Anti-Black cultural racism impedes benefits of youth psychotherapy interventions

Youth psychotherapy interventions with majority-Black samples were significantly less effective among communities with higher anti-Black cultural racism, according to results of a meta-analysis.

“Although addressing sources of stress among minoritized individuals — including racism — is theorized to enhance the efficacy of interventions for marginalized groups, there has been surprisingly little research on whether racism moderates treatment effect heterogeneity,” Maggi A. Price, PhD, a psychology associate in the department of psychology at Harvard University, and colleagues wrote in Journal of the American Academy of Child & Adolescent Psychiatry. “In the current study, we address this gap by examining whether mental health interventions with majority-Black samples are less effective in communities with higher (vs. lower) levels of anti-Black cultural racism.”

The researchers conducted a systematic search to identify a subset of 194 studies with 14,081 participants aged 2 to 19 years from a prior meta-analysis of youth psychotherapy randomized controlled trials that were published in English between 1963 and 2017. Included studies were conducted across 34 states and comprised 2,678 effect sizes that measured mental health problems, such as depression, targeted by interventions. Price and colleagues used a composite index of 31 items that measured explicit racial attitudes, which they obtained from publicly available sources like the General Social Survey, to operationalize anti-Black cultural racism. They aggregated the items to the state level and linked them to the meta-analytic database. Samples included in the analyses consisted of 36 studies with 50% or more Black youths and 158 studies with 50% or more white youths.

Controlling for relevant area-level covariates, results of two-level random effects meta-regression analyses showed an association between higher anti-Black cultural racism and lower effect sizes for studies with majority-Black youths (beta = 0.2; 95% CI, -0.35, -0.04); however, higher anti-Black cultural racism was not associated with effect sizes for studies with majority-white youths (beta = 0.0004; 95% CI, -0.03, 0.03). Mean effect sizes were significantly lower in states with the highest anti-Black cultural racism compared with states with the lowest racism in studies with majority-Black youths.

“Our study makes a novel contribution to this literature by suggesting a previously overlooked way in which anti-Black racism, measured at the macro (cultural) level, may adversely impact the mental health of Black youth — by undermining their ability to benefit from psychotherapy interventions,” Price and colleagues wrote. “In so doing, our results also uncover new avenues for future research at the intersection of cultural racism, developmental science and mental health interventions.”