Family interventions may reduce discrimination's psychiatric impact on Black adolescents

Participation in family-centered prevention programs mitigated the impact of racial discrimination on subsequent mental health problem increases among Black adolescents, according to study results published in JAMA Network Open.

“The Strong African American–Teen (SAAF–T) program was designed for youth aged 14 to 16 years, and the Adults in the Making (AIM) program was designed for youth aged 17 to 18 years,” Gene H. Brody, PhD, of the Center for Family Research at the University of Georgia, and colleagues wrote. “Both programs were developed to prevent mental health problems and substance use by enhancing protective caregiving. Previous research with the SAAF–T and AIM trials focused on establishing their efficacy and durability in preventing substance use and mental health problems. Both interventions have also been shown to mitigate the effects of life stress on Black adolescents by increasing protective caregiving, and both programs have demonstrated stress-buffering capacities for a range of psychosocial outcomes.”

However, prior studies have not assessed the effects of these interventions on coping with discrimination among youths. To address this research gap, Brody and colleagues conducted the current secondary analysis of two randomized clinical trials that evaluated SAAF-T and AIM, both of which were implemented in community locations accessible to individuals across 12 rural Georgia counties. The SAAF-T and AIM trials included Black adolescents and their primary caregivers, recruited between 2007 and 2008 for SAAF-T (n = 502 adolescent) and between 2006 to 2007 for AIM (n = 367). Adolescents’ baseline data on the frequency of their encounters with racial discrimination served as exposures. SAAF-T comprised five sessions of 10-hour psychosocial intervention for families with a Black adolescent aged 14 to 16 years, and AIM comprised six sessions of 12-hour psychosocial intervention for families with a Black high school senior. Mental health problems, such as conduct problems and anxiety or depression symptoms, served as main outcomes and measures.

Results showed fewer subsequent increases in conduct problems (incident risk ratio = 0.53; 95% CI, 0.34-0.783) among adolescents in the SAAF-T intervention who frequently experienced discrimination at baseline. Moreover, the researchers observed fewer subsequent increases in conduct problems (mean difference = 0.361; 95% CI, 0.577 to 0.144) and in anxiety or depression symptoms (mean difference = 0.22; 95% CI, 0.402 to 0.038) among those in the AIM intervention who frequently experienced discrimination at baseline. All observed interaction effects appeared partially attributable to enhanced protective caregiving, according to moderated mediation analyses.

“Clinically, the findings suggest that SAAF–T, AIM and perhaps other interventions that focus on strengthening protective caregiving could help to forestall or attenuate some of the mental health problems that racial discrimination can produce,” Brody and colleagues wrote. “Of particular relevance to pediatric clinical practice, efficacious family-centered prevention programs designed to enhance protective caregiving are available for Black preadolescents, adolescents and youth who are about to transition to young adulthood. Participation in these programs has been associated with stress-buffering effects on the development of self-control and on reductions in drug use, obesity, cytokine levels, epigenetic aging and, in this study, mental health problems following discrimination.”

In a related editorial, Samantha V. Hill, MD, MPH, and Tamera Coyne-Beasley, MD, MPH, of the department of pediatrics at the University of Alabama at Birmingham, outlined potential avenues for future interventions.

“While interventions like those examined by Brody [and colleagues] are important, it may be ambitious to expect short-term programs to be able to fully ameliorate the psychosocial and physical health outcomes of continuous exposure to racism,” Hill and Coyne-Beasley wrote. “Because ‘racism is a socially transmitted disease,’ as explained [in an American Academy of Pediatrics commentary], future interventions must be intentionally designed, long-term, continuous and aimed at primary prevention and dismantling of racism, the root cause of mental health inequities under investigation by Brody [and colleagues]. Most importantly, that intentionality must extend to all expressions of racism, including less recognized variations, such as prejudices, stereotypes, microaggressions, tokenism and colorblindness.”