Increasing evidence suggests that, as in other medical fields, there are pronounced pediatric mental health disparities with greater burden among marginalized racial and ethnic youth. The reasons for these disparities are not fully understood. One way to explain pediatric mental health disparities is through the lens of environmental stress as a driver of mental health burden, given that marginalized populations are exposed to more structural and individual stress. Although traditionally stress has been linked to specific psychiatric disorders that fall under the umbrella of "stress-related disorders" such as acute/post-traumatic stress disorder or adjustment disorder, broader conceptual frameworks include depression (including suicidality) and anxiety as stress related. More recently, there has been growing recognition of the contribution of early life stressful exposures (ie, childhood adversity) to psychosis spectrum disorders. As such, recognition of the role of stress exposure in psychotic presentations and the fact that exposure to adverse social determinants of health and stressful environments is more common among youth of color can serve as a potential mechanism to explain pediatric disparities in psychosis risk.