Black Men, Trauma, and Mental Health Service Use: A Systematic Review

Background/Purpose: Black males are more likely than all other racial groups to report witnessing violence and feeling unsafe in one’s neighborhood. Homicide rates for young black males 18-24 years of age are (26.77 per 100,000) compared to their white (2.67 per 100,000) counterpart. In addition, young black males are roughly three times more likely to be victims of a nonfatal injury by firearm, and experience the threat or use of fatal and nonfatal police-use-of-force than white males. Many black males who experience a traumatic event will go on with their lives without incurring lasting negative outcomes, while others may experience traumatic stress reactions that lead to deleterious mental and behavioral health outcomes. Exposure to trauma has resulted in reported rates of Post-Traumatic Stress Disorder (15-32%), depression (5-10%) and substance use (67%) among black males.  The prevalence of trauma exposure and subsequent adverse mental health outcomes among black males suggests a significant need for trauma-informed mental health services for this population. Thus, this paper identified and synthesized results from studies that have examined trauma exposed black men utilization of mental health services, barriers to services, and use of trauma-informed services. In addition, implications for practice, policy, and future research in this area are proposed.                                                           

Methods: A systematic review of the literature was conducted to identify studies published after 1990 that included (1) Black men age 18 and older (2) Trauma exposure, and (3) Mental health service utilization. Selected databases included EBSCO, ProQuest, and Web of Science. Titles and abstracts were screened, and articles were retrieved if they met the established inclusion criteria. The reference lists of retrieved papers were also screened to identify additional studies. 

Results: Six studies were included in the final research synthesis. Results showed that trauma exposed black men were significantly less likely to be receiving mental health services than other sex-ethnic groups. Barriers to treatment included: no insurance coverage, unaware of steps to obtain services, service eligibility issues, and fear of side effects from medication. Further, the majority of black males with current PTSD was not receiving appropriate medications or psychotherapy, although they disclosed psychiatric symptoms or traumas to their physicians. 

Conclusions and Implications: The findings from this review suggests that trauma exposed black men, particularly those residing in urban communities, are more likely to seek psychiatric treatment in primary care settings than from mental health specialists. Due to their over reliance on primary care practitioners, utilizing an integrated system of care consisting of primary care, mental health care, and substance abuse services is warranted. Future research investigating factors associated with mental health service use among trauma exposed black males is essential for improved mental health outcomes, and informing policy and practitioners in the mental health care profession. Engagement in services that provide a platform for black males to address traumatic experiences is vital.