SUMR Scholar: Nehanda Khemet Mentor: Terry Richmond

SUMR Scholar: Nehanda Khemet
Mentor: Terry Richmond
The health disparities of urban
black men
›  Minority
and low-income groups receive poor
health care
› 
Especially residents of inner-city areas
›  Black
males are more likely to be injured and
among the least likely population to seek help
for psychological consequences
›  PTSD in the general population is 9-12%
› 
But 40% among inner city and economically
disadvantaged minority populations
Injury can lead to…
›  Chronic
›  37%
health and mental problems
to 56% of injured patients experience
depression
›  38% of injured patients were depressed by 6
months
›  The injured are more likely to commit
suicide
›  The injury can lead to acute stress disorder
and PTSD
Why is this study needed?
›  The
average hospital stay is less than 2
weeks
›  PTSD is diagnosed after symptoms persist
for 90 days following the event
›  Depression is diagnosed after 2 weeks
›  Depression and PTS develop after hospital
discharge and are often missed at
medical follow-up
Study Aims
›  SA
1: 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.
›  SA 2: 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.
›  SA 3: Gain a richer understanding of black men’s
experiences, to elucidate strategies used that
enhance or detract from their emotional recovery and
their attitudes towards seeking help for psychological
symptoms after injury.
Sample
›  Injured
black men
›  18 years or older
›  Speak and understand English,
›  Provide informed consent
›  Reside in Philadelphia
›  Exclusion criteria:
pre-existing mental status dysfunction or CNS
injury men with DSM IV axis 1 psychotic disorders
›  currently receiving treatment for depression/
PTSD.
›  Not currently under arrest
› 
Method
› 
› 
› 
900 black men will be enrolled in-hospital after injury
There will be a follow-up interview at 3 months.
Quantitative measures
› 
› 
Examine the interplay between risk, protective factors
and peri-traumatic experiences with depression/PTS.
Qualitative interviews
› 
› 
› 
Examine their experience at 3 months after injury
Determine what strategies they use to mitigate
psychological effects of injury
Determine what approaches influence their willingness
to seek care
Geocoding
Adverse Childhood
Experiences
› 
› 
› 
The Adverse Childhood Experiences (ACE)
Study assess associations between childhood
maltreatment and later-life health and wellbeing.
Certain experiences are major risk factors for
the leading causes of illness and death as well
as poor quality of life in the United States.
Health and social problems in our nation can
arise as a consequence of adverse childhood
experiences.
ERRI and Ace Study Average
ERRI Subjects (N=304): ›  17.9% 0 ACE ›  36.8% 1-2 ACE ›  45.2 % 3+ ACE
ACE Study Avg. Scores
for Males:
›  38%
›  44.3
›  17.8
0 ACE
1-2 ACE
3+ ACE
Only 4.6% of total population,
males and females, were
black
Source: http://www.cdc.gov/violenceprevention/acestudy/
prevalence.html ACE Burden of Injured Black
Males
ACE Categories
Injured Black
Males (n=308)
Felitti (n=8,056)*
Psychological abuse
40.9%
11%
Physical abuse
43.2%
10.8%
Sexual abuse
10.3%
22%
Substance abuse
53.9%
25.6%
Mental Illness/suicide
32.3%
18.8%
Domestic violence exposure
39.2%
12.5%
Household family member
incarcerated before subject
was 18
44.4%
3.4%
*Felitti Sample: 80% white; 52% female
The Changing Landscape
“We are remiss if we do not address acute psychological
responses with the same steely resolve that we address
airway, breathing, and circulation. No longer can
psychological assessment be viewed as a ‘nice add-on.’
It must be integrated into the very essence of trauma
care if we are to improve the outcomes of survivors of
serious injury.”
Richmond TS. (2005). Editorial commentary. J Trauma,
59, 1335.
So how do we do that?
›  Build
a risk profile to understand and
predict who will develop PTSD
›  Determine the best way to help them
›  Make it palatable to urban black men
Role in Project
›  In
hospital interviews
›  Geocoding
›  Data Entry
›  Transcriptions
Lessons Learned
›  Being
comfortable with interviewing
injured men
›  Injuries and the psychological effects
›  Geocoding
›  Qualitative interviews
Acknowledgements
›  Terry
Richmond, Jessica Webster, and
Andrew Robinson
›  Joanne Levy, and Safa Brown
›  LID Institute