As many communities across the country struggle with rising violence, a team of researchers from Drexel’s Dornsife School of Public Health took a unique approach to better understand the experiences of victims of urban violence in Philadelphia. In their study, recently published in the Journal of Urban Health, they talked to 147 adults who were victims of violence in the city to understand how prior childhood trauma could put someone more at risk for PTSD symptoms after experiencing violence.
The researchers connected with subjects within three months of their treatment in an emergency room after an attack and asked a series of questions to assess whether they had any adverse childhood experiences growing up and if they were suffering from any PTSD symptoms following the recent attack.
The adverse childhood experiences were widespread — nine out of 10 respondents experienced at least one adverse childhood experience and nearly four out of 10 experienced more than six.
The team found a strong link between adverse childhood experiences and odds of experiencing PTSD symptoms following an attack. Specific adverse childhood experiences — particularly emotional neglect — were associated with a greater number of PTSD symptoms. Patients who had more adverse childhood experiences also experienced worse PTSD symptoms; and patients with higher numbers of adverse childhood experiences showed higher odds of PTSD after being the victim of violence than those who reported few or no adverse childhood experiences.
The team’s data suggests that healing the trauma from adverse childhood experiences early in life that lingers well into adulthood may help prevent the PTSD symptoms that violence victims often experience.
The paper supports the benefits of the work of Healing Hurt People, a Drexel program that delivers trauma-focused healing through evidence-based therapy, supportive case management, and peer services to survivors of violent attacks, and to those who are exposed to violence.
Lead author Loni P. Tabb, PhD, an associate professor in the Dornsife School of Public Health, recently discussed why addressing poor environmental factors associated with violence, as well as the trauma experienced from adverse childhood experiences – such as abuse, neglect, or violence — may help treat victims of violence and convince them not to retaliate.
Why is it valuable to look retrospectively at the past adverse childhood experiences among victims of violence?
While much of the work that involves looking at current day health and social outcomes, like violence, is necessary, it’s important to consider the lifetime exposures to unfortunate realities, like trauma. Taking a holistic view of how victims of violence are exposed to trauma is key in addressing and intervening so that future violence is curtailed. Looking at adverse childhood experiences is a great way to take this holistic view, because ignoring such trauma will likely undermine not only the true reasons behind said violence, but allow for a more informed approach at helping victims of violence.
The study mentions that the disproportionate impact of exposure to violence is experienced by Black males and youth. Can you mention some of the systemic factors that may contribute to this?
One of the major factors that contribute to this disproportionate impact of exposure to violence – experienced at alarming rates by Black males and especially young Black males – lies in one’s neighborhood. Neighborhoods matter, at a micro and macro level. For instance, our research noted that in Philadelphia’s safest police district, which is predominantly white, there are little to no reported firearm homicides; however, in the most violent district in the city, which is mostly made up of Black residents, there are stark numbers of shooting victims. We know this is not by chance.
Contributing factors lie at the intersection of historical and present day, persistent structural racism, health and social inequities, as well as poverty. So when we think about this disproportionate impact being experienced by Black males, especially the younger ones, we need to make sure we are acknowledging that the environments they live in are not setting them up for success. When thinking about the social determinants of health, this is what we mean: The conditions in the places in which people live, learn, work, play and worship all have implications on health and social outcomes – violence is no exception.
We know adverse childhood experiences (ACEs) increase the odds of developing lifetime post-traumatic stress disorder. What made you and your colleagues decide to look at this population of youth in Philadelphia?
Unfortunately, Philadelphia’s homicide rate surpasses the national rate (similar to other large cities across the U.S.). And, even though the city is racially and ethnically diverse, the homicide rate among Black residents is nearly ten-fold that among white residents. Additionally, two of the three trauma centers in our study are located in North Philadelphia (Temple University Hospital and Einstein Medical Center) – which are both areas in the city with the highest emergency department encounter rates. The third hospital, Hahnemann University Hospital (which closed post-2019 data collection) was located in Center City, and although the demographics differed from the other two sites, this site was considered one of Philadelphia’s safety-net hospitals, providing care to individuals from underserved communities.
In looking at those Philadelphia residents that participated in our study, nearly all of them (90%) experienced at least one adverse childhood experience.
What are the most important insights from this study for local officials and organizations responsible for preventing violence and the health professionals supporting victims of attacks?
One of the most important insights to consider – especially for local officials and organizations responsible for addressing this public health crisis – is to understand that ACEs, along with a myriad of other individual- and neighborhood-level contextual factors matter. While the focus of our research leaned heavily on the importance of ACEs, and how experiencing such trauma at a young age can lead to unfortunate negative health and social outcomes, including violence, we must pay very close attention to the impact that neighborhoods have on our overall health.
What can be done based on these findings?
The implications of this research land on the desperate need to provide support and resources to survivors of violence given what we know about how trauma can exert detrimental effects on physical and psychological health.
Hospital-based violence intervention programs, like Healing Hurt People, have been shown to decrease symptoms of trauma, and we need to invest in these of types of programs and in furthering our understanding of how intervening early on among survivors of violence can decrease PTSD for those who carry this burden of trauma.
Additionally, while these types of intervention programs are necessary at the individual level, it’s critical to simultaneously focus on investing in neighborhoods, just like Philadelphia, where our Black youth are set up for success. What does that mean? It means they are growing up in neighborhoods that are clean, safe, filled with access to quality health care, education and housing.
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