- Chronic exposure to life-threatening traumatic events can lead to negative mental and physical health outcomes.
- Due to structural racism, Black individuals with few economic resources are more likely to experience trauma than other groups.
- Racism is the root of racial health inequities.
By Meghna Ravi, B.S.A., Sean Minton, B.A., and Sanne van Rooij, Ph.D., on behalf of the Atlanta Behavioral Health Advocates
Fifteen years ago, healthcare professionals noticed high rates of trauma and chronic physical health conditions in patients seeking primary care at Atlanta’s premier safety net hospital. Since then, the Grady Trauma Project has worked to understand the effects of that trauma and has surveyed over 12,000 primarily Black individuals living in urban communities with low socioeconomic resources, making it the largest study to date on stress and trauma in non-veterans. Our work demonstrates that this community is disproportionately affected by severe and life-threatening traumatic events; 90 percent of the individuals we spoke to have experienced trauma, and 48 percent have experienced at least 4 different types of traumatic events in their lifetime (Gillespie et al., 2009), such as severe violence or sudden and near-lethal illness.
Effects of chronic trauma exposure
The effects of chronic trauma exposure are profound. Exposure to trauma can lead to posttraumatic stress disorder (PTSD), which is characterized by many debilitating symptoms, including always being on high alert, anticipating danger, nightmares and unwanted thoughts of the trauma, irritability, loss of interest or pleasure, and social isolation. PTSD has a deeply negative impact on quality of life and can impact the most basic aspects of people’s lives, including sleep (Rahman et al., 2018), ability to work, and personal relationships.
While about 6 percent of the general population and between 7 percent and 14 percent of veterans will be diagnosed with PTSD in their lifetime (Schein et al., 2021), our research has shown that lifetime rates of PTSD in Black individuals living in urban low-resourced neighborhoods is 46 percent (Gillespie et al., 2009). We have also found that more than a third (37 percent) of this group have experienced depression (Gillespie et al., 2009), which is much higher than the general population.
Experiencing trauma also increases the risk for other chronic illnesses, such as heart disease and diabetes (Spann et al., 2014). As such, there are large physical health inequities: rates of diabetes, heart disease, and other chronic illnesses are much higher in Black individuals living in inner-city environments compared to the general population. In addition, we have observed high concentrations of biological molecules indicating risk for chronic illnesses in study participants. For example, the average concentration of the inflammatory molecule C Reactive Protein (CRP), which is known to increase in response to trauma or chronic stress, in our community sample is about 5 ng/ml (Michopoulos et al., 2015). To put that number in context, the American Heart Association identifies people with concentrations of CRP above 3 ng/ml at high risk for developing heart disease (Pearson et al., 2003). Importantly, the detrimental health effects of chronic trauma exposure are not limited to one generation; the biological effects of stress can be passed down from mother to child (Breen et al., 2018), and as a result, trauma has long-lasting effects on both individuals and communities.
While trauma clearly can result in negative health consequences, one other aspect of our research focuses on efforts to reduce the burden of trauma for Black individuals living in urban environments, to ensure that affected individuals have access to healing resources. Importantly, many individuals who we have surveyed did not develop PTSD or depression, despite having experienced trauma.
Exciting new research is working to understand the factors that promote such resilience to develop treatments that are culturally appropriate and that can help people foster resilience. For example, practices like culturally tailored mindfulness (Watson-Singleton et al., 2019) or racial socialization (e.g., where Black children are taught about cultural beliefs, values, and pride) (Metzger et al., 2020) are some of the methods that can help people reduce some of the negative effects of the stress they experience. In some instances, external stimulation of specific brain regions is a safe technique that may help people’s mental health (Petrosino et al., 2021).
But while we must find solutions for affected people to get immediate relief, trauma can still have long-lasting health impacts (Katrinli et al., 2020). Thus, the ultimate solution to addressing health inequities is to ensure that communities of color do not face so much trauma to begin with.
Structural racism makes trauma more likely
The science is clear: Black individuals living in urban environments are more likely to experience higher levels of trauma as compared to other groups, which can lead to many negative health consequences. The high rates of trauma experienced by Black people living in urban environments are not random or accidental. Other researchers have shown that structural racism makes this group more likely to experience trauma (Jacoby et al., 2018; Rivara, 2022).
Former official policies like redlining allowed for the government to under-invest in Black neighborhoods and communities, and the consequences of redlining are still felt today (Appel & Nickerson, 2016; Lynch et al., 2021). Violence rates in these neighborhoods are often high, leading to high rates of trauma exposure. Not only does racism make Black individuals more likely to experience trauma, but racial discrimination itself can alter brain structure (Fani et al., 2022), worsen mental health outcomes (Mekawi et al., 2021), and can take a physical toll on the body (McKenna et al., 2021).
Because of the effects of racism on health, and because racism is a constant threat to Black individuals, racism can be thought of as a form of trauma itself (racial trauma). We must remember that racism does not only express itself through the more commonly talked about police brutality or hate crimes, but also through the other traumas our participants experience, and therefore the health inequities they face. It is therefore crucial for clinicians to seek training on addressing their internal biases about race, and on how to help treat racial trauma.
Thousands of our participants have given their time to help us understand the widespread consequences of exposure to trauma, and their participation has greatly contributed to the general understanding of how trauma impacts the individual. For more resources on the impact of trauma on health and ways to improve health equity among Black individuals, check out Resilient Georgia, SisterLove Inc., and the Center for Black Women’s Wellness. An overview of resources can be found on the Grady Trauma Project resource list.
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