This application responds to PA-10-236: Health Promotion in Ethnic and Racial Minority Men with a focus on injury as a flashpoint from which interventions can be introduced to improve health and reduce disparity in urban black men. Although an acute event, injury is a known portal to significant long-term health problems. The risk of sustaining a recurrent injury is as high as 40 percent, and being black itself is an independent risk factor for recidivism. The psychological effects of injury are substantial and often unrecognized: 20-56 percent develops depression and 20 percent develop post-traumatic stress (PTS) and they exacerbate the risk of injury recidivism. To improve the ability to recognize post-injury depression and PTS in black men, a comprehensive conceptual framework guides this investigation to understand the risk and protective factors that are borne by the intersection of class, race, and location. To this end, this study will innovatively assess lifetime accumulation of risk and protective factors at the personal and institutional levels, incorporate environmental data using geographic information systems, and will link these rich data to acute peri-traumatic subjective experiences. Doing so will enable more accurate identification of black men who will develop post-injury depression or PTS, and thereby capitalize on injury as a point of intervention to mitigate negative health outcomes. Given that black men have high exposure to stressors, are more likely to be hospitalized for injury in urban settings, are more likely to have psychological consequences, but are less likely to have psychiatric disorders diagnosed than whites, steps must be taken to address this health disparity. Symptoms typically surface after discharge, making it imperative to develop an empirically based risk stratification system to focus limited resources on black men most likely to need follow-up care. In response, the goals of this study are to a) create a risk profile for the emergence of post-injury depression or persistence of PTS by having accurately measured the unique contributions of personal, institutional, environmental risk and protective factors, and peri-traumatic subjective experiences, and 2) complement those findings with participants'expressions of their personal experiences. This will be accomplished by enrolling a cohort of 900 urban black men who are hospitalized for injury and followed for 3 months post-discharge to measure the primary outcomes: depression and PTS.
The specific aims of this mixed-methods study are to: 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~ 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 the novel risk and protective factors this study will obtain~ and 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.

Public Health Relevance

Black men in urban areas are at high risk for injury and to develop depression and posttraumatic stress symptoms after injury. Although black men have high exposure to stressors, are more likely to be hospitalized for injury in urban settings, and are more likely to have psychological consequences but less likely to have psychiatric disorders diagnosed than whites, steps must be taken to address this health disparity. The purpose is to examine the contribution of personal, institutional, environmental risk and protective factors and peri- traumatic subjective experiences to the emergence of post-injury depression or persistence of post-traumatic stress.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR013503-02
Application #
8549310
Study Section
Health Disparities and Equity Promotion Study Section (HDEP)
Program Officer
Roary, Mary
Project Start
2012-09-21
Project End
2016-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
2
Fiscal Year
2013
Total Cost
$513,547
Indirect Cost
$168,575
Name
University of Pennsylvania
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104