Is State-Level Anti-Black Cultural Racism Associated with Black Youth’s Mental Health?

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Description: Research consistently links internalizing/externalizing symptomatology in Black youth to discrimination (Benner et al., 2018), with a near exclusive focus on interpersonal racism (Williams, 2018). Despite recent calls (Trent et al., 2019), few studies have explored anti-Black racism at the macro level, including if and how cultural racism (i.e., a dominant culture’s values/beliefs regarding another racial group; Hicken et al., 2018) relates to Black youth’s mental health. This is an important area of inquiry, as evidence reveals significant associations between higher community-level anti-Black cultural racism and poor health (e.g., COVID; Thomas et al., 2020), worse therapy efficacy (Price et al., 2021), and altered brain development (e.g., hippocampal volume; Hatzenbuehler et al., 2020). Building on this work, we explored associations between state-level anti-Black cultural racism and mental health symptom severity in Black youth, anticipating that Black youth from higher-racism states would report greater internalizing/externalizing symptoms. Data were pooled across three psychotherapy trials (Weisz et al., 2012, 2018, 2020) with 112 clinic-referred Black youth (Mage=10.7; 53% boys) from four states. Participants’ pretreatment internalizing/externalizing symptoms (Youth Self-Report; Achenbach & Rescorla, 2001) were linked to a previously developed composite measure of anti-Black cultural racism (aggregating individuals’ explicit anti-Black attitudes by state; Price et al., 2021). Multilevel models (to account for youth nested in states) examined associations between anti-Black cultural racism and symptom severity (adjusting for age, gender, state income inequality, and Black/White population density). Anti-Black cultural racism was significantly associated with self-reported externalizing (β=11.8, SE=4.9, p=.018) but not internalizing symptomatology, with Black youth from states with greater anti-Black attitudes reporting more severe concerns. As a negative control, we reran our analysis with 489 White youth (Mage=10.3; 54% boys) from the same trials (and thus states), finding no such associations. Findings extend a growing body of literature highlighting the insidious effects of anti-Black racism. We demonstrate that greater levels of anti-Black cultural racism may undermine Black youth’s mental health, at least with respect to externalizing symptoms. It is possible that Black youth from higher-racism states are more likely to be exposed to, and may internalize, racial bias/stereotypes, such as those implicated in unjust institutional (e.g., school discipline; Riddle & Sinclair, 2019) and assessment (e.g., overdiagnosis of externalizing disorders; Fadus et al., 2020) practices, wherein Black youth are labeled as more defiant and aggressive than their White peers (Goff et al., 2014). Additionally, anti-Black cultural racism has been linked to reduced hippocampal volume in Black youth (Hatzenbuehler et al., 2020), and such alterations may contribute to externalizing behaviors (Roberts et al., 2021). Accordingly, anti-racist approaches to mental health care, which address causes and consequences of anti-Black racism, may be particularly beneficial to Black youth in high-racism communities.


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