Black men in Philly are more likely to experience poor mental health after severe injury, a new study shows

by Sojourner Ahébée, WHYY

Sara F. Jacoby spent several years working as a trauma nurse in Philadelphia, where she became interested in how the lived environment and experiences of people influence their ability to recover.

“If you spend time in the trauma centers in Philadelphia, it’s not hard to recognize the racialized patterns of who is hurt,” said Jacoby, an assistant professor of nursing at the University of Pennsylvania whose work looks at injuries from public health and urban health perspectives.

In a recent study from the Penn School of Nursing, Jacoby and co-investigators explored the ways that returning to work after an injury predicts mental health outcomes in Black men living and recovering in Philadelphia.

Analyzing data from 498 Black men age 18 or older living in the city who were admitted to Level I trauma centers for injuries between January 2013 and June 2017, the study found that Black men who did not return to work after serious traumatic injury had almost three times the odds of poor mental health when compared to men who did.

Psychological distress in the form of post-traumatic stress disorder and depression was common among the surveyed men, and served as one of the key barriers to getting back to work in the first place. The study notes the low-income Black men, in particular, experienced worse mental health outcomes after job loss than their white counterparts. A lot of that has to do with something Jacoby calls structural vulnerability.

Black working men in Philadelphia were more likely to have jobs that didn’t accommodate changes in physical ability or provide adequate disability relief, and their disproportionate exposure to racism in the workplace and throughout their lifetime — in the form of city planning, the education system, and public policy — predisposed them to poorer physical and mental health outcomes down the line, the study says. And about one-half of the Black men in the surveyed group had been injured intentionally, typically through a violent assault such as a gunshot wound. At least 111 people have been murdered in the city so far this year, a 29% increase over the same time in 2020, the deadliest year in three decades.

“So how does that play out in the ability for Black men, first of all, to be free from the risk for things like community violence and other forms of injury and also return to places where they are able to optimize their recovery process to either go home and restore the social and economic roles in the way that they had prior to injury or reestablish something different?” said Jacoby.

The decision to study perceptions of racism among this group was intentional. If returning to work is an indicator of healing and positive mental health outcomes for formerly injured people, research investigators wanted to understand how someone’s exposure to racism in former workplaces and social life might affect their perceptions of future employment opportunities.

“If someone perceived that … their ability to seek out work in which they wouldn’t be stigmatized and which they would be able to operationalize or to use their education was contingent on their freedom from racism, then we were interested in how that might play into the relationship between injury, work, and recovery,” said Jacoby.

Perception of mental health care costs prevented access to care

Ultimately, research shows that return to work is a dependable indicator of healing and recovery. But experts say the criteria for trauma care has historically focused on managing physical wounds incurred at the time of injury, and less so on the way one’s mental health is affected in the aftermath of the injury itself.

The Penn Nursing study notes that there were significant barriers to seeking out professional psychological care among Black men after their injuries. When compared to the general public, a much larger proportion of the surveyed group was either uninsured at the time of injury or qualified either in the hospital or otherwise for public health insurance.

And Jacoby said there was a common perception that mental health care was too expensive or would not be covered by their own insurance. Of the almost 500 men whose data was studied, a quarter of them participated in interviews in which researchers asked specific questions about factors that were incentives or disincentives to care. Investigators at Penn conducted an in-depth analysis of 32 of those interviews in a separate but related study.

“More than half of the men interviewed perceived psychological suffering, perceived that they were still suffering three months after injury,” Jacoby said. “Financial constraints or the fear of cost of mental health sort of limited access … and fear of judgment and stigmatization, fear of being labeled crazy or institutionalized on the basis of that outreach.”

Then there were the remaining men who didn’t feel as if their injuries warranted professional care. Sometimes, that meant they proceeded without any psychological care at all. But there were men in this group who also reported seeking out counsel from social networks in the Black community, such as through their clergy or church.