Health Policy$ense

Traumatic Injury Lingers Long After Wounds Heal

Urban Black Men Describe Emotional Responses

Black men in the United States are disproportionately affected by traumatic injuries. Understanding the emotional consequences of injuries among this population is important for addressing the mental health challenges that may arise after injury.

In a study from the University of Pennsylvania School of Nursing that was recently published in Injury, my co-authors and I examined how urban Black men described their emotional responses in the three months after acute traumatic injury. We talked with men asking them to describe their recovery and found that emotional responses to injuries are affected by whether the injury was intentional (for example, a violent assault) or unintentional (for example, a car crash).

Men who survived intentional injuries expressed issues around negative mental health effects of living in neighborhoods of concentrated disadvantage and experiencing persistent exposure to violence. Men described having been directly exposed to violence, witnessing violence, and surviving the homicidal death of family members and friends. Men described experiencing persistent stress and fear of future assaultive events. A survivor of a gunshot wound expressed fear of being re-injured in his neighborhood:

I was scared to walk around everywhere. Scared to go outside. I was scared to go in my neighborhood ‘cause I’m thinking that the same person probably have family trying to come after me. And I just try to avoid everybody.

Survivors of intentional injuries reported distrusting and distancing themselves from people in their lives because of the violent nature of their injuries. One man who had been stabbed described feeling on guard around others:

Like a lot of things stress me out. Or just will set me off. Like my friend now, like if he’ll come in and sneak up or I don’t hear it. I’m like Oh my god, like what are you doing? Like automatically assuming he’s trying to get me. When I know deep down it’s not the case...I feel different. I feel like I’m jumpy. I feel like I’m scared of people. When I never used to be afraid of anybody. Or afraid to do anything. Now I’m like, oh my god, I don’t want to go outside.

Men who experience social withdrawal due to distrust of others may not receive adequate social support. This is concerning after a serious injury since social support can protect people from the development of posttraumatic stress symptoms. Unlike men who had been intentionally injured, men whose injuries were unintentional did not express a similar distrust of others.

Regardless of whether the injury was intentional or unintentional, men experienced anger because they felt they were not independent during their recovery phase because they needed assistance from others and also expressed concerns over their ability to return to their pre-injury lives. One survivor of a gunshot wound said:

I used to get up and take my daughter to school and pick her up every day. And go to the market. And go to doctor’s appointments. And do a whole bunch of stuff throughout the day. Running back and forth. And I can’t really do that now. ‘Cause it does get to me. It slows me up. And that makes me mad. When I realize that I can’t do that.

It is important for all of us to remember that injuries are not just physical but can also result in profound emotional responses. The intent of injury can have a powerful influence on how someone responds to traumatic injuries. Our findings underscore the importance of developing trauma-informed interventions that address previous and current adversities among intentionally injured Black men. This is particularly important for men who return to areas of concentrated disadvantage to decrease risk of re-traumatization and mental health challenges. 

Tammy Jiang was a 2015 LDI SUMR Scholar and is now a PhD student at Boston University. Her co-authors are Jessica L. Webster, Andrew Robinson, Nancy Kassam-Adams, and Therese S. Richmond.