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Meta-Analysis
. 2022 Jun;61(6):754-763.
doi: 10.1016/j.jaac.2021.07.808. Epub 2021 Aug 6.

Meta-analysis: Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism?

Maggi A Price  1 , John R Weisz  2 , Sarah McKetta  3 , Nathan L Hollinsaid  2 , Micah R Lattanner  2 , Allecia E Reid  4 , Mark L Hatzenbuehler  2
Affiliations
Meta-Analysis

Meta-analysis: Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism?

Maggi A Price et al. J Am Acad Child Adolesc Psychiatry. 2022 Jun.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Am Acad Child Adolesc Psychiatry. 2022 Nov;61(11):1396. doi: 10.1016/j.jaac.2022.05.005. Epub 2022 Jun 4. J Am Acad Child Adolesc Psychiatry. 2022. PMID: 35688788 No abstract available.

Abstract

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.

Keywords: anti-Black cultural racism; psychotherapy; spatial meta-analysis; treatment effect heterogeneity; youth.

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Figures

Figure 1.
Figure 1.. Anti-Black Cultural Racism and Effect Size Across Subsets by Majority Race
g = type of effect size, specifically Hedge’s g.
Figure 2.
Figure 2.. Predicted Effect Size in States with Low vs High Anti-Black Cultural Racism Across Assessment Period
g = type of effect size, specifically Hedge’s g.
See this image and copyright information in PMC

Comment in

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