General Psychiatry

Family-Centered Prevention Interventions Reduce Mental Health Problems that Follow Frequent Exposure to Discrimination

Mary Stroka
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African American teenage girl has her hand on her head while suffering from a headache. A male doctor is reviewing her medical results with her.
Researchers conducted a secondary analysis of data from 2 randomized clinical trials conducted in Georgia that tested family-centered prevention programs.

Participation in family-centered preventative interventions reduced the association between frequent exposure to discrimination and subsequent mental health problems, researchers found in a secondary analysis of 2 randomized clinical trials that was published in JAMA Network Open.

The 2 trials — the Strong African American Families-Teen (SAAF-T) program and the Adults in the Making (AIM) program — were conducted in rural Georgia.  

The SAAF-T trial included Black adolescents who were randomly selected from the lists 6 counties’ schools provided of 10th-grade students and their respective primary caregivers. The AIM trial drew from 6 other rural Georgia counties’ lists of 12th-grade Black or African American students and their respective primary caregivers.

Individuals with developmental disabilities or psychiatric illnesses that prevented them from completing data collection or participating in the intervention were excluded from both trials.

In SAAF-T, caregivers and youth met for 5 weekly, 2-hour sessions. Caregivers learned emotional and instrumental support, limit setting, adaptive racial socialization, and communication strategies regarding sex and alcohol use. Youth separately learned the importance of abiding by household rules, setting goals, and strategies for resisting substance use. All participants then practiced together the skills they had learned.

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AIM provided support for developmentally appropriate caregiving before the students graduate, gain employment, and continue education. Youth and caregivers attended 6 consecutive weekly meetings for separate curricula during each 2-hour session. Caregivers learned protective emotional and instrumental support, occupational and educational mentoring, cooperative problem solving, and communication skills. Youth learned to make plans to meet their goals, to identify people in their communities who could help them with goal attainment, and to formulate self-care strategies.

Adolescents who underwent the interventions who experienced frequent discrimination evinced fewer increases in conduct problems (SAAF–T: incident risk ratio, 0.530 [95% confidence interval (CI), 0.340 to 0.783]; AIM: mean difference, −0.361 [95% CI, −0.577 to −0.144]). The adolescents in AIM’s intervention group who experienced frequent discrimination evinced fewer increases in depression or anxiety symptoms (mean difference, −0.220 [95% CI, −0.402 to −0.038]) than youth in a control group.

After controlling for youth sex, family socioeconomic risk, and baseline levels of protective caregiving and youth variables, regression models indicated that primary caregivers in both trials showed significant improvements in protective caregiving when youth experienced frequent discrimination (SAAF–T: mean difference, 0.429 [95% CI, 0.164 to 0.694]; AIM: mean difference, 1.664 [95% CI, 0.458 to 2.870]).

Improvements in protective caregiving were negatively associated with conduct problems among both trials’ participants (SAAF-T β= −0.148 [95% CI, −0.266 to −0.030]; AIM β= −0.029 [95% CI, −0.049 to −0.009]) and with depression or anxiety symptoms among AIM participants (β= −0.022 [95% CI, −0.039 to −0.006]).

Moderate mediation analyses indicated suggested that enhanced protective caregiving was partially responsible for the interaction effects (indirect effect: SAAF-T conduct problems, −0.063 [95% CI, −0.127 to −0.001]; AIM conduct problems, −0.048 [95% CI, −0.095 to −0.001]; AIM depression or anxious symptoms, −0.036 [95% CI, −0.074 to 0]).

Limitations of the study included lack of data on the effectiveness of the trials outside of the geographic areas where they were developed and potential common method bias.

References

Brody GH, Yu T, Chen E, Miller GE, Barton AW, Kogan SM. Family-centered prevention effects on the association between racial discrimination and mental health in black adolescents Secondary analysis of 2 randomized clinical trials. JAMA Network Open. Published online March 24, 2021. doi:10.1001/jamanetworkopen.2021.1964