The Impact of Family-Level Factors on African American Youth's Behavioral Health Outcomes: A Systematic Review

Background:  African American (AA) youth tend to be labeled with more severe mental health diagnoses and are hospitalized at rates two to three times that of white youth.  Additionally, youth of lower socioeconomic status; that includes AA youth, are more likely to report any mental and behavioral health disorders, particularly Attention Deficit Hyperactive Disorder.  These alarming statistics substantiates that AA youth psychopathology is a significant public health concern, and the statistics suggest a lack of prevention and treatment of mental health services for AA children.  Thus, research should be conducted to identify factors that can be used to prevent and develop effective treatments and interventions for this population.  Grounded by AA research and the Afrocentricity paradigm that encourages researchers to consider the unique characteristics of AA families to overcome challenges and improve outcomes, we chose to identify family-level factors in a systematic review that can be used in future research concerning treatments and interventions for this population.  This review will answer the following research question:  What are the family-level factors associated with behavioral health outcomes in AA children?

Methods: This study was guided by systematic review methods postulated by PRISMA Group and Gough and colleagues. The research team consisted of three assistant professors and one social work graduate research assistant; and we sought consultation services from a university librarian and an academic writing coach with expertise in systematic reviews.  In general, our research team used the following steps to conduct the review:  create protocol; search, store, & screen studies; data extraction; synthesis; and write report.  To enhance the quality of the review, we utilized internal and external quality procedures; such as double-blind screening and coding.  We also pilot tested the study’s coding instruments (e.g., data extraction form).  An electronic search of Social Work Abstracts, PsycInfo, SocIndex, PubMed, Social Service Abstracts, and Sociological Abstracts databases from 2003 to 2013 was performed (hand searches were also performed).  Inclusion criteria consist of family-level independent variables, behavioral health dependent variables, 100% AA sample, ages 0 to 18 years old, English-only manuscripts, etc…

Results: The searches identified 3,873 articles, 387 underwent full review and of these 36 studies were eligible. We utilized PRISMA diagram, tables, and narratives to analyze data that revealed parenting practices as the most examined family-level factor to predict behavioral health. Parental support, positive parenting, mother’s psychological control, and parental monitoring were associated with better behavioral health outcomes.  Harsh discipline was found to negatively affect behavioral health. Other family-level factors associated with behavioral health were mother’s mental health and social support, and family’s functioning & socioeconomic status.  Inconsistencies in reporting of externalizing behaviors were found.   

Implications:  Given the study’s key findings that suggest the importance of parenting practices on children’s behavioral health, it is clear that practitioners should work with parents to support specific parenting skills and positive interactions between parents and youth.  Due to the emergence of literature that reveals association between racial discrimination & socialization and children mental and behavioral health; future research should consider their effect on parenting practices.