Identifying Risk and Protective Factors in Research on Mental Health and Black American Adolescents: 1990 Through 2022

Abstract

This literature review synthesizes research on Black American adolescents’ mental health published between 1990 and 2022 to identify prominent risk factors and highlight key protective factors for their mental health. Two research questions guided this review: (a) How did researchers examine mental health in Black American adolescents; and (b) What are the risk and protective factors that contribute to mental health outcomes among Black American adolescents? Across more than 30 years of investigation and over 300 published articles, researchers identified several prominent factors that pose risk to Black American adolescents’ mental health, including neighborhood conditions, violence exposure and victimization, racism and racial discrimination, and, more recently, the COVID-19 pandemic. However, research also elucidated factors that protect or directly promote Black American adolescents’ mental health, including family, racial and ethnic socialization, racial and ethnic identity, out-of-school time activities, interpersonal relationships, coping, sleep, and social-cognition. The authors conclude with future directions for research and implications for practice.

Keywords

adolescents Black African American mental health risk and protective factors

Numerous factors impact Black Americans’¹ mental health during adolescence, a dynamic phase in human development defined by myriad biological, cognitive, and social transitions. Common mental health concerns, such as anxiety and impulsivity, typically emerge during adolescence (Blakemore, 2019), with 50% of mental health disorders having their first onset by the age of 14 (Kessler et al., 2005). Although historically rates of mental health disorders among Black American adolescents have generally been lower than the national average, the prevalence of anxiety, depression, and other mental health challenges among Black American adolescents has been increasing (Rennie, 2022). Between 2015 and 2018, there was an increase in rates of major depression among Black American adolescents (ages 12 to 17; Substance Abuse and Mental Health Services Administration [SAMHSA], 2018). In 2020, suicide emerged as the third leading cause of death among Black Americans between the ages of 15 and 24 (Centers for Disease Control and Prevention [CDC], 2020). In 2017, data from the CDC alerted that Black girls were 70% more likely to attempt suicide than White girls (CDC, 2021a). Unfortunately, the rate of suicide appears to be increasing among Black adolescents faster than any other racial/ethnic groups (Congressional Black Congress [CBC], 2019; Gordon, 2020; Vandiver, 2023).

Although myriad studies have been conducted to investigate Black American adolescents’ mental health, to our knowledge, no comprehensive literature review exists. Such a review will help the field identify gaps in prior literature and point to future directions for research, practice, and policy. Furthermore, while much of the prior mental health research involving Black American adolescents highlights risk factors that contribute to mental health problems (Pierre et al., 2020), this perspective is limiting and does not acknowledge the strengths that Black American adolescents, their families, and community provide to support their mental health. An understanding of both risk and protective factors can help promote healthy adjustment and fewer mental health symptoms (Hicks et al., 2020; Neblett, 2023). Considering both risk and protective factors can contribute to the development of more effective practices and policies aimed not only at helping Black American youth survive but also thrive.

Current Study

The purpose of this study was to synthesize and summarize over 30 years of research (published between 1990 and 2022) assessing mental health in Black American adolescents and to identify both risk and protective factors for Black American adolescents. This review of the literature included empirical studies (qualitative and quantitative), literature reviews, and meta-analyses that assessed mental health in Black American adolescents. We focused on adolescents (ages 10–17) to inform prevention and intervention efforts. Two research questions guided this review: (a) How did researchers examine mental health in Black American adolescents; and (b) What are common risk and protective factors that contribute to mental health outcomes among Black American adolescents?

Method

Data Sources

We used three online databases (American Psychological Association's PsycInfo, Google Scholar, and PubMed) to identify articles. We limited our search to sources published between 1990 and 2022 to obtain a breadth of research. The sources were limited to peer-reviewed journal articles; omitting books, dissertations, online/ conference talks, abstracts, newspaper and magazine articles, opinion pieces, and reports/research that were not peer reviewed. This approach yielded 438 sources.

Procedures

To identify articles, we utilized specific key terms in a variety of combinations, including African American, Black, teen, adolescent, high school, middle school, internalizing (and related terms), and externalizing (and related terms). We used the Matrix Method (Garrard, 2007) to document and organize our sources in a literature review matrix. The matrix allowed us to sort and analyze articles by content and themes related to our research questions, as well as by age, gender, income, mental health measure(s), data source, and key findings. We conducted a detailed review of each source to determine whether it met our inclusion criteria: studies that (a) included or solely focused on youth who were identified as Black or African American, (b) included or solely focused on adolescents (ages 10–17), and (c) assessed mental health and related terms (such as internalizing, externalizing, depression, anxiety, and conduct dis- order). Based on our thorough review of the individual articles, we excluded articles that referenced “youth” but only included children under 10 years of age or adults over 18 years old. We excluded empirical articles that did not assess mental health outcomes. For example, empirical articles on mental health seeking, substance use, police violence, and interventions were ex- cluded if mental health was mentioned but was not assessed. After excluding articles that did not meet the criteria (n = 121), our final review sample contained 317 articles. All authors reviewed the included articles to identify common themes (i.e., how mental health was assessed and risk and protective factors). A literature review matrix containing the articles reviewed for this study with relevant demographic information and methodology is available for other researchers to access at [https://osf.io/67erz/].

Results

We addressed two research questions: (a) How did researchers examine mental health in Black American adolescents; and (b) What are the common risk and protective factors that contribute to mental health outcomes among Black American adolescents? We have provided select citations as representative examples for each research question and theme (e.g., risk and protective factors) from the 317 articles reviewed for this study (see Moore et al., 2023 for the full citation list). Articles reviewed represented research conducted in various contexts (family, schools, and neighborhoods), reflective of various populations of youth (community samples and system-involved), and involved in mental health care from assessment to intervention.

How Did Researchers Assess Mental Health Symptoms and Conditions?

During adolescence, various physical, cognitive, and social changes can affect mental health, both internalizing and externalizing issues. Internalizing involves mood disorders such as feelings of sadness, worry, fear, low self-esteem, and a pervasive sense of melancholy. While depressive diagnoses have been less frequent among Black Americans, when present, they tended to be chronic and more severe (Bailey et al., 2019; CDC, 2021b). Most studies in our review focused on symptoms of depression and anxiety (e.g., Assari et al., 2018; Kim et al., 2003; Perry et al., 2015), rather than actual internalizing disorders or diagnoses, with a few exceptions (e.g., Assari & Caldwell, 2017a; Byck et al., 2013; Chapman et al., 2012). We discovered that many studies er- roneously indicated they were focused on internalizing disorders when they only assessed symptoms, not diagnoses.

Externalizing disorders involve observable disruptive behaviors directed toward others, indicating difficulty in managing emotions, impulses, and actions. Typical externalizing disorders are oppositional defiant disorder (ODD), conduct disorder (CD), and attention-deficit hyperactivity disorder (ADHD). Attention-deficit hyperactivity disorder prevalence in Black Americans has been found to be similar to the general population, but there has been a disparity in diagnosis and treatment access (Bailey et al., 2010). Black American youth have been more likely to be diagnosed with ODD and CD rather than ADHD compared to other racial/ethnic groups (Coker et al., 2016; Fadus et al., 2020). This overrepresentation appears to be based on biased perceptions of Black American youth. They are often viewed as older (e.g., adultification; Goff et al., 2014) and their behaviors are often viewed more negatively and more severe (Epstein et al., 2017; Okonofua & Eberhardt, 2015), possibly resulting in over-referrals for inequitable discipline (Bradshaw et al., 2010), treatment, and special education (Bean, 2013). In our review, some research demonstrated that African American boys were at a higher risk of being diagnosed with externalizing behaviors than African American girls (Bean, 2013).

Despite the prevalence of measures for depression and anxiety symptoms, few measures have been validated with samples of an ample number of Black Americans (Chao & Green, 2011; Kim et al., 2021). Black American youth, as well as adults, have often experienced mental health symptoms that are not typically accounted for in national surveys (Liu et al., 2017). Notably, the symptomatology associated with internalizing and externalizing symptoms in Black American youth can overlap significantly. Furthermore, there is a high level of comorbidity between internalizing and externalizing symptoms among Black American adolescents, with symptoms of depression often including irritability, anger, and aggression (Anderson & Mayes, 2010; Liu et al., 2017). Consequently, researchers and practitioners may misidentify symptoms of depression as externalizing problems (Liu et al., 2017). Additionally, Black American adolescents have frequently reported somatic complaints linked to internalizing disorders (Kingery et al., 2007). These findings underscored the potential existence of a unique underlying structure of mental health challenges among Black American adolescents, warranting further investigation (Liu et al., 2017).

Risk Factors for Mental Health

Neighborhood Conditions

Several studies linked neighborhood characteristics to Black American adolescents’ mental health (e.g., Brody et al., 2003; Chancy et al., 2022). Neighborhood conditions, such as the “broken windows effect” where visual indicators of neighborhood disorganization contributed to further disarray, were found to indirectly and negatively impact African American adolescents’ mental health (Voisin & Kim, 2018). Structural characteristics of the neighborhood (e.g., socioeconomic stratification and racial/ethnic segregation) also were found to shape adolescents’ perceptions of their neighborhood (Romero et al., 2015), increasing adolescents’ sense of fear (Hall et al., 2008) and reducing their sense of safety (Assari & Caldwell, 2017a). These characteristics may contribute to increased internalizing symptoms and other mental health conditions (e.g., major depressive disorder). Additionally, poverty and adult unemployment at the neighborhood level are associated with increased internalizing and externalizing symptoms in African American adolescents, but these associations can be buffered by social support and neighborhood cohesion (Hurd et al., 2013). In some cases, gentrification can erode social cohesion and indirectly harm adolescents’ mental health (Sadler et al., 2022). Research based in ecological risk models found that neighborhoods can affect African American adolescents’ mental health by negatively impacting caregivers’ parenting (e.g., Brody et al., 2003) and increasing youth’s involvement with deviant peers (Ge et al., 2002). Neighborhoods can also directly affect African American adolescents’ mental health by exposing them to violence (Cobbina et al., 2008).

We found that much of the research on neighborhoods utilized Census tract data, which may not accurately represent the boundaries of Black youth’s neighborhoods or reflect how they experience their neighborhoods. Researchers should consider integrating more diverse methods (e.g., ethnography and interviews) with quantitative data to better understand the impact of neighborhood conditions on Black adolescents’ mental health.

Violence Exposure and Victimization

Studies linking violence exposure to mental health outcomes in Black American adolescents assessed prevalence (frequency of violent events), timing (retrospective vs. current events; age of exposure), degree (moderate to extremely violent events), type (physical, emotional, or sexual abuse), length of exposure (chronic vs. acute), source (e.g., parent, peer, and police), context (family, school, and community), and the impact of violence exposure as a witness and/or a victim. Some studies highlighted the impact of adverse childhood experiences on mental health in childhood, adolescence, and into adulthood (e.g., Leslie et al., 2023; Sanchez et al., 2013). Given the variety of situations and diverse ways Black American adolescents may cope with, respond, and adapt to these experiences, it is not surprising that studies examining associations between violence exposure and victimization and Black American adolescents’ mental health outcomes yielded differential findings.

Generally, violence exposure is associated with increased mental health problems, including higher levels of internalizing and externalizing symptoms. Exposure to community violence have been found to contribute to increased depressive symptoms, hyper-arousal, aggression, and delinquency (e.g., Copeland-Linder et al., 2010; Lambert et al., 2012). However, some researchers found lower levels of depressive symptoms among African American youth chronically exposed to community violence, indicating emotionally muted responses or desensitization effects (e.g., Gaylord-Harden et al., 2016; Howard et al., 2002). Some research indicated that experiencing violence as a victim may be more impactful on mental health than witnessing violence (Reid-Quiñones et al., 2011).

Gender differences have been found to exist, such that African American girls seemed to internalize both witnessing and being a target of violence (Foster et al., 2004). Although African American boys tended to report more incidences of violence exposure (e.g., Voisin & Neilands, 2010), African American girls were more likely to report higher levels of post-traumatic stress in response to violence exposure (Foster et al., 2004). In more recent studies, social media represented an important context where Black American youth may encounter violence and victimization through texting, cyberbullying, and viewing harmful content (e.g., Mereish et al., 2019). Given the established connections to poor mental health, additional research is essential to investigate the varied contexts and experiences of Black American adolescents who are exposed to violence and victimization, as well as ways to mitigate exposures.

Racial Discrimination

A robust body of the literature investigated the impact of racial discrimination on Black American adolescents’ mental health. Researchers elucidated the importance of assessing discrimination from different sources (e.g., teachers and peers) and in different contexts ranging from interpersonal (between individuals) to institutional (societal- and group-level perceptions and treatment) and structural (laws and policies). Studies consistently demonstrated that racial discrimination (directly and indirectly) are linked to mental health challenges in Black American adolescents, including increased depression and anxiety symptoms (e.g., Greene et al., 2006; Seaton et al., 2008), conduct issues, and delinquency (Burt & Simons, 2015). It is possible that depressive symptoms and emotional responses (anger and hostile attribution) mediated the relationships between racial discrimination and behavioral issues (Simons et al., 2003). Other research indicated that racial discrimination predicted mental health outcomes via post-traumatic stress (Loyd et al., 2019). Findings from longitudinal research illuminated long-term and cumulative effects of racial discrimination on mental health over time (Assari et al., 2017; Smith-Bynum et al., 2014). Longitudinal research further demonstrated that early experiences with discrimination predicted more internalizing and externalizing symptoms during adolescence and into young adulthood (English et al., 2020).

The literature exploring gender differences yielded mixed results, with some studies showing racial discrimination was more strongly linked to internalizing symptoms in Black boys than in Black girls (Assari et al., 2017). Other researchers found racial discrimination to be more strongly linked to internalizing symptoms in African American girls than in African American boys (English et al., 2014). Others discovered stronger associations between racial discrimination and conduct issues among African American boys than African American girls; however, no gender differences were observed regarding depressive symptoms (Brody et al., 2006). Notably, recent literature has begun to investigate the impact of gendered racism on Black American girls’ mental health indicating nuanced experiences based on intersectionality (e.g., Winchester et al., 2022).

Despite the mixed gender difference findings, research generally indicates racial discrimination is a significant risk factor for Black adolescents’ mental health. While much of prior literature focused on interpersonal forms of racial discrimination, recent literature has begun to consider the structural impacts of racism on Black Americans’ mental health. Thus, future studies should explore these impacts on Black American adolescents, as well as advocate for policies to reduce the impacts.

COVID-19 Pandemic

The emergence of the coronavirus (COVID-19) pandemic in 2020 changed life for everyone. This insidious disease became a significant and potentially deadly risk factor for health and development impacting how individuals all over the world lived, worked, and schooled. The nature of how the virus was spread required social isolation whereby people were confined to their homes. Youth navigated adolescence while experiencing remote learning and social isolation. During this time, there were increased rates of sadness, hopelessness, depression, anxiety, and other mental health issues among Black adolescents and other youth from historically marginalized racial and ethnic groups (Chakawa et al., 2021). Amidst the increased risks of the COVID-19 pandemic, Black youth continued to experience disparities in their access to mental health services (Chakawa et al., 2021) alongside more COVID-related stress and racial stress related to the Black Lives Matter movement (Stinson et al., 2021). Like neighborhood conditions, violence exposure and victimization, racism, and racial discrimination, the COVID-19 pandemic has and will continue to pose a risk for Black American adolescents’ mental health into the foreseeable future.

Protective Factors for Mental Health

Family

The critical role that family support plays in the mental health of Black American adolescents is well-documented. Family, particularly parents, often provides the most consistent atmosphere, which fosters other protective and promotive factors, that support Black youth in and outside of the home. Bains (2014) reported several examples of youth voicing their families as an instrumental psychological support system during personal crises. Similarly, Hammack et al. (2004) identified social support, maternal closeness, and time spent with family contributed to protecting adolescents who witnessed community violence. Though parenting in general can promote the well-being of Black American adolescents, researchers have examined the unique maternal and paternal contributions. For example, paternal support has been shown to reduce externalizing and internalizing behaviors in African American adolescents and has been shown to reduce adolescents’ depressive symptoms regardless of one’s gender, grade level, and socioeconomic status (Bean et al., 2006). In a culturally affirming intervention focused on enhancing paternal monitoring and communication strategies among African American families, Caldwell et al. (2010) reported that improved parental monitoring from fathers increased sons’ intentions to avoid violence.

Collectively, research demonstrated supportive parenting (Maslowsky et al., 2015), parent communication (Ahn et al., 2021), and parenting practices (Lei et al., 2021) are associated with lower levels of externalizing and internalizing behaviors and positive outcomes in Black American adolescents. Ultimately, protective factors for Black American adolescents operate firmly within the context of family. Though mental health outcomes of Black American adolescents are also linked to structural factors (e.g., racism), families who provide support (e.g., showing love, setting limits, and teaching responsibility) may better protect youth from potential risk factors. However, a major limitation of the literature examining family’s impact on Black American adolescents has been the overwhelming focus on mothers only. Like much of the psychological literature, mothers are used as the proxy for understanding the role of family. The few studies (e.g., Bean et al., 2006; Caldwell et al., 2010) that have considered fathers found differences between mothers and fathers in regard to their adolescents’ mental health. Given the various family configurations in the Black American community, it is important to examine the differential effects of family members beyond mothers.

Racial and Ethnic Socialization

Racial and ethnic socialization emerged as another key protective factor for Black American adolescents’ mental health. Racial socialization predicted fewer internalizing symptoms among African American adolescents, above the influence of gender, neighborhood risk, and resources (Davis & Stevenson, 2006). This finding may be explained by caregivers’ roles in the socialization and identity development processes of African American adolescents as it relates to healthy psychological functioning, resilience against anticipated discrimination, and externalizing behaviors (Burt & Simons, 2015; Caldwell et al., 2004). Henry et al. (2015) found that high maternal messaging reduced aggressive behaviors and depressive symptoms. In this study, mothers who provided consistent messages of cultural pride and racial appreciation better supported their children from the adverse effects of violence exposure. Additionally, racial socialization for Black American adolescents may involve preparing them to manage racialized and discriminatory spaces by providing them with effective cultural coping strategies (Anderson et al., 2018). For example, Lambert et al. (2015) reported a protective relationship between cultural alertness to racial discrimination and depression among boys, particularly when mother–adolescent relationships were characterized by high degrees of communication and trust. Additionally, researchers have illustrated how gendered racial socialization—particularly messages of gendered racial pride and empowerment—can influence indicators of mental health (e.g., stress and anxiety symptoms) and internalized gendered racial oppression in Black youth (Winchester et al., 2022). Specifically, gendered racial socialization can support the development of positive gender and racial identities in Black girls and equip them with skills to navigate interracial and intraracial environments of gendered racism (Winchester et al., 2022). Because much of the prior literature examined Black parents and adolescents’ experiences in separate studies, subsequent research should examine the alignment between parental socialization practices and adolescents’ interpretations of the conveyed socialization messages in tandem.

Racial and Ethnic Identities

Racial and ethnic identities and associated components—e.g., centrality, pride, regard, and awareness—have been examined as protective factors for Black American adolescents’ mental health (e.g., Caldwell et al., 2004; Davis et al., 2017). Most studies in our review measured racial and/or ethnic identity using the Multidimensional Model of Racial Identity (Sellers et al., 1998), which was developed specifically to capture the experiences of Black American adults and then applied to Black American adolescents (e.g., Sellers et al., 2006); few studies used the Multigroup Ethnic Identity Measure (MEIM, Phinney, 1992; e.g., Mandara et al., 2009), which was informed by developmental theory, but was not specifically developed for Black adolescents. In foundational research, Sellers et al. (2006) determined private and public regard beliefs served as critical protective factors against the academic and psychological impacts of racial discrimination. Personal positive attitudes toward African Americans—private regard—were associated with positive psychological outcomes. Public regard (how adolescents perceive society views their group) was shown to buffer the impact of racial discrimination on academic and psychological development. McMahon and Watts (2002) found a strong positive sense of ethnic identity and global self-worth in African American adolescents was related to increased active coping strategies, fewer beliefs supporting aggressive behaviors, and fewer self-reported aggressive behaviors.

Mandara et al. (2009) examined associations between racial identity and mental health among African American adolescents. The authors concluded that increases in racial identity reduced depressive symptoms for African American boys transitioning into eighth grade, while increases in racial identity reduced anxiety symptoms for African American girls. Using survey data from African American adolescent boys detained in the juvenile justice system, DeGruy et al. (2012) also found that positive racial attitudes and racial respect significantly buffered the negative effects of chronic exposure to community violence on adolescents’ violent behaviors. Gibson et al. (2022) reported that higher private regard attenuated the negative effects of cultural racism on depressive symptoms.

Studies collectively highlighted the complex interplay between racial and ethnic identities, mental health, and various contextual factors, underscoring the importance of considering multiple dimensions of racial and ethnic identity in understanding their impact on Black adolescents' well-being, and emphasizing the role of a positive identity in mitigating mental health challenges among Black adolescents. The foundational theories formulated in the 1990s and 2000s might not accurately capture the current perspectives of today’s youth regarding racial and ethnic identities. For example, Black American adolescents might develop their racial and ethnic identities in the context of global Africentric values that they learned about through social media. Moreover, racial and ethnic identities constitute just one facet of Black adolescents’ broader sense of identity. Future studies should recognize the significance of exploring other dimensions of identity that may be equally important to Black American adolescents.

Out-of-School Time

Out-of-School Time (OST) programs and activities were identified as another protective factor for Black American adolescents' mental health. Research demonstrated that participating in OST programs reduced mental health challenges and behavioral issues and was especially important for African American youth who resided in high-crime and high-poverty areas (Assari & Caldwell, 2017a; Gutman et al., 2005). Bohnert et al. (2009) found that although involvement in structured activities was not directly associated with less delinquency or fewer depressive symptoms, active and passive unstructured activities were associated with positive adjustment in African American adolescents. Other researchers found that participating in extracurricular activities in school-aged years reduced the development of behavioral problems during adolescence (Feldman et al., 2021). Overall, OST programs appeared to offer a conducive environment for fostering positive development and potentially offering therapeutic interventions for Black American youth’s mental health (e.g., Cromer et al., 2019) but are underutilized and underexamined.

Interpersonal Relationships

Relationships with friends, teachers, and other caring adults have been found to serve an important protective role for Black American adolescents’ mental health. Social support and feelings of belonging protect African American adolescents from the adverse effects of violence exposure (e.g., Pierre et al., 2020). Fitzpatrick et al. (2005) found social capital—access to quality interrelationships—was associated with less depressive symptoms and higher self-esteem in African American adolescents. Bains (2014) identified “strength of the inner circle” as a recurring theme. In a qualitative study exploring the common modalities that African American adolescents may use to manage depression, Al-Khattab et al. (2016) illuminated a typology called Being With Others—with thematic categories ranging from “seeking help from others” to “having others reach out.” In the school context, teachers characterized as warm, trusting, and exhibiting low conflict were especially important for African American youth experiencing internalizing and externalizing symptoms (Baker et al., 2008). In the community context, Hurd et al. (2009) assessed the role of non-parental adult influences (e.g., natural mentors) and found role models provided protective effects for internalizing, externalizing, and school conduct behaviors. The presence of natural mentors was also associated with less aggressive behavior, conduct, and anger in African American adolescents—independent of family support or gender (Kogan et al., 2011).

Positive relationships with peers and non-parental adults appeared to function as a protective factor for Black American adolescents’ mental health. We identified mentors and supportive adults as mitigating mental health challenges and promoting positive outcomes for Black American youth. Given the importance of interpersonal relationships for Black adolescents’ lives and mental health, more research is needed to explore the potential for leveraging interpersonal relationships in schools and communities to promote mental health in Black youth.

Coping

The ways Black American adolescents have coped with stress and other risk factors provided significant insights into effective strategies for reducing mental health challenges (e.g., Edlynn et al., 2008). For example, Sanchez et al. (2013) discovered African American girls’ self-reports of avoidant coping strategies significantly buffered internalizing and externalizing symptoms associated with violence exposure. Some research has investigated the relationship between mindfulness and post-traumatic stress symptoms in African American youth, offering recommendations that infuse mindfulness strategies in promotive coping education (Schmitz et al., 2021). Gaylord-Harden and Cunningham (2009) examined the role of coping strategies in buffering the relationship between racialized stress and internalizing symptoms, finding that culturally relevant coping strategies (e.g., communal coping, spiritual coping, and emotional debriefing) significantly moderated the association between racial discrimination and anxiety. Further, researchers have explored how spirituality and religious coping (another form of culturally relevant coping) influence African American adolescents with depression (Breland-Noble et al., 2015). Utilizing focus groups and interviews, the researchers illuminated themes such as “Finding Support in the Church” and “Prayer and Agency” and uncovered how faith encourages practices of collaboration, self-direction, and initiative—components useful for mental health and wellness among African American youth. They concluded prayer and participation in faith communities play key roles in reducing African American adolescents’ depressive symptoms. Because Black American adolescents experience myriad race-related stressors, it is essential that research involving Black adolescents must consider the role of culturally relevant coping.

Sleep

In recent literature, sleep emerged as an important facet of development linked to adolescent mental health and well-being (e.g., El-Sheikh et al., 2020; Zeringue et al., 2021). Social and behavioral factors, such as staying up late and increased screen time, have been identified to negatively impact adolescents’ sleep quality and healthy behaviors (Rubens et al., 2019). Better sleep quality is linked to working memory, memory consolidation, and emotional regulation (Baum et al., 2014). Limited research involving Black American adolescents suggested sleep duration (measured in minutes) and sleep quality are associated with less externalizing behaviors and better mental health (El-Sheikh et al., 2019). Notably, discrimination appeared to reduce sleep quality (El-Sheikh et al., 2022). However, longer sleep duration, greater sleep efficiency, and less variability in sleep duration were found to be a protective factor against the effect of discrimination on adolescent outcomes (El-Sheikh et al., 2022). Although an important aspect of adolescent development, much of the prior research has focused on risk factors for sleep or explored the links between poor sleep and mental health (Sasser et al., 2021). Future studies should also consider factors that promote sleep quality and the link between sleep quality and better mental health. It is important to note the studies we reviewed included Black adolescents but did not focus specifically on this demographic; therefore, future studies should also consider implementing a within-group design to explore diversity within Black youth’s experiences.

Social-Cognition

Social and cognitive development may play a protective role in helping Black American adolescents navigate discriminatory and hostile environments and may also directly promote better mental health. For example, future orientation—a concept involving connecting one’s attitudes and behaviors to positive plans for the future—may be a vital protective factor for African American adolescents exposed to violence and delinquency (So et al., 2018). Assari and Caldwell (2017b) examined sense of mastery—the extent to which individuals feel a sense of control over their life—in relation to depression, finding that high mastery among both Black boys and Black girls predicted lower levels of depressive symptoms. Additionally, self-worth was a factor that researchers have explored in relation to mental health outcomes in Black American adolescents. Specifically, self-worth (measured as global self-esteem) appeared to be associated with better psychological adjustment and behavioral outcomes (e.g., Copeland-Linder et al., 2011). Additional research is needed to explore the extent to which other social-cognitive factors (e.g., appraisals, perceptions, and sense of purpose) may serve as protective or promotional factors for Black American adolescents’ mental health.

Discussion

The purpose of this review was to examine how researchers have assessed mental health in Black American adolescents and to identify prominent risk factors and highlight key protective factors for their mental health. The findings offer important avenues for research, practice, and policy, and have significant implications for the field of Black psychology. Regarding our first research question, most studies investigated depressive and anxious symptoms, conduct behaviors, delinquency, and aggression. Few studies (e.g., Assari & Caldwell, 2017a; Byck et al., 2015; Chapman et al., 2012) examined actual DSM-5 diagnoses. Because much of the research focused or assessed symptoms rather than diagnosable disorders, we recommend researchers use language that accurately reflects the issues that were measured and consider implications of assessment when interpreting study findings. Misidentifying symptoms as diagnoses is highly problematic not just in terms of the meaning of the research findings but in terms of treatment implications and accurate diagnostic rates for Black American adolescents. Importantly, as most tools were not developed specifically for Black American adolescents, additional research is needed to examine the psychometric properties of mental health measures currently used with Black American adolescents.

Regarding our second research question, studies identified factors posing risk for Black American adolescents’ mental health, including neighborhood conditions, violence exposure, racism, and the recent impact of identified the COVID-19 pandemic. Protective factors included family, racial and ethnic socialization and identity, out-of-school time activities, interpersonal relationships, coping, sleep, and social-cognition. Many of the risk and protective factors identified in this review can be addressed through advocacy and policy. For example, H.R. 2116, the CROWN Act of 2022 in the United States, which prohibits discrimination based on hairstyles and hair texture, may aid in reducing race-based discrimination for Black youth in schools. Out-of-school time programs offer another promising avenue for promoting Black adolescents’ mental health. Yet, there appears to be a greater allocation of funding and motivation to support policing in Black communities rather than community organizations and mental health services. The COVID-19 pandemic disproportionately affected Black communities, highlighting an urgent need for targeted recovery efforts (National Academies of Science, Engineering, and Medicine, 2023). Importantly, the well-documented exclusion of Black scientists from federal funding opportunities requires intentional efforts to increase relevant and culturally informed research on Black American adolescents’ mental health.

Regarding methodology, many studies were cross-sectional, providing descriptive and informative insights, but constraining our capacity to draw causal inferences or pinpoint mechanisms of change. Further research is needed to investigate how underlying processes, such as coping and social-cognition, connect with mental health. Additionally, advances in methodological and analytic techniques, including longitudinal designs, person-centered analyses, and ecological momentary assessments, will enable researchers to uncover within-person effects and pinpoint targets for interventions across various levels, from individuals to systems. We found few studies that investigated physiological processes (e.g., Phan et al., 2020; Shakiba et al., 2022), which are also linked to mental health symptoms, including hormone fluctuations due to puberty, hypothalamus-pituitary-adrenal regulation, cortisol (a hormone linked to stress), and neurological development.

Future Research

Future studies should consider variability in Black American youths' experiences based on intersectional differences (Galán et al., 2022). In our review, few studies examined ethnic and cultural differences among and between Black American adolescents (e.g., Assari & Caldwell, 2017b; Seaton et al., 2008); most were comparative by racial group and/or gender. Although important for identifying health disparities, comparative research masks important within-group differences and nuances (Brittian, 2012; Volpe et al., 2022). Additionally, our study brings attention to a distinctive age-related gender difference. In the realm of adult literature, much research has focused on Black women’s mental health. Our findings reveal a greater emphasis on Black adolescent boys, particularly in the context of externalizing behaviors. There is a notable scarcity of research specifically exploring mental health in Black American girls. Additionally, a substantial portion of mental health research on Black American adolescents focused on youth from low-income communities. This focus provides a narrow understanding of the factors related to Black American adolescents' mental health because it only focuses on one segment of the Black American community. It also presents a false narrative that all Black Americans are from low socioeconomic backgrounds. Few exceptions focused on Black American adolescents from middle- to high-income communities. These exceptions have revealed that Black American adolescents residing in affluent neighborhoods face a heightened risk of encountering racial discrimination and psychological violence, particularly Black boys (e.g., Assari, 2018). Our review also revealed limited research on the intersection of gender identity and sexuality, specifically among LGBTQ+ Black American adolescents and mental health, illuminating another critically important area for future inquiry. Future research should examine mental health in Black American youth from diverse backgrounds and identities.

Limitations

This study offers many unique contributions to the literature, including being the first to identify themes in over 30 years of published research, but it is not without limitations. The literature review matrix we cultivated serves as a valuable tool for researchers interested in the topic (Moore et al., 2023); however, it does not incorporate studies published after our review was conducted. We strongly encourage researchers to supplement the matrix with the latest findings. For example, amidst concerns around the adolescent mental health crisis and youth’s frequency of social media use, emerging literature highlighted the potential for social media to negatively impact Black adolescents’ mental health (Mereish et al., 2019). We recommend future studies consider both the potential for harm as well as the benefits of social media (LeBlanc & Loyd, 2022). Suicide risk and suicide ideation emerged in more recent literature (e.g., Talley et al., 2021); a trend we anticipate will continue given the increased attention and funding opportunities in this area (Gordon, 2020) and calls for more research on Black youth’s mental health published since we conducted our review (Vandiver, 2023). We recommend reviewing the 2023 issue on Black Youth Suicide and Beyond in the Journal of Black Psychology. Finally, while our review captures broad themes, the constraint of page limits prevents an in-depth analysis of the methods employed in each of the over 300 articles we reviewed for this study. Such a detailed examination of each study is beyond the scope of our review.

Implications for Practice

Based on this review, we propose research-informed strategies to prevent mental health challenges and promote positive mental health in Black American adolescents. The first is to consider the assessment of symptoms. Conducting a more nuanced clinical interview when assessing internalizing and externalizing disorders and noting that Black American adolescents may also present symptoms of aggression and anger when they are depressed will aid in this effort. Clinicians as well as teachers and parents should be aware that Black American adolescents may experience and express internalizing symptoms through somatic complaints, and not necessarily through a sad mood. It is important to deeply examine adolescents’ reports of stomach and body complaints as these may be signs of depression or anxiety. Further, clinicians should consider that symptoms may present differently based on gender and other cultural factors (e.g., Watkins & Neighbors, 2007). It is critical that clinicians are trained in culturally relevant assessment and treatment practice. Not only does symptom presentation as it relates to mental health diagnoses vary among Black American adolescents, but there may also be a difference in positive and effective coping strategies. For example, clinicians can encourage racial socialization practices among parents or caregivers of Black American adolescents, which is known to promote healthy coping and positive identity (Anderson et al., 2019). Furthermore, although the focus of this review was mental health as described in the DSM-5 (American Psychiatric Association, 2013), we urge researchers and professionals to consider that mental health is not merely the absence of mental health challenges, and to embrace a more holistic view of positive mental health and well-being for Black American adolescents as well as (culturally relevant) protective factors.

Conclusion

Since we initiated this research, there have been significant racial and political changes that have occurred in the U.S., which have implications for Black American adolescents’ mental health. These shifts have increased feelings of anxiety, uncertainty, fear, depression, stress, and hopelessness. At the same time, they further shed light on known disparities in both diagnosis and treatment for Black American adolescents. The findings in this review, representing over 300 articles published over 30 years, collectively aid the field in better understanding mental health in Black American adolescents by identifying key risk and protective factors associated with mental health. The unique positive contribution of Black American culture was evident in the family, racial and ethnic socialization and identity, and culturally relevant coping factors. These findings should inform efforts to design and implement more effective research, practice, and policy to prevent and treat mental health challenges and, in turn, promote thriving in Black American adolescents.

Footnotes

Acknowledgments

We thank the undergraduate researchers in the Youth Health and Development Lab for their assistance with identifying and screening articles published between 2019 and 2022.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Aerika Brittian Loyd

Aremu M. Smith

Note

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