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

Purpose:  African American (AA) children’s mental disorders (i.e., depression, anxiety) are a public health concern that exacts a toll on children, families, and communities.  For example, African American youth tend to be labeled with more severe mental health diagnoses than White youth, and research indicates that mental disorders are closely linked to health damaging behaviors such as suicide among Black adolescents.  These alarming statistics not only substantiates that AA children’s mental disorders are a significant public health concern, but they also suggest a lack of prevention and treatment of mental health services for AA children.  Therefore, research should be conducted to identify factors that can be used to prevent and develop effective treatments for this population.  This systematic review has two aims: 1) examine the characteristics (e.g., research design, instrumentation) of studies exploring family-level factors associated with depression and anxiety in AA children; 2) examine studies that explore the association between family-level factors and depression and anxiety among AA children. 

Methods: This review was guided by systematic review methods postulated by the PRISMA Group and Gough and colleagues.  Our research team consisted of university professors and social work undergraduate and graduate research assistants; 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; assess for risk of bias; date synthesis; and write report.  We enhanced the quality of the review by utilizing internal and external quality procedures; such as double-blind screening and coding, and pilot testing 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 was performed. Inclusion criteria consist of family-level as independent variables, depression and anxiety as dependent variables, 100% AA sample, ages 0 to 18 years old, English-only manuscripts, etc…

 

Results: The searches identified 3,873 studies, 387 underwent full-text review and of these 31 studies were eligible. We utilized a PRISMA diagram, tables, and narratives to analyze data that revealed parenting practices as the most examined family-level factor to predict depression and anxiety (13 of 31; 42%).  For example, parental support, positive parenting, mother’s psychological control, and parental monitoring were associated with better mental health outcomes.  Family functioning & environment was the most frequently examined other family-level factor in this review. The most used scales were the Child Depression Inventory to assess depression (9 of 31 studies; 29 %), and the Brief Symptoms Inventory (3of 31 studies; 10%) to assess anxiety.   

Implications:  Given the review’s key findings that suggest the importance of parenting practices on children’s mental 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 associations between racial discrimination & socialization and children’s mental and behavioral health; future research should consider their effect on parenting practices.