Mental+Health+in+Adolescents+Exposed+to+Community+Violence

toc Mental health and exposure to Violence and trauma are inextricably linked, specifically for adolescents. The adolescent brain is extremely vulnerable, therefore, exposure to violence has an even greater impact on their mental health than adult brains. Adult brains have certain mechanisms that defend itself which helps adult cope better with exposure. Adolescent brains, however, lack these structures. Mental health issues have a large impact on an individual’s ability to cope, adapt, and respond to everyday pressures, thereby greatly diminishing one’s quality of life. As our knowledge of the brain and its interactions with the environment increases, the need for research in communities with high levels of violence becomes increasingly important.

=Prevalence of Community Violence = Prevalence of violence in urban and poor neighborhoods is at an all time high. Studies have suggested that “approximately 80-90 % of adolescents in poor, urban areas have reported either direct victimization or witnessing violence in their schools and or communities” (Narra et al., 2014). Another study conducted in 2009 found that one in four children have witnessed the victimization of another person in the past year (Findelhor et al., 2009). With a higher prevalence rate of witnessing violence found among adolescents’ living in poor and urban areas. Being a witness to violence has been associated to negative health outcomes including, both short-term and long-term symptoms such as: [|trauma], depression, anxiety, aggressive behavior, delinquency, and engaging in risky health behaviors (Cooley-Strickland et al, 2009). Youth were more likely to report witnessing one or more violent events (n=317, 41%) than their parents (n=115, 15%). Youth who also reported witnessing violence were associated with having a higher occurrence of trauma symptoms. (Lewis et al., 2012). The research clearly shows the disproportionate exposure to violence youth in urban and poor communities are subjected to on a daily basis. This extreme exposure to violence has various implications for adolescents and mental health.

This chart displays the different types of community violence young girls and boys are exposed to.

=Impact of Ethnic Identity on Stress in Adolescents Exposed to Violence = In a study conducted by Narra et al., the researchers looked at the role of ethnic identity in mitigating harmful effects of exposure to violence. The researchers found that for white, Asian, and multiracial adolescents, a strong tie to their ethnic identity had positive effects on their ability to cope with the cognitive stress experienced. For minority youth, however, strong ethnic identity had a profoundly negative effect. The researcher’s hypothesized that for minorities, “ethnic identities may exacerbate distress” due to the fact that, “ethnic identity is associated with ethnic minorities increased attention to interethnic dynamics” (Narra et al., 2014). This is to say, minorities are increasingly aware of their perceived identity and treatment by the dominant culture. This heightened awareness leads to increased stress, which decreases one’s ability to cope with the stress of being exposed to violence.

[|Digital Image] Graphic displaying the interethnic dynamics that play a role in African American youths' development of mental illnesses.

=Fear in Adolescents Exposed to High Levels of Community Violence = A study conducted by Cooley-Quille et al., looked at inner-city adolescents who were exposed to high levels of community violence, found that these youths possessed a greater number of fears than adolescents exposed to low levels of violence. The fears reported were of injury, the unknown, danger, and living in hostile environments. The study found that more male adolescents were exposed to community violence, while female adolescents who were exposed to high levels of community violence displayed more internalizing problems, such as withdrawal and anxiety, when compared to females exposed to low levels of violence. Although the research found correlations between high exposure to violence and an elevation of fears, there was not a significant link to depression (Cooley-Ouille et al. 2001). The development and exacerbation of fears in adolescents can lead to the emergence of debilitating mental health disorders.

=Depression, Suicidal Ideation, and PTSD = As stated in the previous section, high levels of exposure to community violence leads to the development of fears in adolescents. In low-income and urban neighborhoods, depression and suicidal ideation are observed at high levels, which arise from various conditions in which the youth are exposed to (Perry, Tabb, & Mendenhall, 2015). Although exposure to community violence has not been scientifically linked to the development of mental health disorders such as depression, and suicidal ideation, one study found a significant link to development of PTSD. In research conducted by Mazza and Reynolds, they found that PTSD symptomatology was the only mental illness with significant correlations to exposure of violence. Although depression and suicidal ideation were not directly related to violence exposure, this does not negate their importance as mental health concerns for young adolescents exposed to violence. PTSD may lead to feelings of loneliness, isolation, and helplessness, which can all lead to the development of other mental health disorders such as depression and suicidal ideation (Mazza & Reynolds, 1999). Without proper treatment of these psychological disorders, youth face immense challenges in obtaining positive life outcomes.

=Treatment = Due to the high level of exposure to violence for youth living in poor and urban communities, youth in these areas are at risk for developing a multitude of mental health disorders. Help seeking has been found to buffer against PTSD symptoms in adolescents exposed to community violence (Narra et al., 2014). However, oftentimes youth do not seek help from adults and authority figures, rather seeking out help from friends and classmates. Since poor mental health can greatly hinder adolescents’ opportunities for success in life, it is imperative for poor and urban neighborhoods to have access to proper treatment. There is a dearth in availability of treatment for adolescents in poor and urban neighborhoods. One study conducted on youth in these areas found that only as few as a third of adolescents with mental health disorders receive any form of treatment (Merikangas et al., 2011). Mental health care services are costly. It has been found that, “one in three patients that needed mental health services reported unmet needs for mental health care, and affordability was the top reason for unmet needs” (Jones et al.,2009). Other reasons found in this study included transportation barriers, lack of health care coverage, and a lack of knowledge on how to access mental health care resources. All of these concerns create a differential access to mental health care services, which greatly impacts youth living in poor and urban neighborhoods. Another factor affecting treatment is the caused by differential associations. Among poor, urban, African-American youth, there is a prevailing stigma surrounding mental health treatment. For young African-Americans, mental health is not discussed, and therefore a language surrounding mental health is not developed and treatment for such disorders does not become normalized. Due to these socialization factors, African-American youth are found to disproportionately terminate therapy prematurely (Fraynt et al., 2014), therefore, diminishing their ability to properly cope with their stress and mental health. <span style="font-family: Arial,Helvetica,sans-serif;">The stigma surrounding mental health within low-income communities coupled with a lack of proper access to care, thereby perpetuates the cycle of violence and mental health disorders within these communities.

=<span style="font-family: Arial,Helvetica,sans-serif;">Conclusion = <span style="font-family: Arial,Helvetica,sans-serif;">In conclusion, exposure to violence has a large impact on the development of mental illness. Research in this field becomes extremely important in order to help mitigate the negative consequences mental illness can have on individuals throughout their life. Due to the lack of access to proper mental health care, adolescents in poor and urban communities are becoming marginalized even further. In the future, research concerning treatment of mental health disorders in low-income communities should address the associated stigma and the lack of education on mental health in order to better treat youth in these communities. Research should also focus on how gender, race, and ethnicity interact with community violence in the development of mental health disorders.

=<span style="font-family: Arial,Helvetica,sans-serif;">References =

<span style="font-family: Arial,Helvetica,sans-serif;">Cooley-Strickland, M., Quille, T. J., Griffin, R. S., Stuart, E. A., Bradshaw, C. P., & Furr-Holden, D. (2009). Community Violence and Youth: Affect, Behavior, Substance Use, and Academics. Clinical Child and Family Psychology Review, 12(2), 127-156.

<span style="font-family: Arial,Helvetica,sans-serif;">Cooley-Quille, M., Boyd, R. C., Frantz, E., & Walsh, J. (2001). Emotional and Behavioral Impact of Exposure to Community Violence in Inner-City Adolescents. Journal of Clinical Child & Adolescent Psychology, 30(2), 199-206.

<span style="font-family: Arial,Helvetica,sans-serif;">Findlehor, D., Turner, H., Ormrod, R., Hamby, S., & Kracke, K. (n.d.). Children's Exposure to Violence: A Comprehensive National Survey. PsycEXTRA Dataset.

<span style="font-family: Arial,Helvetica,sans-serif;">Jones, Emily, Lydie A. Lebrun-Harris, Alek Sripipatana, and Quyen Ngo-Metzger. "Access to Mental Health Services Among Patients at Health Centers and Factors Associated with Unmet Needs." Journal of Health Care for the Poor and Underserved 25, no. 1 (2014): 425-36. doi:10.1353/hpu.2014.0056.

<span style="font-family: Arial,Helvetica,sans-serif;">Lewis, T., Thompson, R., Kotch, J. B., Proctor, L. J., Litrownik, A. J., English, D. J., Dubowitz, H. (2012). Parent–youth discordance about youth-witnessed violence: Associations with trauma symptoms and service use in an at-risk sample. Child Abuse & Neglect, 36(11-12), 790-797.

<span style="font-family: Arial,Helvetica,sans-serif;">Mazza, J., & Reynolds, W. (1999, June 27). Exposure to Violence in Young Inner-City Adolescents: Relationships with Suicidal Ideation, Depression, and PTSD Symptomatology. Journal of Abnormal Child Psychology, 27(3).

<span style="font-family: Arial,Helvetica,sans-serif;">Merikangas, K. R., He, J., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., Olfson, M. (2011). Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 32-45.

<span style="font-family: Arial,Helvetica,sans-serif;">Perry, Danielle M., Karen M. Tabb, and Ruby Mendenhall. "Examining the Effects of Urban Neighborhoods on the Mental Health of Adolescent African American Males: A Qualitative Systematic Review." The Journal of Negro Education 84, no. 3 (2015): 254. doi:10.7709/jnegroeducation.84.3.0254.

<span style="font-family: Arial,Helvetica,sans-serif;">R. Fraynt, L. Ross, B.L. Baker, I. Rysatd, J. Lee, E.C. Briggs. Predictors of treatment engagement in ethnically diverse, urban children receiving treatment for trauma exposure. Journal of Traumatic Stress, 27 (2014), pp. 66–73.

<span style="font-family: Arial,Helvetica,sans-serif;">Tummala–Narra, Pratyusha, Zhushan Li, Tao Liu, and Yang Wang. "Violence Exposure and Mental Health among Adolescents: The Role of Ethnic Identity and Help Seeking." Psychological Trauma: Theory, Research, Practice, and Policy 6, no. 1 (2014): 8-24.

=**Hyperlinks**= <span style="font-family: Arial,Helvetica,sans-serif;">Mental health <span style="font-family: Arial,Helvetica,sans-serif;">Violence <span style="font-family: Arial,Helvetica,sans-serif;">[|trauma] <span style="font-family: Arial,Helvetica,sans-serif;">depression <span style="font-family: Arial,Helvetica,sans-serif;">anxiety <span style="font-family: Arial,Helvetica,sans-serif;">[|Digital Image] <span style="font-family: Arial,Helvetica,sans-serif;">suicidal ideation <span style="font-family: Arial,Helvetica,sans-serif;">socialization <span style="font-family: Arial,Helvetica,sans-serif;">treatment