R. Are some ethnic groups more
vulnerable to COVID-19 than others? [Internet].
The Institute for Fiscal Studies; 2020 [cited 2020
Sep 28]. Available from: https://www.ifs.org.uk/
inequality/chapter/are-some-ethnic-groups-more-
vulnerable-to-covid-19-than-others/
6. Pan D, Sze S, Minhas JS, Bangash MN, Pareek
N, Divall P, et al. The impact of ethnicity on clinical
outcomes in COVID-19: A systematic review.
EClinicalMedicine. 2020 Jun;23:100404.
7. Coronavirus (COVID-19) related deaths
by ethnic group, England and Wales - Oce
for National Statistics [Internet]. [cited 2020
Sep 28]. Available from: https://www.ons.
gov.uk/peoplepopulationandcommunity/
birthsdeathsandmarriages/deaths/articles/
coronaviruscovid19relateddeathsbyethnicgroup
englandandwales/2march2020to15may2020
8. Abuelgasim E, Saw LJ, Shirke M, Zeinah
M, Harky A. COVID-19: Unique public health
issues facing Black, Asian and minority ethnic
communities. Current Problems in Cardiology. 2020
Aug;45(8):100621.
9. How is COVID-19 aecting children and young
people in BAME communities? | RCPCH [Internet].
[cited 2020 Sep 28]. Available from: https://www.
rcpch.ac.uk/news-events/news/how-covid-
19-aecting-children-young-people-bame-
communities
10. Bamford J, Klabbers G, Curran E, Rosato M,
Leavey G. Social Capital and Mental Health Among
Black and Minority Ethnic Groups in the UK. Journal
of Immigrant and Minority Health. 2020 Jul 4;1–9.
11. Stossel L. A Letter From...New York, USA. Lancet
Psychiatry. 2020 Jun 1;7(6):486.
12. Garmezy N, Masten AS, Tellegen A. The Study
of Stress and Competence in Children: A Building
Block for Developmental Psychopathology. Child
Development. 1984;55(1):97–111.
13. Lavis P, on behalf of the Children and Young
People’s Mental Health Coalition. The importance
of promoting mental health in children and young
people from black and minority ethnic communities:
A Race Equality Foundation Brieng Paper [Internet].
Race Equality Foundation; 2014 [cited 2020 Nov
10]. Available from: http://raceequalityfoundation.
org.uk/wp-content/uploads/2018/02/Health-
Brieng-332.pdf
14. Bruton J, Jones K, Jenkins R, Davies B, Ward
H, Toledano M. Enabling participation of Black
and Minority Ethnic (BME) and seldom-heard
communities in health research: a case study from
the SCAMP adolescent cohort study. Research for
All. 2020; 4(2), 207-19.Available from: http://spiral.
imperial.ac.uk/handle/10044/1/80087
15. Grey T, Sewell H, Shapiro G, Ashraf F. Mental
Health Inequalities Facing U.K. Minority Ethnic
Populations. Journal of Psychological Issues in
Organizational Culture. 2013 May 1;3(S1):146–57.
16. Reframing Racism: Explaining ethnic inequalities
in the UK labour market. [Internet]. Runnymede
Trust; 2017 [cited 2020 Sep 28]. Available from:
https://www.runnymedetrust.org/uploads/
Runnymede%20Reframing%20Racism%20
TUC%20brieng.pdf
17. Roe J. Ethnicity and children’s mental health:
making the case for access to urban parks. The
Lancet Planetary Health. 2018 Jun 1;2(6):e234–5.
18. Edbrooke-Childs J, Patalay P. Ethnic Dierences
in Referral Routes to Youth Mental Health Services.
Journal of the American Academy of Child &
Adolescent Psychiatry. 2019 Mar 1;58(3):368–375.e1.
19. Edbrooke-Childs J, Newman R, Fleming I,
Deighton J, Wolpert M. The association between
ethnicity and care pathway for children with
emotional problems in routinely collected child and
adolescent mental health services data. European
Child Adolescent Psychiatry. 2016 May 1;25(5):539–46.
20. Harding S, Read UM, Molaodi OR, Cassidy
A, Maynard MJ, Lenguerrand E, et al. The
Determinants of young Adult Social well-being
and Health (DASH) study: diversity, psychosocial
determinants and health. Social Psychiatry and
Psychiatric Epidemiology. 2015 Aug;50(8):1173–88.
21.Bhui KS, Lenguerrand E, Maynard MJ, Stansfeld
SA, Harding S. Does cultural integration explain
a mental health advantage for adolescents?
International Journal of Epidemiology. 2012
Jun;41(3):791–802.

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22. Maynard MJ, Harding S. Perceived parenting
and psychological well-being in UK ethnic minority
adolescents: Parenting and well-being in ethnic
minority youth. Child: Care, Health and Development.
2010 Sep;36(5):630–8.
23. Maynard MJ, Harding S. Ethnic dierences in
psychological well-being in adolescence in the
context of time spent in family activities. Social
Psychiatry and Psychiatric Epidemiology. 2010
Jan;45(1):115–23.
24. Umaña-Taylor AJ, Lee RM, Rivas-Drake D,
Syed M, Seaton E, Quintana SM, et al. Ethnic and
Racial Identity During Adolescence and Into Young
Adulthood: An Integrated Conceptualization. Child
Development. 2014;8 5(1):21–39.
25.Wallace JM, Muro JR. Preventing Substance
Abuse Among African American Children and
Youth: Race Dierences in Risk Factor Exposure and
Vulnerability. Journal of Primary Prevention. 2002
Mar 1;22(3):235–61.
26.Gutman LM, Samero AJ, Eccles JS. The
Academic Achievement of African American
Students During Early Adolescence: An Examination
of Multiple Risk, Promotive, and Protective Factors.
American Journal of Community Psychology. 2002
Jun 1;30(3):367–99.
27.Robinson L. Racial Identity Attitudes and Self-
Esteem of Black Adolescents in Residential Care: An
Exploratory Study on JSTOR. The British Journal of
Social Work. 2000;30:3–24.
28. Rivas-Drake D, Markstrom C, Syed M, Lee
RM, Umaña-Taylor AJ, Yip T, et al. Ethnic and
Racial Identity in Adolescence: Implications for
Psychosocial, Academic, and Health Outcomes.
Child Development. 2014;85(1):40 –57.
29. Wakeeld WD, Hudley C. Ethnic and Racial
Identity and Adolescent Well-Being. Theory into
Practice. 2007 Apr 30;46(2):147–54.
30. Yip T. Ethnic/Racial Identity—A Double-Edged
Sword? Associations With Discrimination and
Psychological Outcomes. Current Directions in
Psychological Science. 2018 Jun 1;27(3):170–5.
31. Bannon WM, McKay MM, Chacko A, Rodriguez
JA, Cavaleri M. Cultural Pride Reinforcement as
a Dimension of Racial Socialization Protective of
Urban African American Child Anxiety. Families in
Society. 2009 Jan 1;90(1):79–86.
32. Wang M-T, Henry DA, Smith LV, Huguley JP,
Guo J. Parental ethnic-racial socialization practices
and children of color’s psychosocial and behavioral
adjustment: A systematic review and meta-analysis.
American Psychologist. 20190506;75(1):1.
33. Whitbeck LB, McMorris BJ, Hoyt DR, Stubben
JD, LaFromboise T. Perceived Discrimination,
Traditional Practices, and Depressive Symptoms
among American Indians in the Upper
Midwest. Journal of Health and Social Behavior.
2002;43(4):400–18.
34. Lee S, Rose R. Unexpected benets: new
resilience among intergenerational Asian-
Americans during the Covid-19 pandemic. Social
Work with Groups. 2021 Jan 5;0(0):1–7.
35. Malinakova K, Trnka R, Bartuskova L, Glogar
P, Kascakova N, Kalman M, et al. Are Adolescent
Religious Attendance/Spirituality Associated with
Family Characteristics? International Journal of
Environmental Research and Public Health [Internet].
2019 Aug 16 [cited 2020 Sep 28];16(16). Available
from: https://europepmc.org/article/pmc/
pmc6721075
36. Hope MO, Assari S, Cole-Lewis YC, Caldwell
CH. Religious Social Support, Discrimination, and
Psychiatric Disorders among Black Adolescents.
Race and social problems. 2017 Jun;9(2):102–14.
37. Kulis SS, Tsethlikai M. Urban American Indian
Youth Spirituality and Religion: A Latent Class
Analysis. Journal for the Scientic Study of Religion.
2016 Dec 1;55(4):677– 97.
38. Estrada CAM, Lomboy MFTC, Gregorio ER,
Amalia E, Leynes CR, Quizon RR, et al. Religious
education can contribute to adolescent mental
health in school settings. International Journal of
Mental Health Systems. 2019 Apr 26;13(1):28.
39. Newman PA, Fantus S, Woodford MR, Rwigema
M-J. “Pray That God Will Change You”: The Religious
Social Ecology of Bias-Based Bullying Targeting
Sexual and Gender Minority Youth—A Qualitative
Study of Service Providers and Educators. Journal of
Adolescent Research. 2018 Sep 1;33(5):523–48.
40. Islam F, Campbell RA. “Satan Has Aicted Me!”
Jinn-Possession and Mental Illness in the Qur’an.
Journal of Religion and Health. 2014 Feb 1;53(1):229–43.
41. Wesselmann ED, Graziano WG. Sinful and/or
Possessed? Religious Beliefs and Mental Illness
Stigma. Journal of Social and Clinical Psychology.
2010 Apr 1;29(4):402–37.
42.Eisman AB, Zimmerman MA, Kruger D, Reischl
TM, Miller AL, Franzen SP, et al. Psychological
Empowerment Among Urban Youth: Measurement
Model and Associations with Youth Outcomes.
American Journal of Community Psychology. 2016
Dec 1;58(3–4):410–21.
43. Karatzias A, Chouliara Z, Power K, Swanson V.
Predicting general well-being from self-esteem
and aectivity: An exploratory study with Scottish
adolescents. Quality of Life Research. 2006 Sep
1;15(7):1143–51.

10
45.Perkins DD, Zimmerman MA. Empowerment
theory, research, and application. American Journal
of Community Psychology. 1995 Oct 1;23(5):569–79.
46. Ozer E, Schotland M. Psychological
empowerment among urban youth: measure
development and relationship to psychosocial
functioning. Health education & Behavior. 2011;
38(4):348-56. Available from: https://pubmed.ncbi.
nlm.nih.gov/21606379/
47. Copeland-Linder N, Lambert SF, Ialongo NS.
Community Violence, Protective Factors, and
Adolescent Mental Health: A Prole Analysis. Journal
of Clinical Child & Adolescent Psychology. 2010 Feb
26;39(2):176– 86.
48. Gerard JM, Buehler, C. Cumulative
Environmental Risk and Youth Maladjustment:
The Role of Youth Attributes. Child Development.
2004; 75(6):1832-1849. Available from: https://srcd.
onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-
8624.2004.00820.x
49. Walsh F. Loss and Resilience in the Time
of COVID‐19: Meaning Making, Hope, and
Transcendence. Family Process. 2020 Sep;59(3):898–
911.
50. Sabolova K, Birdsey N, Stuart-Hamilton
I, Cousins AL. A cross-cultural exploration of
children’s perceptions of wellbeing: Understanding
protective and risk factors. Children and Youth
Services Review. 2020 Mar;110:104771.
51. Scott SM, Wallander JL, Cameron L. Protective
Mechanisms for Depression among Racial/
Ethnic Minority Youth: Empirical Findings, Issues,
and Recommendations. Clinical Child and Family
Psychology Review. 2015 Dec 1;18(4):346– 69.
52. Hammack PL, Richards MH, Luo Z, Edlynn ES,
Roy K. Social Support Factors as Moderators of
Community Violence Exposure Among Inner-City
African American Young Adolescents. Journal of
Clinical Child & Adolescent Psychology. 2004 Aug
1;33(3):450–62.
53. Wang M-T, Brinkworth M, Eccles J. Moderating
eects of teacher-student relationship in
adolescent trajectories of emotional and behavioral
adjustment [Internet]. Developmental psychology.
2013 [cited 2020 Oct 22]. Available from: https://
pubmed.ncbi.nlm.nih.gov/22582833/
54. Meyer IH. Prejudice, Social Stress, and Mental
Health in Lesbian, Gay, and Bisexual Populations:
Conceptual Issues and Research Evidence.
Psychological Bulletin. 2003 Sep;129(5):674–97.
55. Cho S, Crenshaw KW, McCall L. Toward a Field
of Intersectionality Studies: Theory, Applications,
and Praxis. Signs: Journal of Women in Culture and
Society. 2013 Jun 1;38(4):785–810.
56. Masten AS, Motti-Stefanidi F. Multisystem
Resilience for Children and Youth in Disaster:
Reections in the Context of COVID-19. Adversity
and Resilience Science. 2020 Jun 1;1(2):95–106.
57. Collette A, Ungar M. Resilience of Individuals,
Families, Communities, and Environments: Mutually
Dependent Protective Processes and Complex
Systems. In: Ochs M, Borcsa M, Schweitzer J,
editors. Systemic Research in Individual, Couple,
and Family Therapy and Counseling European
Family Therapy Association Series [Internet].
Cham: Springer; 2020. Available from: https://doi.
org/10.10 07/978-3-030-36560 -8_6
58. Metzl JM, Hansen H. Structural competency:
Theorizing a new medical engagement with stigma
and inequality. Social Science and Medicine 1982.
2014 Feb;103:126–33.
59. Milner A, Jumbe S. Using the right words to
address racial disparities in COVID-19. Lancet Public
Health. 2020 Aug;5(8):e419-e420. doi: 10.1016/
S2468-2667(20)30162-6. Epub 2020 Jul 21. PMID:
32707127; PMCID: PMC7373398.
Authors of this research bite
Mia Eisenstadt PhD, Hannah Merrick PhD,
Rosa Town, Snigdha Dutta PhD, Alan
Lally-Francis, Lauren Garland, Jessica
Deighton PhD and Julian Edbrooke-
Childs PhD.
Acknowledgements
Many thanks to readers Yvonne Field,
Somia Imran PhD, Tim Linehan, Danya
Andrew and Anna Moore for helpful
comments, feedback and insight.
Funding acknowledgement
This report is independent research
supported by the National Institute
for Health Research ARC North
Thames. The views expressed in this
publication are those of the authors and
not necessarily those of the National
Institute for Health Research or the
Department of Health and Social Care.

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44. Mann M (Michelle), Hosman CMH, Schaalma HP, de Vries NK. Self-esteem in a broad-spectrum approach for mental health
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