Date of Award

Fall 10-1-2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Investigative Medicine

First Advisor

Anderson, Elijah

Abstract

Survivors of gun violence have significant sequelae including mental health disorders that often go undiagnosed and untreated. Survivors of gun violence are at high risk for both re-injury with a firearm as well as interaction with the criminal justice system. These poor outcomes for survivors of gun violence contribute to the cycle of gun violence that plague communities across the United States. Learning from historical public health successes, survivors of gun violence are an important population for targeted secondary prevention efforts. Despite this, the mechanisms for these outcomes among survivors of gun violence are largely unknown and there is a dearth of research on effective prevention strategies. Combining qualitative and quantitative research methods, I sought to better describe the experience of recovery for survivors of gun violence, conduct a pilot study of a mental health intervention for post-traumatic stress symptoms, and describe the effect of the COVID-19 pandemic on community violence in Connecticut (CT). In Aim 1, I used a qualitative research study design and a community-based participatory research approach to better understand how Black male gunshot wound survivors in the United States describe their experience of recovery and their perceptions of their mental, emotional and social health following the event. We conducted in-depth interviews with 20 Black male gunshot wound survivors from New Haven, CT. This study identified five themes which define the psychological recovery after intentional injury from gun violence as well as describe the various strategies used by survivors of gun violence to cope with a disrupted sense of safety when returning to their communities. In the secondary analysis of the data, I found that participants described distrust for the police and an ecology of guns that confers symbolic, social and strategic meaning to owning a gun. These findings suggest that barriers to mental health treatment may be addressed through “credible messengers” who can develop relationships of trust with this high-risk population and that interventions to decrease gun violence should address the cultural value of a gun as well as focus on improving police relations with racial/ethnic minoritized communities. In Aim 2, I designed a pilot study evaluating the feasibility of completing a randomized controlled trial to test the Screening and Tool for Awareness and Relief of Trauma (START), a targeted mental health intervention developed for patients that come from communities of color with sustained and persistent trauma. I conducted the study at Yale New Haven Hospital in New Haven, CT through the YNHH Violence Intervention Program beginning in January 2020. For a variety of reasons but most notably due to the disruption caused by the COVID-19 pandemic, only 11 patients were enrolled in the study. With this small cohort, I was able to conclude that (1) Successful recruitment hinges on enrollment in the local hospital-based violence intervention program and the effectiveness of credible messengers in the organization; (2) The START techniques would be improved by additional audiovisual resources; (3) The novel survey to measure alienation is reliable and (4) Testing the START intervention may be most successful in a stepped wedge cluster randomized controlled trial design so that all centers in the study will receive the intervention. In Aim 3, I examined the effect of the COVID-19 pandemic on community violence in the state of Connecticut (CT). Through the CT Hospital-based Violence Intervention Program Collaborative, I used the trauma registries from Yale New Haven Hospital, Bridgeport Hospital, St. Francis Hospital, and Hartford Hospital to collect data on all violence-related trauma presentations in the emergency room from January 1st, 2018 to January 1st, 2021. I compared the pattern of violence-related trauma presentation from pre- and post-COVID-19 using an interrupted time series linear regression model, adjusted for seasonality. Using this data set, we stratified the analysis by race and ethnicity (Black/Latino patients compared with white patients) to determine whether race and ethnicity acted as an effect modifier on community violence during the COVID-19 pandemic. My analysis demonstrated a 55% increase in violence-related trauma presentations overall, a 61% increase in violence-related trauma presentations among racial/ethnic minoritized patients, and a 76% increase in penetrating injuries in the post-COVID time period as compared with the pre-COVID time period. In summary, I described the experience of recovery for survivors of gun violence, piloted a targeted mental health intervention to mitigate symptoms of post-traumatic stress for this high-risk population and studied the effect of the COVID-19 pandemic on community violence in Connecticut.

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