Stress, Trauma, Coping, and Mental Health Among Urban, Low-Income Jobseekers: Preliminary Findings from an Innovative Trauma-Informed Protocol to Improve Employment Outcomes

Background and purpose: Blacks and Latinos in America disproportionately experience unemployment. Structural factors contribute significantly to this problem, and policies must be enacted to achieve greater employment equity. At the same time, there is also a known connection between trauma and employment among urban adults of color, demonstrating a need for trauma-informed practices within agencies assisting jobseekers. The Healthy Worker Healthy Wisconsin (HWHW) partnership has responded to this service gap by implementing an innovative trauma screening, brief intervention, and referral to treatment (T-SBIRT) protocol to help low-income jobseekers in Milwaukee improve employment outcomes. T-SBIRT assesses trauma exposure and symptoms and refers participants to mental health treatment when indicated. Using HWHW data, this study addresses the following three research questions:

1. What are the rates of PTSD, anxiety and depression in this low-income, urban sample, and do trauma symptoms predict depression and anxiety symptoms;
2. What are the current stressors faced and coping strategies used; and
3. What percentage accepted a mental health treatment referral, and do trauma, anxiety, and depression symptoms predict referral acceptance?

Methods: The sample was predominately Black (78%) and male (70%), with an average age of 38. Most participants’ annual income was less than $5,000 (62%), but 75% had health insurance and over half had a regular place to go for healthcare. Nearly all (99%) experienced at least one traumatic life event.

This study gathered cross-sectional, self-report data (N=65) on trauma exposure (Trauma History Screen), trauma symptoms including PTSD (Primary Care Post-Traumatic Stress Disorder), depression (Patient Health Questionnaire-9), and generalized anxiety (Generalized Anxiety Disorder-7). Open-ended interview questions elicited information about participants’ current stressors and coping strategies. Service providers facilitated and recorded referral acceptance through T-SBIRT.

Results for the first and third study questions emerged from descriptive analyses of quantitative data along with linear or logistic regression analyses controlling for race, gender, and age. Results for the second question were generated from thematic analyses of qualitative data.

Results: Preliminary findings suggested that 49.2% of respondents met the cutoff criteria for PTSD, 49.0% generalized anxiety disorder, and 36.5% depression. There was a significant adjusted relationship between PTSD and both generalized anxiety disorder (p=.001) and depression (p<.001), respectively.  The top sources of stress included employment problems, housing issues, finances, relationships and family situations, and parenting. Nonetheless, the following positive coping strategies were readily identified: social support from family or friends, physical activity, spirituality and faith community. Participants commonly endorsed substance use as a negative coping strategy. The rate of mental health referral acceptance was 59%, and while anxiety symptoms predicted referral acceptance (p=.046), trauma and depression symptoms did not.

Implications and conclusion: These preliminary findings reinforce the connection between trauma and mental health among urban, low-income jobseekers, while also revealing the promise of T-SBIRT to generate mental health referrals. Furthermore, the findings highlight that participants have positive coping strategies on which to draw, in spite of significant sources of stress. This study demonstrates a need for further research on the impact of T-SBIRT and other trauma-informed interventions within employment services.