Are Psychotherapies Less Effective for Black Youth in Communities with Higher Levels of Anti-Black Racism?

Abstract

Objective: The study examined whether cultural racism moderates the efficacy of psychotherapy interventions among youth.Method: We analyzed a subset of studies from a previous meta-analysis of five decades of youth psychotherapy randomized controlled trials. Studies were published in English between 1963 and 2017 and identified through a systematic search. The 194 studies (N=14,081; ages 2-19) across 34 states comprised 2,678 effect sizes (ESs) measuring mental health problems (e.g., depression) targeted by interventions. Cultural racism was operationalized using a composite index of 31 items measuring explicit racial attitudes (obtained from publicly available sources; e.g., General Social Survey), aggregated to the state level and linked to the meta-analytic database. Analyses were conducted with samples of majority (i.e., ≥50%) Black (n=36 studies) and majority-White (n=158 studies) youth.Results: Two-level random effects meta-regression analyses indicated that higher cultural racism was associated with lower ESs for studies with majority-Black youth (β=-0.21, CI: -0.37, -0.05, p=0.01) but was unrelated to ESs for studies with majority-White youth (β=0.003, CI: -0.03, 0.03, p=0.80), controlling for state-level poverty and White population density. In studies with majority-Black youth, mean ESs were significantly lower in states with the highest cultural racism (>1 SD above the mean; g=0.19) compared to states with the lowest racism (<1 SD below the mean; g=0.60). Conclusions: Psychotherapy randomized controlled trials with samples comprised of majority-Black youth were significantly less effective in states with higher (vs. lower) levels of cultural racism, suggesting that cultural racism may be one contextual moderator of treatment effect heterogeneity.

Does Stigma Moderate the Efficacy of Mental- and Behavioral-Health Interventions? Examining Individual and Contextual Sources of Treatment-Effect Heterogeneity

“…The left-hand graph shows results for samples with more than 50% Black participants; the right-hand graph shows results for samples with more than 50% White participants. Adapted from “Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism?” by M. A.…”

“…Two spatial meta-analyses of behavioral-health intervention studies (i.e., HIV-prevention interventions: 99 effect sizes, Reid et al, 2014) and mental-health intervention studies (i.e., psychotherapies: 385 effect sizes, Price et al, 2021) have addressed whether structural stigma moderates intervention efficacy. The interventions in these studies were typically nonadapted; that is, they were general health interventions designed to reduce adverse mental- and behavioral-health outcomes among all respondents, irrespective of whether they had a stigmatized identity, condition, or status.…”

“…Both spatial meta-analyses examined structural stigma related to race, which was measured by aggregating racial attitudes in the counties (Reid et al, 2014) and states (Price et al, 2021) where these interventions were conducted. (Reid et al, 2014, additionally measured racial residential segregation, which yielded similar results.)…”

“…Results from Price et al’s (2021) spatial meta-analysis of the relationship between race-related structural stigma and the efficacy of psychotherapy interventions among youth: effect size (Hedges’s g —the standardized mean difference between the intervention and control conditions) as a function of cultural racism, which was measured with a composite index of 31 items assessing explicit racial attitudes. These items were obtained from three different sources: the General Social Survey (e.g., “Are we spending too much, too little, or about the right amount on improving the conditions of Blacks?”), the American National Election Survey (e.g., “Irish, Italians, Jewish and many other minorities overcame prejudice and worked their way up.…”

“…Second, the study by Price and colleagues (2021) included a nonstigmatized comparison (i.e., majority-White samples). No association was observed between structural stigma and intervention efficacy in the nonstigmatized group (Fig.…”