Health Policy$ense

Understanding the Effects of Traumatic Injury in Urban Black Men

At the Intersection of Health Care, Social Disparities, and Lived Experience

Black men bear the disproportionate burden of traumatic injury in the United States, and the disparities are especially acute for violent and intentional trauma. While the physical and psychosocial consequences of trauma can last a lifetime, strategies to mitigate trauma-associated psychological distress remain elusive. Recent studies by Therese Richmond and colleagues are filling this knowledge gap.

Over four years, the researchers interviewed more than 600 Black men living in Philadelphia who had been admitted to a level 1 trauma center, and followed up three months after discharge. They gathered demographic, injury, medical, and psychological data through both self-reports and hospital records.  The studies shed light on contributing factors to post-injury post-traumatic stress disorder (PTSD) and depression, and identify facilitators and barriers to help-seeking.

They found pre-injury factors, such as childhood adversity, prior mental health challenges, and physical health prior to the injury, can increase the likelihood of post-injury depression and PTSD. The nature of the injury also matters, with intentional injuries (such as assaults) having a stronger correlation with psychological distress. Given the fact that Black men are more likely to have encountered childhood adversity, these findings highlight the need to design, implement, and evaluate strategies for improving handoffs to mental health care in many trauma settings.

Barriers to help-seeking are nuanced

The latest analysis focuses on pathways to help-seeking. In a subset of research participants, the authors studied the intersectional relationships of the health system, trauma, lived racial discrimination, life trajectory, and economic deprivation. This approach reflects the reality of lived experiences, in which health outcomes are influenced by interactions between lived racial discrimination and other determinants of health.

The findings showed several pathways to help seeking. For example, men with high depression symptom severity and an absence of financial worry were more likely to seek help, as were men with high levels of both PTSD and depression symptom severity. Finally, men without high PTSD symptom severity were also likely to seek help when they had reported racial  discrimination and high financial worry.

Two other causal paths to not seeking help were also identified. In particular, men with low depression symptoms were less likely to seek help when they did not have high financial worry, as were men with low PTSD symptoms who faced low levels of discrimination and minimal financial worry. Put another way, there were several distinct paths to both seeking help and not seeking help for Black men who suffer trauma, and no single causal condition was sufficient.

Taken together, these studies highlight the importance of incorporating measures of racial discrimination, life experiences, and financial distress when assessing the mental health needs of trauma patients. As with earlier work identifying social factors associated with development of PTSD and depression, there is a complex interplay between social and health factors at every step of the care continuum. The odds of experiencing trauma and developing PTSD or depression are affected by pre-injury factors, which also change the likelihood of help-seeking.

Increasingly, researchers and policymakers recognize that most people who survive traumatic injuries suffer from psychological distress soon after and while most recover, other have persistent and disabling symptoms. But while referral to physical rehabilitation is routine after a traumatic injury, evaluation for psychological symptoms is far less common. If health systems are going to improve their approaches to mental health and racial disparities, assessing for symptoms of depression and PTSD is essential but not sufficient. This growing body of evidence shows they must pay attention to the broader context of life experiences including racial discrimination, childhood adversity, and financial distress in order to address disparities and overcome structural barriers to care.