Emotional Responses and Recovery After Traumatic Injury in Urban Black Men (ERRI Study)

SUMR Scholar: Tammy JiangMentor: Therese Richmond, PhD

My motivation: Understand the consequences of trauma for a vulnerable population that is already struggling with unemployment and poverty

Depression

Sources: Curran et al., J Head Trauma Rehabil. 2000 Dec;15(6):1256-74., Vles et al., J Trauma. 2005 Jan;58(1):126-35., Zatzick et al., Psychosomatics. 2003 Nov-Dec;44(6):479-84., Zatzick et al., J Trauma. 2004 Aug;57(2):360-6.

PTSD

Sources: Curran et al., J Head Trauma Rehabil. 2000 Dec;15(6):1256-74., Vles et al., J Trauma. 2005 Jan;58(1):126-35., Zatzick et al., Psychosomatics. 2003 Nov-Dec;44(6):479-84., Zatzick et al., J Trauma. 2004 Aug;57(2):360-6.

The emergence of depression and PTS occurs after hospital discharge

Vulnerable Population

Black males are more likely to be injured than white men, more likely to have psychological consequences and less likely than whites to seek help for psychological symptoms

Lawson WB. (2003) Mental health issues for African Americans. Thousand Oaks, CA: Sage Publications.Neighbors et al., Arch Gen Psychiatry. 2007;64(4):485-494. doi:10.1001/archpsyc.64.4.485

Key StudiesSnowden L. (2001)- Poor African Americans suffer from mental disorders at higher rates than

poor Whites- Mental illness carries considerable stigma and seeking treatment is not

always encouraged for many African Americans- Perhaps because of a history of self-reliance and mistrust of mental

health providers, many African Americans appear to deny mental health problems

Neighbors et al. (2007)- The underuse of mental health services among black Americans remains

a serious concern- 39.9% of African Americans and Caribbean Blacks with serious mental

illness had contact with mental health care specialistsSnowden, Mental Health Services Research. 2001;Volume 3, Issue 4, pp 181-187Neighbors et al., Arch Gen Psychiatry. 2007;64(4):485-494. doi:10.1001/archpsyc.64.4.485

Psychological EffectsDepression

PTS

Known Outcomes

Disability

Substance Abuse

Injury Recidivism

Criminal Behaviors

Psychological EffectsDepression

PTS

Known Outcomes

Disability

Substance Abuse

Injury Recidivism

Criminal Behaviors

RisksPersonal

InstitutionalEnvironmental

Psychological EffectsDepression

PTS

Known Outcomes

Disability

Substance Abuse

Injury Recidivism

Criminal Behaviors

RisksPersonal

InstitutionalEnvironmental

ProtectivePersonal

InstitutionalEnvironmental

Psychological EffectsDepression

PTS

Known Outcomes

Disability

Substance Abuse

Injury Recidivism

Criminal Behaviors

InjuryPeri-Traumatic

subjective experiences

RisksPersonal

InstitutionalEnvironmental

ProtectivePersonal

InstitutionalEnvironmental

Life Course of Cumulative Exposure

Psychological EffectsDepression

PTS

Known Outcomes

Disability

Substance Abuse

Injury Recidivism

Criminal Behaviors

InjuryPeri-Traumatic

subjective experiences

RisksPersonal

InstitutionalEnvironmental

ProtectivePersonal

InstitutionalEnvironmental

Specific AimsSA1: Evaluate and refine a model elucidating the interplay among peri-traumatic subjective experiences, risk factors, and protective factors that best predicts depression and PTS in black men after traumatic injury

SA2: Evaluate the predictive ability of two established, short clinical screeners to predict the future development of post-injury depression and PTS and examine whether predictive performance could be improved by including additional risk and protective factors

SA3: Gain a richer understanding of black men’s experiences, to elucidate strategies that enhance or detract from their emotional recovery and their attitudes towards seeking help for psychological symptoms after injury

Sample400 Injured black men18 years or olderSpeak and understand EnglishProvide informed consentReside in PhiladelphiaExclusion criteria:

Pre-existing mental health status dysfunctionCurrently receiving treatment for depression/PTSDUnder arrest

Mixed Methods ApproachProspective cohort of 900 black men will be enrolled in-hospital after injury and seen at follow-up at three months post-injuryQuantitative Measures:Demographics, peri-traumatic subjective experience, risk & protective factors, clinical screenersQualitative interviews at three months post-injury: Used to elucidate the experience of black men at 3 months after injury, strategies they use to mitigate psychological effects of injury and to understand approaches that affect their willingness to seek care

Demographic Characteristics

SA3: Gain a richer understanding of black men’s experiences, to elucidate strategies that enhance or detract from their emotional recovery and their attitudes towards seeking help for psychological symptoms after injury

Mixed Methods ApproachProspective cohort of 900 black men will be enrolled in-hospital after injury and seen at follow-up at three months post-injuryQuantitative Measures:Demographics, peri-traumatic subjective experience, risk & protective factors, clinical screenersQualitative interviews at three months post-injury: Used to elucidate the experience of black men at 3 months after injury, strategies they use to mitigate psychological effects of injury and to understand approaches that affect their willingness to seek care

Qualitative Interviews

75 semi-structured interviews with men three months after injury

Interviews conducted by experienced interviewers at participants’ homes

Men offered compensation for participation

Analysis

Interview tapes transcribed verbatim

Narrative texts were parsed into lines and stanzas on the basis of Gee’s method

De-identified transcripts uploaded into NVivo 10TM

Code book createdSystematic thematic analysis

Emergent Themes

Discomfort talking about emotions and sharing their feelings

Neglecting emotional effects because of other priorities

Belief that they can deal with emotions on their own

Lack of access to mental health resources

Looks for a counselor who has been in similar circumstances

Looks for a counselor who will not judge and be open

Expressed in their words

Discomfort talking about emotions and sharing their feelings

It’s not part of our culture.It’s not part of our upbringing.It’s not normal for us to seek counseling.So because of thatIgnorance perpetuates.Mental health issues.As far as everywhere.Even though I think it’s, uh, unaddressed.I think it’s a lot of psychosis that’s unaddressed within the Black community.Where your mother or father wouldn’t even realize that their ch –A mother or father may never realize that their son or daughter is suffering from some type of mental illness.Based on their actionsBecause a lot of those actions are normal actions withinWithin the community where truly those things are not normal.And if it was wit, witnessed by trained eye.They would have help.But then we’re talking about people in this, the Black community.

-P1443

Feeling that they have to deal with emotions on their own

I, I’m kinda personal,

you know,

first of all.

So I don’t, I don’t want to talk to nobody about it

Because I don’t want nobody knowin’ what I’m goin’ through.

And, second of all,

I have an attitude.

Like if—

Nobody can help me with me,

but me.

I know what my problem is.

So me talking to somebody is.

Mm, I don’t feel, I don’t feel like it gon’ do me some help.

I know what my problem is.

And I know everything takes time, you know.

I can talk to who I want to talk to.

But if I’m not ready to let it go and get over it,

This not gon’ happen.

No matter how much I say outta ma mouth

or talk or how I feel.

It’s not gon’ happen.

So I know I’m the best person,

You know, to deal with it.

I mean I know there are great souls.

And great help to some people.

You know but I’m kinda stubborn.

And set in my ways.

So I know, yeah

When I’m, when I’m ready to deal with it,

I’ll deal with it

And I’ll deal with it the right way.

-P1417

Looks for a counselor who has been in similar circumstances

A therapist that’s also in this situation.Like I met a therapist that was also a paraplegic. So, with talking to him,that really made it like strong.Because he’s in this situation also.So, it’s like I can take a lot of advice. I can feel where he’s coming from.He can feel where I’m coming from.He know my feelings.He know the situations. So, like that would make it more better.Because it’s easy to talk to someone who’s not like this.But at the same time, they can’t really relate.

So it’s like they’re just listening and taking advice.And they’re shootin’, giving out feelings.And you’re just like trying to catch themAnd trying to pinpoint what feelings you have. But like with somebody, like my group,that’s also paraplegic,They hit it right on the nose. Like, yeah I know you struggle in this point.Yeah, I know you get sad at these times,Yeah I know you get sad when someone asks to help you. And it’s like how did you know that?It’s like you know everything, like.

-P1313

Implications Develop strategies to improve willingness to seek care that include educating injured men about the potential psychological effects of their injuries

Create strategies to normalize the psychological aspects of and difficulties associated with injury experience which may increase a patient’s willingness to seek help

Connect with counseling resources and people who are strongly familiar with the circumstances that they are in

Next StepsContinue data collection

Develop a risk profile for emergence of post-injury depression/PTS and create programs to promote trauma-informed clinical care for black men at highest risk for disabling post-injury psychological consequences

ReflectionsDevelop qualitative data analysis and interpretation skills needed to assess health of community

Collect valid and reliable quantitative data

Build rapport with participants

Understand the diversity of individuals and populations as it applies to culture, values, race, and mental and physical abilities

Acknowledgements

Therese Richmond, PhD, FAAN, CRNP Jessica Webster, MS, LPCAndrew RobinsonJoanne Levy, MBASafa BrowneHoag LevinsMegan Pellegrino 2015 SUMR Cohort

ReferencesCurran, C. A., Ponsford, J. L., & Crowe, S. (2000). Coping strategies and emotional outcome following traumatic brain

injury: a comparison with orthopedic patients. The Journal of Head Trauma Rehabilitation, 15(6), 1256–1274.Lawson, W. (2003). Mental health issues for african americans. In G. Bernai, J. Trimble, A. Burlew, & F. Leong (Eds.),

Handbook of racial & ethnic minority psychology. (pp. 561-571). Thousand Oaks, CA: SAGE Publications, Inc. doi: http://dx.doi.org/10.4135/9781412976008.n28

Neighbors HW, Caldwell C, Williams DR. et al. Race, ethnicity, and the use of services for mental disorders: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64(4):485–494

Snowden, L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3(4), 181–187.

Vles, W. J., Steyerberg, E. W., Essink-Bot, M.-L., van Beeck, E. F., Meeuwis, J. D., & Leenen, L. P. H. (2005). Prevalence and determinants of disabilities and return to work after major trauma. The Journal of Trauma, 58(1), 126–135.

Zatzick, D. F., Russo, J. E., & Katon, W. (2003). Somatic, Posttraumatic Stress, and Depressive Symptoms Among Injured Patients Treated in Trauma Surgery. Psychosomatics, 44(6), 479–484. http://doi.org/10.1176/appi.psy.44.6.479

Zatzick, D., Jurkovich, G., Russo, J., Roy-Byrne, P., Katon, W., Wagner, A., … Rivara, F. (2004). Posttraumatic distress, alcohol disorders, and recurrent trauma across level 1 trauma centers. The Journal of Trauma, 57(2), 360–366.

Questions