Shook Ones: Understanding the Intersection of Nonfatal Violent Firearm Injury, Incarceration, and Traumatic Stress Among Young Black Men

Abstract

Violent injury is a leading cause of death and disability among young Black men, with the highest rates occurring in low-income urban populations. Hospital-based violence intervention programs (HVIPs) offer a promising opportunity to address the biopsychosocial factors that adversely affect this population. However, there are major gaps between the needs of young Black male survivors of violent injury and the forms of care provided by HVIPs. Patient-centered outcomes research provides a useful mode of inquiry to develop strategies to decrease these differences. Care for survivors, including treatment for traumatic stress disorders, must be reconceptualized to center the lived experiences of young Black men. This paper qualitatively explores how these survivors of gun violence express symptoms of traumatic stress and the ways in which their narratives can inform the implementation of the biopsychosocial model in HVIPs. A phenomenological variant ecological systems theory framework was used to analyze participant narratives to aid in understanding their symptoms of traumatic stress and post-injury affective changes as both psychologically and socially important experiences. Such insight may inform changes to HVIP practice to address persistent health disparities related to violence.

Not All Survivors Are the Same: Qualitative Assessment of Prior Violence, Risks, Recovery and Perceptions of Firearms and Violence Among Victims of Firearm Injury

“…The majority of our participants were employed or in school prior to injury similar to victims identified in other studies (Vella et al, 2019) and did not specifically mention a need or benefit of getting employment support services after injury, but many expressed that employment gave them a sense of purpose and value. However, participants often revealed a new sense of mission or call to service, which was also found by Richardson et al (2020). HVIPs can have a role in helping survivors identify volunteer, advocacy and employment opportunities that may capitalize on their new sense of mission, as they can provide a sense of empowerment and purpose.…”

“…Many also reported difficulty forming trusting relationships, and having emotional lability that complicated their relationships. These themes were frequently reported by a sample of Black men that survived firearm assaults (Richardson et al, 2020). Many expressed that getting support services for mental health and psychological needs after injury was imperative, but this was often inadequate.…”

“…Only one qualitative study of victims of gun violence previously explored perceptions of health care after hospitalization in an urban male population, noting significant barriers in patient-provider communication, access to after-care and psychological services, and feelings of marginalization by the medical system (Patton et al, 2009). Another recent study explored perceptions of traumatic stress among Black men involved in the criminal justice system after firearm injury, which highlighted the prevalence of PTSD, avoidance, and challenge of forming trusting relationships after injury (Richardson et al, 2020). To our knowledge, prior qualitative studies have not investigated perceptions of firearm injury risk and injury prevention among victims of firearm injuries; more investigation is needed to improve supportive services for recovery and outcomes, especially in diverse patient populations.…”

An intersectional analysis of historical and contemporary structural racism on non-fatal shootings in Baltimore, Maryland

“…This sizeable number of shootings in a city of 585 000 people has resulted in numerous physical injuries, high healthcare system costs and an immense amount of trauma, grief and stress for city residents 3 4. Survivors of non-fatal shootings in particular experience profound physical, psychological, medical and financial impacts after their shooting 5 6. However, non-fatal shootings receive far less media attention compared with fatal shootings 7.…”

The commission of crime from the perspective of decision-making differences

“…Investigators argue that improved comprehension of associations of criminal decision-making with recidivism rates can be gained by exploring how socioeconomic status of offenders is shaped and sustained by lifestyle characteristics ( Esqueda et al, 2008 ; Espinoza et al, 2015 ). By using retrospective interviews to explore criminal decision making, research also point out that offenders’ efforts to earn the financial and social capital needed to cement, maintain, and reduce biopsychosocial stressors may generate a bounded rationality in which offenders discount or ignore punishment sensitivity and the formal risks of crime ( Maschi et al, 2011 ; Richardson et al, 2020 ). Psychosocial risk factors have also been shown to affect decision-making and impulsivity, which may be associate with deviant or criminal behavior, such as drug or substance addiction, learning or intellectual disabilities, mental illness (e.g., bipolar I or II disorder), and ADHD ( Gunnison and Mazerolle, 2007 ; Curcio et al, 2013 ; Aebi et al, 2014 ).…”