COVID-19 pandemic has further unveiled the distressful reality of racial disparity in the United States. African Americans are bearing a disproportionate burden of morbidity and mortality due to COVID-19. In many cities like Chicago, although African Americans are only 30% of the population, they make up more than 50% of COVID-19 cases and about 70% of COVID-19 deaths. 1 COVID-19 health and economic consequences have a detrimental effect on mental health, 2 particularly among African Americans. 3 According to Kaiser Health News report, compared with the rest of the population, African American adults are 20% more likely to experience mental health issues. Systemic racism exacerbates the adverse impacts of social determinants of health, causing racial health disparities in African Americans. 2 African Americans are more susceptible to contract COVID-19 due to systemic racism that historically carved out the type of work they are obliged to perform including deliberate neighborhood and school segregation policies which currently explain their increased work place and environmental exposure to COVID-19 infection. As a result, a greater proportion of African Americans now suffer from the stress, anxiety and depression engendered by COVID-19. No previous study has delineated inequities incentivized by systemic racism, and whether synergistic effects impose an abnormally high burden of social determinants of mental health on African American families in the era of COVID-19 pandemic. In this study, we hypothesized systemic racism to be the primary operator of the mental health disparity, which disproportionately affects the psychological well-being of African American families at all levels of the socio-ecological model (SEM).
A rapid search of the literature on COVID-19 pandemic, the social determinants of mental health, systemic racism, as well as their impact on the mental health of African American families was conducted in PubMed and Google scholar. Next, the SEM was employed to portray inequities induced by systemic racism, which aggravates the adverse effect of social determinants of mental health on African American families. The SEM considers the complex interplay across individual, interpersonal, organizational, community, and public policy level factors. 4 The model emphasizes that behaviors and the social environment have a symbiotic relationship and impact each other. 4
The rapid search yielded 30 research articles and only seven of them were included in this review. We found that COVID-19 disproportionately impacts African American families and their mental health due to systemic racism, which intensifies the adverse effects of the social determinants of mental health. Figure 1 represents a social ecological model that delineates social determinants of mental health aggravated by systemic racism among African American families in the era of COVID-19 pandemic.
From the SEM we found that at the individual level, African Americans may experience stress from perceived knowledge of COVID-19 that may be inaccurate and may stem from biased information presented by the local media and other social media networks. Misinformation and more than 10 conspiracy theories have been trending since the beginning of the pandemic and have led to confusion and stress. 5 Misinformation is more likely to trend among communities with limited access to quality educational resources. Studies show that majority of African Americans are systemically disadvantaged from proper education, distinctly afforded by Asians and Whites. 6 Therefore, misinformation may be more likely to prey on African Americans than Caucasians. At the interpersonal level, heightened stress and fear may also originate from family members and relatives whose lives and jobs are affected by COVID-19. Because Black families have been impacted disproportionally, they likely experience more stress than Whites. According to the Centers for Disease Control and Prevention (CDC), African Americans are less than 13% of the population but make up 33.1% of hospitalized COVID-19 patients. 1 At the organizational level, African Americans endure discrimination and racism at school and or work, while at the community level, African Americans lack access to equitable mental healthcare, healthy food options, and recreational facilities. 6 COVID-19 health problems in the African American community manifest not because African Americans do not like to social distance or take care of themselves, but because resources are abominably inadequate in their neighborhood. Finally, at the public policy level, African Americans are disadvantaged by segregated housing and lack of access to equitable education and job opportunities. Compared with Caucasians, African Americans are more likely to live in densely populated areas, increasing their potential contact. 7 As the number of contacts increases, so does the anxiety of being exposed to COVID-19. In addition, African Americans make up the majority of the "essential" workforce, including 30% of bus drivers, and 20% of food service workers. 6 These structural conditions exacerbate the impact of COVID-19 on mental health as consequences of stress, fear, anxiety, and despair, which in severe cases result in posttraumatic stress disorder (PTSD) and or depression. 2
COVID-19 has impacted African American lives, including their mental health, at a higher rate compared to other racial/ethnic groups. 1 As we had hypothesized, we found systemic racism to be the primary operator of the mental health disparity, which disproportionately affects the mental health of African American families at all levels of the SEM.
As a result of systemic racism that affects African Americans at different levels, the standard mental health promotion approaches may not work in this population. Studies show that public policies and health interventions that are tailored and adapted for local contexts and community characteristics are more beneficial and effective than standard approaches. 2 Programs tailored towards improving the mental health of African Americans should be culturally appropriate and community competent. They also need to consider the nuances of systemic racism, discrimination, and other institutionalized biases at each level of the SEM in order to reduce the disproportionate detrimental effects of COVID-19 on the mental health of African Americans. More importantly, policymakers and program implementers need to develop laws and programs that would dismantle systemic racism. Public policies have the power to mitigate the impact of COVID-19 among African Americans and improve their mental health outcomes or to exacerbate health disparities. Interpersonal Level (IL): Stress from family members and relaƟves whose lives and jobs may be affected by COVID-19.
Stress from perceived knowledge that may be inaccurate and/or bias informaƟon on media and other social media networks. 
• African Americans are bearing a disproportionate burden of morbidity and mortality due to COVID-19 pandemic. • Systemic racism is the primary operator of mental health disparity, which disproportionately affects African American families at all levels of the social ecological model (SEM). • Programs tailored towards reducing the disproportionate detrimental effects of COVID-19 on the mental health of African Americans need to be culturally appropriate and consider the nuances of systemic racism, discrimination, and other institutionalized biases.