Price, M.A., Weisz, J.R., McKetta, S., Hollinsaid, N.L., Lattanner, M.R., Reid, A.E., Hatzenbuehler, M.L. (2021). Meta-analysis: Are psychotherapies less effective for Black youth in communities with higher levels of anti-Black racism? Journal of the American Academy of Child & Adolescent Psychiatry.
Racism is a system in which racial groups are ranked, devalued, and provided limited opportunities and resources. Individual racism refers to how individuals of stigmatized groups respond to racism (self-devaluation, hopelessness), interpersonal racism refers to how people discriminate or mistreat others based on race, and structural or cultural racism refers to collective beliefs regarding racial groups that become enacted by larger social systems and institutions. Historically, health research on the negative effects of racism has focused on interpersonal racism. More recently, research has studied the association between structural or cultural racism and adverse health outcomes. Few studies have examined the effects of cultural racism on mental health outcomes especially among Black youth. In this meta-analysis, Price and colleagues identified 194 studies across 34 US states. They measured anti-Black cultural racism by analyzing publicly available surveys that tapped into racism. The authors statistically aggregated the scores for each US state thus providing a cultural racism score for each state. The authors categorized the 194 studies according to the composition of race of its participants, such that studies had either majority-White samples (k = 158) or majority-Black samples (k = 36). To examine the independent effect of state-level cultural racism, the authors also controlled for several confounding variables in their analyses (state-level White or Black population density, state poverty rate). Higher anti-Black racism at the state level was associated with lower effects of psychotherapy in studies in which most of the youth were Black (β = -0.20, 95% CI: -0.35, -0.04, p = .02). However, the effect of cultural racism was unrelated to the effects of psychotherapy in studies in which most of the youth were White (β = 0.0004, 95% CI: -0.03, 0.03, p = .98). The standardized effect sizes in states with the highest anti-Black racism (g = 0.19) were significantly lower than in states with the lowest racism (g = .60). A concerning finding was that the differences between low and high racism states widened at follow-up, indicating that cultural racism eroded some of the gains made by Black youth in high racism states.
Researchers have long known the negative health disparities related to racism, but this is the first study to evaluate the effects of cultural racism on the effects of psychotherapy. This meta-analysis indicates that anti-Black cultural racism reduced psychotherapy effectiveness for Black youth, and some gains tended to decline at follow up. Psychotherapists should consider modifying their treatments for Black youth to derive most benefit and to adopt a multicultural orientation. Nevertheless, stigma and racism have negative effects at multiple levels that require structural and community interventions to target racism at its source.