Kassam-Adams, Nancy

Reilly, Patrick M.

Rich, John

Richmond, Therese S.

Shults, Justine

Wiebe, Douglas J.

English

ScholarlyCommons@Penn

University of PennsylvaniaScholarlyCommonsResearch Briefs Leonard Davis Institute of Health Economics6-5-2019Contributors to Post-Injury Mental Health InUrban Black Men With Serious InjuriesTherese S. RichmondDouglas J. WiebePatrick M. ReillyJohn RichJustine ShultsSee next page for additional authorsFollow this and additional works at: https://repository.upenn.edu/ldi_researchbriefsThis paper is posted at ScholarlyCommons. https://repository.upenn.edu/ldi_researchbriefs/56For more information, please contact repository@pobox.upenn.edu.Richmond, Therese S.; Wiebe, Douglas J.; Reilly, Patrick M.; Rich, John; Shults, Justine; and Kassam-Adams, Nancy. Contributors toPost-Injury Mental Health In Urban Black Men With Serious Injuries. LDI Research Briefs. 2019; No. 56. https://ldi.upenn.edu/brief/contributors-post-injury-mental-health-urban-black-men-serious-injuries" >https://ldi.upenn.edu/brief/contributors-post-injury-mental-health-urban-black-men-serious-injuriesContributors to Post-Injury Mental Health In Urban Black Men WithSerious InjuriesKeywordsmental health, PTSD, injuryLicenseThis work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 License.Author(s)Therese S. Richmond, Douglas J. Wiebe, Patrick M. Reilly, John Rich, Justine Shults, and Nancy Kassam-AdamsThis brief is available at ScholarlyCommons: https://repository.upenn.edu/ldi_researchbriefs/56THE QUESTIONAlthough injury is a short-term event, it can lead to long-term mental health problems, with up to 50% of patients experiencing post-injury depression and posttraumatic stress disorder (PTSD). Injured black men are particularly vulnerable because they have high exposure to stressors, are more likely to be injured than white men, and are more likely to have undiagnosed psychological consequences than white men. Sending these men back to the community with unrecognized mental health problems contributes to suboptimal recovery, and can lead to repeated injuries, self-medication for symptoms, or interactions with the criminal justice system.Urban black men from disadvantaged neighborhoods are exposed to racism, poverty, and other traumas throughout their lives, which may contribute to the severity of mental health conditions after injury. In this study, the authors use statistical modeling to understand the factors from childhood and adulthood that contribute to depression and PTSD severity in black men with serious injuries.THE FINDINGSThe final sample included 500 black men, over half (55.5%) of whom had intentional injuries due to interpersonal violence. Almost half (45%) met diagnostic criteria for either depression or PTSD three months post-injury: 65 (13%) were positive for depression, 51 (10.2%) were positive for PTSD, and 111 (22.2%) were positive for both outcomes.The flow chart on the next page shows the risk and protective factors across the life trajectory that influence depression severity post-injury. Childhood adversity was associated with acute psychological reactions to injury (e.g., immediate emotional reactions, physical reactions, and subjective appraisal of life threat). A history of prior mental health challenges influenced poor pre-injury health, while psychological/emotional health and resources (e.g., self-efficacy and hope) protected against poor pre-injury health. In turn, acute psychological reactions to injury, poor pre-injury health, and intentional injury, were each associated with depression severity. The model for PTSD symptom severity showed similar results.CONTRIBUTORS TO POST-INJURY MENTAL HEALTH IN URBAN BLACK MEN WITH SERIOUS INJURIESTherese S. Richmond, Douglas J. Wiebe, Patrick M. Reilly, John Rich, Justine Shults, Nancy Kassam-AdamsJAMA Surgery – published online June 5, 2019KEYFINDINGS Factors over the life course affect the mental health of urban black men with serious injuries. Childhood adversity, pre-injury physical and mental health conditions, and intentional injury (violence) are risk factors for post-injury depression and posttraumatic stress. Clinicians should expand assessment beyond the acute injury event to identify patients at risk for poor mental health outcomes.DATA  D R I V E N . P O L I C Y  F O C U S E DBRIEFResearchLDIResearch to Improve the Nation’s Health System  2019 . No. 4COLONIAL PENN CENTER   |   3641 LOCUST WALK   |   PHILADELPHIA, PA 19104-6218   |   LDI.UPENN.EDU   |   P: 215-898-5611   |   F: 215-898-0229   |   @PENNLDIBRIEFResearchLDITHE IMPLICATIONSThe intersection of prior trauma and adversity, exposure to challenging disadvantage, and poor pre-injury health should not be overlooked in acute injury care. These findings support the importance of trauma-informed care for injury patients, especially black men, who as a group have disproportionately high rates of childhood adversity. The current findings have clinical importance since, in a national survey of trauma centers, only 7% of centers incorporated routine screening for PTSD symptoms. Because symptoms develop after hospital discharge, further development and use of screening tools designed to assess post-injury mental health problems is warranted. Collaborative services that integrate trauma and mental health care and cross phases of care (from acute to community care) are also needed. The findings of this study identify characteristics and exposures of injured black men at higher risk for poor mental health outcomes, factors that can be obtained from a focused history and that can help target services to those with highest need.THE STUDYThe study used a prospective, cohort design in which men were enrolled during acute hospitalization at an urban, level 1 trauma center in Philadelphia, and followed up three months post-discharge. Men with injuries who were hospitalized, self-identified as black, were 18 years or older, and resided in the Philadelphia region were eligible. Those experiencing a cognitive dysfunction or psychotic disorder, hospitalized because of attempted suicide, or receiving treatment for depression or PTSD were excluded. The data were collected from January 2013 to October 2017.Recruitment, written informed consent, and baseline interviews were conducted in the hospital when the participant was medically stable. Demographic and injury-associated information were obtained via self-report and from the medical record, while self-reports of acute stress responses and risk and protective factors were collected during interviews. Interviews to assess PTSD and depressive symptoms were conducted three months after hospital discharge, primarily in the participant’s home.LEAD AUTHORDR. THERESE RICHMONDTherese S. Richmond, PhD, FAAN, CRNP is the Andrea B. Laporte Professor of Nursing and the Associate Dean for Research & Innovation at the University of Pennsylvania’s School of Nursing. Dr. Richmond’s research focuses on improving recovery from serious injury by addressing the interaction between physical injury and its psychological repercussions, particularly in vulnerable populations. Two decades ago she co-founded what is now the Penn Injury Science Center, an interdisciplinary center that conducts research and translates scientific discoveries into practice and policy with the greatest potential to prevent injury and violence and improve outcomes. Her co-authors are Douglas J. Wiebe, PhD, Patrick M. Reilly, MD, and Justine Shults, PhD, all of the University of Pennsylvania; John Rich, MD, MPH, of Drexel University; and Nancy Kassam-Adams, PhD, of the Children’s Hospital of Philadelphia. This research was supported by the National Institute of Nursing Research of the National Institutes of Health (grant R01NR013503).Life Trajectory Risk and Protective Factors for Post-injury DepressionINJURYPRE-INJURY POST-INJURYChildhood  adversityPrior mental health challengesPoor pre-injury healthDepression severity  3 months post-injury*green arrow denotes protective effectPsychological/emotional health and resources*Intentional  InjuryAcute psychological reactions to injuryRichmond TS, Wiebe DJ, Reilly PM, Shults J, Rich J, Kassam-Adams N. Contributors to Postinjury Mental Health in Urban Black Men with Serious Injuries.  JAMA Surgery. 2019 Jun 5. doi:10.1001/jamasurg.2019.1622

Contributors to Post-Injury Mental Health In Urban Black Men With Serious Injuries

Kosmopolis

University of Pennsylvania
ScholarlyCommons
Research Briefs Leonard Davis Institute of Health Economics
6-5-2019
Contributors to Post-Injury Mental Health In
Urban Black Men With Serious Injuries
Therese S. Richmond
Douglas J. Wiebe
Patrick M. Reilly
John Rich
Justine Shults
See next page for additional authors
Follow this and additional works at: https://repository.upenn.edu/ldi_researchbriefs
This paper is posted at ScholarlyCommons. https://repository.upenn.edu/ldi_researchbriefs/56
For more information, please contact repository@pobox.upenn.edu.
Richmond, Therese S.; Wiebe, Douglas J.; Reilly, Patrick M.; Rich, John; Shults, Justine; and Kassam-Adams, Nancy. Contributors to
Post-Injury Mental Health In Urban Black Men With Serious Injuries. LDI Research Briefs. 2019; No. 56. https://ldi.upenn.edu/
brief/contributors-post-injury-mental-health-urban-black-men-serious-injuries
" >
https://ldi.upenn.edu/brief/contributors-post-injury-mental-health-urban-black-men-serious-injuries
Contributors to Post-Injury Mental Health In Urban Black Men With
Serious Injuries
Keywords
mental health, PTSD, injury
License
This work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 License.
Author(s)
Therese S. Richmond, Douglas J. Wiebe, Patrick M. Reilly, John Rich, Justine Shults, and Nancy Kassam-
Adams
This brief is available at ScholarlyCommons: https://repository.upenn.edu/ldi_researchbriefs/56
THE QUESTION
Although injury is a short-term event, it can lead to long-term mental 
health problems, with up to 50% of patients experiencing post-injury 
depression and posttraumatic stress disorder (PTSD). Injured black men 
are particularly vulnerable because they have high exposure to stressors, 
are more likely to be injured than white men, and are more likely to have 
undiagnosed psychological consequences than white men. Sending these 
men back to the community with unrecognized mental health problems 
contributes to suboptimal recovery, and can lead to repeated injuries, self-
medication for symptoms, or interactions with the criminal justice system.
Urban black men from disadvantaged neighborhoods are exposed to 
racism, poverty, and other traumas throughout their lives, which may 
contribute to the severity of mental health conditions after injury. In this 
study, the authors use statistical modeling to understand the factors 
from childhood and adulthood that contribute to depression and PTSD 
severity in black men with serious injuries.
THE FINDINGS
The final sample included 500 black men, over half (55.5%) of whom had 
intentional injuries due to interpersonal violence. Almost half (45%) met 
diagnostic criteria for either depression or PTSD three months post-
injury: 65 (13%) were positive for depression, 51 (10.2%) were positive for 
PTSD, and 111 (22.2%) were positive for both outcomes.
The flow chart on the next page shows the risk and protective factors 
across the life trajectory that influence depression severity post-injury. 
Childhood adversity was associated with acute psychological reactions 
to injury (e.g., immediate emotional reactions, physical reactions, and 
subjective appraisal of life threat). A history of prior mental health 
challenges influenced poor pre-injury health, while psychological/
emotional health and resources (e.g., self-efficacy and hope) protected 
against poor pre-injury health. In turn, acute psychological reactions to 
injury, poor pre-injury health, and intentional injury, were each associated 
with depression severity. The model for PTSD symptom severity showed 
similar results.
CONTRIBUTORS TO POST-INJURY MENTAL HEALTH 
IN URBAN BLACK MEN WITH SERIOUS INJURIES
Therese S. Richmond, Douglas J. Wiebe, Patrick M. Reilly, John Rich, Justine Shults, Nancy Kassam-Adams
JAMA Surgery – published online June 5, 2019
KEYFINDINGS 
Factors over the life course affect the mental health of urban black men with serious injuries. Childhood adversity, pre-
injury physical and mental health conditions, and intentional injury (violence) are risk factors for post-injury depression 
and posttraumatic stress. Clinicians should expand assessment beyond the acute injury event to identify patients at risk 
for poor mental health outcomes.
DATA  D R I V E N . P O L I C Y  F O C U S E D
BRIEFResearchLDI
Research to Improve the Nation’s Health System  2019 . No. 4
COLONIAL PENN CENTER   |   3641 LOCUST WALK   |   PHILADELPHIA, PA 19104-6218   |   LDI.UPENN.EDU   |   P: 215-898-5611   |   F: 215-898-0229   |   @PENNLDI
BRIEFResearchLDI
THE IMPLICATIONS
The intersection of prior trauma and adversity, exposure to challenging 
disadvantage, and poor pre-injury health should not be overlooked in 
acute injury care. These findings support the importance of trauma-
informed care for injury patients, especially black men, who as a group 
have disproportionately high rates of childhood adversity. 
The current findings have clinical importance since, in a national survey 
of trauma centers, only 7% of centers incorporated routine screening for 
PTSD symptoms. Because symptoms develop after hospital discharge, 
further development and use of screening tools designed to assess post-
injury mental health problems is warranted. Collaborative services that 
integrate trauma and mental health care and cross phases of care (from 
acute to community care) are also needed. The findings of this study 
identify characteristics and exposures of injured black men at higher risk for 
poor mental health outcomes, factors that can be obtained from a focused 
history and that can help target services to those with highest need.
THE STUDY
The study used a prospective, cohort design in which men were 
enrolled during acute hospitalization at an urban, level 1 trauma center 
in Philadelphia, and followed up three months post-discharge. Men with 
injuries who were hospitalized, self-identified as black, were 18 years 
or older, and resided in the Philadelphia region were eligible. Those 
experiencing a cognitive dysfunction or psychotic disorder, hospitalized 
because of attempted suicide, or receiving treatment for depression or 
PTSD were excluded. The data were collected from January 2013 to 
October 2017.
Recruitment, written informed consent, and baseline interviews were 
conducted in the hospital when the participant was medically stable. 
Demographic and injury-associated information were obtained via 
self-report and from the medical record, while self-reports of acute stress 
responses and risk and protective factors were collected during interviews. 
Interviews to assess PTSD and depressive symptoms were conducted 
three months after hospital discharge, primarily in the participant’s home.
LEAD AUTHOR
DR. THERESE RICHMOND
Therese S. Richmond, PhD, FAAN, CRNP is the Andrea B. Laporte Professor of Nursing and the Associate Dean for Research & Innovation 
at the University of Pennsylvania’s School of Nursing. Dr. Richmond’s research focuses on improving recovery from serious injury by 
addressing the interaction between physical injury and its psychological repercussions, particularly in vulnerable populations. Two decades 
ago she co-founded what is now the Penn Injury Science Center, an interdisciplinary center that conducts research and translates scientific 
discoveries into practice and policy with the greatest potential to prevent injury and violence and improve outcomes. 
Her co-authors are Douglas J. Wiebe, PhD, Patrick M. Reilly, MD, and Justine Shults, PhD, all of the University of Pennsylvania; John Rich, 
MD, MPH, of Drexel University; and Nancy Kassam-Adams, PhD, of the Children’s Hospital of Philadelphia. This research was supported by 
the National Institute of Nursing Research of the National Institutes of Health (grant R01NR013503).
Life Trajectory Risk and Protective Factors for Post-injury Depression
INJURY
PRE-INJURY POST-INJURY
Childhood  
adversity
Prior mental health 
challenges
Poor pre-injury 
health
Depression severity  
3 months post-injury
*green arrow denotes protective effect
Psychological/emotional 
health and resources*
Intentional  
Injury
Acute psychological 
reactions to injury
Richmond TS, Wiebe DJ, Reilly PM, Shults J, Rich J, Kassam-Adams N. Contributors to Postinjury Mental Health in Urban Black Men with Serious Injuries.  
JAMA Surgery. 2019 Jun 5. doi:10.1001/jamasurg.2019.1622


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Contributors to Post-Injury Mental Health In Urban Black Men With Serious Injuries

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