Meta-analysis: Are psychotherapies less effective for black youth in communities with higher levels of anti-black racism?
Open accessAbstract
Objective To examine whether anti-Black cultural racism moderates the efficacy of psychotherapy interventions among youth.Method A subset of studies from a previous meta-analysis of 5 decades of youth psychotherapy randomized controlled trials was analyzed. Studies were published in English between 1963 and 2017 and identified through a systematic search. The 194 studies (N = 14,081 participants; age range, 2-19) across 34 states comprised 2,678 effect sizes (ESs) measuring mental health problems (eg, depression) targeted by interventions. Anti-Black cultural racism was operationalized using a composite index of 31 items measuring explicit racial attitudes (obtained from publicly available sources, eg, General Social Survey) aggregated to the state level and linked to the meta-analytic database. Analyses were conducted with samples of majority-Black (ie, ≥50% Black) (n = 36 studies) and majority-White (n = 158 studies) youth.Results Two-level random-effects meta-regression analyses indicated that higher anti-Black cultural racism was associated with lower ESs for studies with majority-Black youth (β = -0.2, 95% CI [-0.35, -0.04], p = .02) but was unrelated to ESs for studies with majority-White youth (β = 0.0004, 95% CI [-0.03, 0.03], p = .98), controlling for relevant area-level covariates. In studies with majority-Black youth, mean ESs were significantly lower in states with the highest anti-Black cultural racism (>1 SD above the mean; Hedges' g = 0.19) compared with states with the lowest racism (<1 SD below the mean; Hedges' g = 0.60).Conclusion Psychotherapies tested with samples of majority-Black youth were significantly less effective in states with higher (vs lower) levels of anti-Black cultural racism, suggesting that anti-Black cultural racism may be one contextual moderator of treatment effect heterogeneity.
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The structural context in which psychotherapies are delivered is associated with psychotherapy efficacy, as shown by findings that psychotherapy is less effective for Black youth in US counties with higher anti-Black racism.
“an emerging body of research has found that the structural context in which psychotherapies are delivered is associated with psychotherapy efficacy. For instance, psychotherapy has been found to be less effective for Black youth living in U.S. counties with higher anti-Black racism (Price et al., 2022).”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Price et al., 2022
The Discussion reports that psychotherapy interventions with majority-Black youth samples were less effective where anti-Black cultural racism was higher. But the study measured racism at the state level, not the county level; the Discussion explicitly identifies county-level analysis as future research. (LLM, conf=0.94)
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- Authors
- Price, M. A., Weisz, J. R., McKetta, S., Hollinsaid, N. L., Lattanner, M. R., Reid, A. E., & Hatzenbuehler, M. L.
- Affiliations
- Boston College (US)
- Harvard University (US)
- Columbia University (US)
- University of Massachusetts Amherst (US)
- Corresponding author
- Price, Maggi A.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 61
- Issue
- 6
- Pages
- 754-763
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC8818051
- OpenAlex
- W3192483033
- Cited by
- 115
- References
- 48
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 46 · 2023: 18 · 2022: 23 · 2021: 2
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Update notices
- erratum (2022-11-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University College London
- American Psychological Foundation
- Institute of Education Sciences (R305B170019)
- John D. and Catherine T. MacArthur Foundation
- National Institute on Alcohol Abuse and Alcoholism
- John Templeton Foundation
- National Institute of Mental Health (MH093511, MH068806, MH085963, T32MH013043)
- U.S. Department of Education
- Centers for Disease Control and Prevention
- Annie E. Casey Foundation
- William T. Grant Foundation
- Topics
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- psychotherapy effectiveness, Black youth, racial attitudes, treatment effect heterogeneity, contextual moderators, youth mental health
- MeSH terms
- Adolescent, Black or African American, Child, Child, Preschool, Humans, Psychotherapy, Young Adult, Racism
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