Evidence that injuries are associated with psychological sequelae is strong. Depression and posttraumatic stress disorder (PTSD) occur after injury and contribute to post-injury disability. Thirty-seven to 56% admitted to a trauma service experience depression and up to 20% develop PTSD. Medical and productivity costs from injuries in the U.S. exceed $400 billion, 80% of which was from lost productivity. Psychological and physical co-morbidity synergistically increase disability and cost. Our challenge is that the emergence of depression and persistence of post traumatic stress(PTS) occurs after hospital discharge. Thus, men are already back in the community when these symptoms become manifest and disabling.
Because black men bring to the injury event a life-time experience of inequality we now bring a broader theoretical lens of cumulative exposure to rigorously capture risk and protective factors over geography and time to test a robust model to see if we can better predict those at risk for post-injury depression/PTS. To our knowledge no previous studies have linked information gleaned from GIS data of environmental exposure (e.g., physical disorder, social stress, collective efficacy) to post-injury psychological effects. We know that being black and being poor are not the predictors of injury and crime, but rather that poor, black men who are relegated to marginalized neighborhoods with high physical disorder and poor land use have increased exposure to crime and injury. Given the complexity of psychological effects, the exposure of black men to the problems that come with marginalized neighborhoods including institutional racism and the lack of resources within these neighborhoods, we believe infusing location-based exposures over geography and time has the potential to move the field in a new direction.
Led by Dr. Therese Richmond in the University of Pennsylvania School of Nursing, this mixed-methods study examines the contribution of personal, institutional, and environmental risk and protective factors, and peri-traumatic subjective experiences to create a risk profile for the emergence of post-injury depression/PTS in a cohort of 900 urban black men who are hospitalized for injury and evaluated for depression during 3 months post discharge.
R01NR013503 (PI: Richmond).