Black History Month: A Q&A With Dr. Khadijah Booth Watkins

Suicide is the second leading cause of death for teens and young adults in the United States. That rate is growing fastest among Black adolescents, with a 55% increase from 2010-2019. 

The Jed Foundation (JED) sat down with Khadijah Booth Watkins, MD, MPH, a member of our Advisory Board, to discuss how parents, caregivers, and schools can better support their needs. 

How did you become affiliated with the JED Advisory Board?
[JED CEO John MacPhee] and I met at Mailman School of Public Health. We spoke often about the mental health of adolescents and young adults. I admired his authenticity and passion about the barriers imposed by our complicated healthcare system. Over the years, John invited me to various engagements. The more I learned about JED, the more I wanted to be involved.

To what do you attribute the rising rates of suicide among Black youth?
Suicide is complicated. It’s multifactorial, and it’s not likely that I can point to a direct cause. This is extremely troubling given that, historically, rates of suicide among Black youth have been lower than their same-age white peers. However, rates among their white peers have been decreasing during this same period of time.

While we must acknowledge and respect the heterogeneity of Black youth–and we cannot take a broad stroke approach–the bottom line is that we can (and we need to) do better by our kids. 

More widely known and understood [risk factors] are the impacts of health inequity, barriers to accessing care, and stigma. Unfortunately, research and funding have been lacking to further investigate and understand some of the other differences. [Studies] on the impacts of structural racism, discrimination, microaggressions, and violence are woefully lacking. In considering the health and well-being of Black youth, we cannot disregard the impact of their experiences. Racism, being discriminated against, being barred from opportunities, and watching images of others resembling you being the victim of violence is demoralizing, stressful, and scary. It takes a hefty emotional toll on our youth, leading to poor mental health.

We are in a National State of Emergency as it relates to children’s mental health across the board. It was noted that worsening child and adolescent mental health is inextricably tied to the stress brought on by [the COVID-19 pandemic] and the ongoing struggle for racial justice.

How should parents and caregivers support their teens?
Parents can support their teens in many different ways. However, this is considerably more difficult if you are in the dark. I encourage having routine, frequent conversations with your teen and creating an inviting and safe platform for them to share what’s going on in their world–their concerns and worries, as well as their hopes and dreams.

Additionally, help foster resilience in your young person. When adversity is unavoidable, resilience will help them bounce back from stressful and traumatic situations.

Parents can model resilience by engaging in self-care, focusing on gratitude, and using coping skills. Parents should name and identify feelings and emotions and help their adolescents do the same. Connection is an extremely important component of resilience, and parents can help their youth by encouraging and facilitating connections with peers and trusted adults.

What can high schools, colleges, and universities do to support Black students?
Colleges, universities, and high schools can better support Black students by creating an environment in which Black students feel supported, included, and affirmed. It’s imperative that schools be deliberate in the recruitment and retention of staff and faculty of culturally and ethnically diverse backgrounds, [including] mental health providers. Schools need to create an atmosphere in which the student feels a sense of belonging. [This can be done by] encouraging cultural pride and facilitating connection with peers and staff of similar cultural backgrounds. Schools must name and call out racism and inequity and be diligent in engaging in initiatives that promote justice, diversity, equity, and inclusion. 

Can you share your thoughts about the effects of institutional racism and trauma within Black communities, and strategies for healing?
Institutional racism is deeply woven into the fabric of our nation and health inequality. It creates barriers to successfully operationalizing prevention and intervention strategies. Racism is an Adverse Childhood Experience (ACE), and structural racism plays a central role in the prevalence of ACEs among individuals who are racially marginalized, leading to poorer health outcomes. 

Racism is stressful, and the impact of stress on the body has been well-studied to include cardiac disease, diabetes, hypertension, and obesity. Healing will require increased understanding and acknowledgement of the unique stressors and protective factors experienced by Black youth and within Black communities.

Khadijah Booth Watkins, MD, MPH, is the Associate Director of the Child and Adolescent Psychiatry Residency Training Program of Massachusetts General Hospital (MGH) and McLean Hospital, as well as the Associate Director of the Clay Center for Healthy Young Minds at MGH. She specializes in the evaluation, diagnosis, and treatment of psychiatric disorders in children, adolescents, and adults, having earned her MD from the University of Tennessee Health Science Center and her MPH from Columbia University. She is a member of the JED Advisory Board.