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Many risk factors contribute to post-injury mental health among black men

In a cohort of urban black men with serious injuries, contributors to post-injury mental health issues were early adverse childhood exposures, preinjury physical and mental health conditions, acute post-injury stress responses and intentional injury, according to study findings.

“Existing biases, dehumanization, and devaluation of this group have limited scientific progress in understanding the health consequences of injury for black men,” Therese S. Richmond, PhD, CRNP, of the University of Pennsylvania School of Nursing, and colleagues wrote in JAMA Surgery. “Addressing the psychological effects of injury can improve health and reduce the disparate outcomes of injury.”

In their prospective cohort study, Richmond and colleagues examined life-long risk and protective factors that contribute to depression and PTSD symptom severity at 3 months after hospitalization among black male patients treated at a U.S. urban trauma center.

Men were asked about their exposure to serious injury requiring hospitalization; adverse childhood experiences, childhood neighborhood disadvantage, and preinjury physical and mental health; and emotional resources, injury intent and acute stress responses. Researchers used the Quick Inventory of Depressive Symptoms–Self-report and the PTSD Check List–5 to evaluate depression and PTSD symptom severity.

Of 623 black men enrolled in the study, 346 (55.5%) had experienced intentional injuries. Of 500 participants with complete follow-up data, 225 (45%) had mental health diagnoses at 3 months.

For both mental health outcomes, structural equation models fit the data well, according to the study.

Richmond and colleagues found that post-injury depressive and PTSD symptom severity in black men were associated with:

• poor preinjury health (standardized weights: 0.28; P < .001 for depression and 0.17; P = .02 for PTSD);
• acute psychological reactions (standardized weights: 0.34 for depression and 0.38 for PTSD; both P < .001); and
• intentional injury (standardized weights: 0.16 for depression and 0.24 for PTSD; both P < .001).

The results also showed that acute psychological reactions were linked to childhood adversity (standardized weights: 0.33 for depression and 0.36 for PTSD; both P < .001). In addition, among urban black participants, history of previous mental health issues (standardized weights: 0.7 for depression and 0.7 for PTSD; both P < .001) and psychological health resources (standardized weights: –0.22 for depression and –0.23 PTSD; both P = .003) contributed to poor preinjury health, which in turn contributed to acute psychological reaction (standardized weights: 0.44 for depression and 0.42 and PTSD; both P < .001).

“Given broader lifetime exposure to personal, institutional, and environmental risk among urban black men, understanding the risk for poor outcomes solely through features of the index injury is grossly inadequate,” the investigators wrote. “Clinicians should expand assessment beyond the acute injury event to identify those patients at risk for poor mental health outcomes.” – by Savannah Demko

Disclosure: Richmond reports personal fees from Sigma Theta Tau International; no other authors reported relevant financial disclosures.