Breaking the Cycle of Inner City Violence with PTSD Care

As many cities across the country actively seek solutions to stem violence, researchers from Emory University, New York University, and the Howard Hughes Medical Institute have confirmed a relationship between Post Traumatic Stress Disorder (PTSD) and exposure to violent behavior among civilians living in urban areas. Though it is most often associated with military veterans, anyone who is exposed to assault, the sudden death of a loved one, or the violent deaths of others can experience PTSD symptoms. When PTSD goes undiagnosed and untreated, individuals who are consistently exposed to violence and trauma are more likely to commit violent crimes themselves. This cycle compromises public safety in many inner cities.

The researchers surveyed over 1,900 patients at Grady Memorial Hospital in Atlanta, Georgia, the majority of whom were female, African American, under-educated and unemployed. They collected data on the participants’ childhood traumatic experiences—including neglect and abuse, trauma they experienced as adults, and the frequency of their PTSD symptoms, such as avoidance and hyperarousal. About one-third of the patients interviewed met the criteria for a PTSD diagnosis. In addition, over half of the participants reported having physically assaulted someone at least once, and almost one-quarter reported assaulting someone with a deadly weapon.

The researchers analyzed the surveys on behavior and trauma in order to create a “violence score.” They then compared these scores with reported symptoms of PTSD. After controlling for demographics and the presence of depression, the researchers concluded that childhood trauma, adult trauma, and PTSD are highly associated with the perpetuation of interpersonal violence. This research also confirmed past findings that hyperarousal symptoms have a strong association with aggressive behavior and that the medications typically provided to treat these symptoms have been shown to reduce the occurrence of violent acts among its users.

These findings were consistent with previous research that has uncovered a relationship between high-crime areas and the prevalence of trauma among area residents.  Similarly, the findings help to underscore the importance of diagnosing and treating PTSD in youth and adults living in violent environments. Children often have access to mental health resources through their schools, especially as districts begin to introduce programs that specifically focus on treating aggressive behavior through medication and counseling. However, once outside the reach of the public education system, many individuals lose access to such necessary resources.

If cities hope to reduce violence through mental health interventions, this research provides the information needed to target specific demographics with the support they need. According to a report from the University of Chicago, the majority of homicide suspects in Chicago were over the age of 19 in 2016. This report also found that about 90 percent of these individuals had at least one prior arrest. These findings suggest that one plausible solution may be diagnosing and treating PTSD in jails and prisons. However, very few inmates receive treatment for behavioral health disorders while incarcerated.

For low-income adults who interact with neither the public education system nor the criminal justice system, mental health resources are even more limited. Patients who are diagnosed with PTSD often experience higher rates of other mental disorders, which drive up the cost of treatment. These costs stretch the limits of both Medicaid and private insurance plans, leaving many patients to abandon treatment altogether. If politicians want to ensure public safety and the personal well-being of these individuals, they must critically consider expanding mental health programs in jails and prisons while also expanding Medicaid to cover a higher share of the costs associated with mental health treatment outside of the criminal justice system.

Cycles of violence are created and perpetuated in numerous ways, and this research offers a particularly stark example of the ways in which violence has proliferated in cities across the country. Individuals who are exposed to violence develop conditions that can lead them to perpetrate more violence, thus expanding exposure to violence and the resulting negative communal effects. Effectively diagnosing and treating PTSD in those individuals could have a significant impact on breaking the cycle of violence.

Article Source: Gilikin, Cynthia, Habib, Leah, Evces, Mark, Bradley, Bekh, Ressler, Kerry and Sanders, Jeff. “Trauma exposure and PTSD symptoms associate with violence in inner city civilians.” Journal of Psychiatric Research (2016).

Featured photo: cc/(Prathaan, photo ID: 501366010, from iStock by Getty Images)