Polytraumatization, mental health, and delinquency among adolescent gang members
December 24, 2019
Gang members. What thoughts and images cross your mind after reading that term? Did it provoke ones of danger, violence, criminal activity, guns, or drugs? Did it elicit associations of individuals involved in the criminal justice system?
What about the term: Traumatized Youth? Did it provoke thoughts and images of fear, sadness, depression, difficulty coping, or behavior problems? Did it trigger feelings of empathy or responsibility to help, or elicit associations that indicate a need for mental health services?
Although these descriptions likely provoked different feelings, and seemingly reflect two distinct types of people in need of different services, our research demonstrates that they are one in the same: Adolescent gang members are traumatized youth.
In our recent Journal of Traumatic Stress publication, we report that 88% of adolescent gang members (aged 14-19) experience polytraumatization, a term that refers to directly or indirectly experiencing multiple (2 or more) potentially traumatic events (e.g., physical or sexual abuse, serious injury, illness or accident, the death of a loved one, etc.). Direct traumatization reflects experiencing events firsthand, whereas indirect traumatization reflects witnessing or hearing about events happening to others (Gustafsson, Nilsson, & Svedin, 2009).
Compared to experiencing a single trauma, polytraumatization exerts a magnified toll on physical, emotional, and behavioral health, particularly among at-risk youth. Specifically, polytraumatization increases the risk of posttraumatic stress disorder (PTSD) and psychological symptoms (e.g., depression, anger, anxiety, conduct problems), behavioral problems and delinquency (e.g., drug use, police involvement, violence), and perpetration of violence or criminal activity (e.g., drug distribution). The relationships between trauma and delinquency may also be reciprocal, wherein trauma increases risk for delinquency and gang involvement, and such involvement increases risk for further traumatization and violence (Begle et al., 2011).
In our qualitative study (Quinn, Pacella, Dickson‐Gomez, & Nydegger, 2017), 58 members of adolescent gangs were interviewed in Milwaukee, WI, one of the most racially segregated cities in America. These youth: 1) were exposed to cumulative trauma and violence within their communities and homes (e.g., familial financial hardship, parental substance use, domestic violence, and parental absence due to incarceration, gang involvement, divorce, and death); 2) learned and understood violence as a normative way to deal with their emotions; and 3) experienced ongoing polyvictimization and neighborhood violence exposure that led many to seek refuge, support, and protection within the gang. However, gang membership introduced additional risk, and reinforced the normalization and perpetuation of violence (Quinn et al., 2017).
This rich qualitative data led to the need to quantify the problem in a representative sample of gang members. Our Journal of Traumatic Stress study represents a novel examination of polyvictimization and its consequences in 441 adolescent gang members (58% male) in Milwaukee. Most subjects were Black (60%) and from single-parent families (73%). Between 70-88% of subjects endorsed direct (e.g., saw someone close die) and indirect potentially traumatic events (saw someone being slapped, punched, hit or beaten up; saw someone pointing a gun at someone else, or saw someone close get very sick or injured). Additionally, 64-68% got slapped, punched, or hit, saw a serious accident, were told or witnessed others being told they were going to get hurt, or saw someone being shot at or shot.
Further, polytraumatization was directly associated with PTSD and depression, delinquency, and drug distribution. These relationships were robust after taking into the account covarying demographic and neighborhood risk factors. Moreover, 40% of subjects screened positive for PTSD, a disproportionately high number compared to the national average (5%) among youth aged 13 – 18 years (National Center for PTSD, 2016).
Our findings underscore the need for ongoing research among adolescent gang members, an understudied, high-risk, hard-to-reach sample, to gain a deeper understanding of their needs and to inform prevention and intervention services. Viewing adolescent gang members through the lens of traumatized youth may create unique opportunities for assessment and treatment of direct and indirect polytraumatization, particularly given that untreated cumulative and ongoing exposure to trauma may lead to additional behavioral and mental health problems. Trauma-informed care may be integrated within the juvenile justice, education, and primary care systems, and tailored to address the chronic and ongoing nature of exposure to trauma and violence within gangs (Quinn et al., 2017; De La Rue & Espelage, 2014).
Notably, more than half of our sample (54%) reported serious injury or illness or being rushed to the hospital, suggesting that hospital-based violence prevention programs may benefit gang-involved youth. These programs operate in the Emergency Department (ED) and offer comprehensive physical, emotional and social services to reduce re-injury and retaliation among violently injured youth (Corbin et al, 2011). During this “golden hour” after injury, violently injured youth may be receptive to making a change; the ED may be an ideal location and time to capture this high-risk sample. For example, the Healing Hurt People program in Philadelphia (Drexel University) includes a multidisciplinary team in the ED (ED physician, internist, psychiatrist, social worker and psychologist) that identifies and works with victims of violence, offering services such as mentoring, posttraumatic stress and substance abuse treatment, housing, job training and placement services, etc. (for detailed information, see: https://drexel.edu/medicine/about/departments/emergency-medicine/healing-hurt-people/)
Further, early interventions for youth exposed to (but not necessarily victims of) trauma may also serve to prevent gang membership, especially if coupled with opportunities to teach adaptive coping methods. A program focused on resisting delinquency, boundary setting, increasing self-esteem and empowerment, promoting leadership and social responsibility, and teaching parenting skills was effective in reducing depression and delinquent behavior in youth at risk for joining gangs (Koffman et al., 2009). Finally, interventions to reintegrate gang members into the community, via education and skills training, family and community mediation, and intensive individualized mental health treatment (Williamson, 2006), may be beneficial.
Taken together, gang-involved youth often face numerous disparities in health, education, employment, and criminal justice involvement. Systems and policy-level interventions, such as collaborations with hospital-based, criminal justice and mental health systems, may serve to improve the physical, mental and behavioral health of at-risk youth, and create opportunities to reduce the experiences and consequences of trauma.
Begle, A. M., Hanson, R. F., Danielson, C. K., McCart, M. R., Ruggiero, K. J., Amstadter, A. B., … Kilpatrick, D. G. (2011). Longitudinal pathways of victimization, substance use, and delinquency: Findings from the National Survey of Adolescents. Addictive Behaviors, 36, 682–689. doi: 10.1016/j.addbeh.2010.12.026
Corbin, T. J., Rich, J. A., Bloom, S. L., Delgado, D., Rich, L. J., & Wilson, A. S. (2011). Developing a trauma-informed, emergency department–based intervention for victims of urban violence. Journal of Trauma & Dissociation, 12(5), 510-525.
De La Rue, L., & Espelage, D. L. (2014). Family and abuse characteristics of gang-involved, pressured-to-join, and non–gang-involved girls. Psychology of Violence, 4, 253–265. doi: 10.1037/a0035492
Gustafsson, P. E., Nilsson, D., & Svedin, C. G. (2009). Polytraumatization and psychological symptoms in children and adolescents. European Child & Adolescent Psychiatry, 18, 274–283. doi: 10.1007/s00787-008-0728-2
Koffman, S., Ray, A., Berg, S., Covington, L., Albarran, N. M., & Vasquez, M. (2009). Impact of a comprehensive whole child intervention and prevention program among youths at risk of gang involvement and other forms of delinquency. Children and Schools, 31, 239–245. doi: 10.1093/cs/31.4.239
National Center for PTSD (2016). PTSD in children and adolescents. Retrieved September 20, 2018, from https://www.ptsd.va.gov/professional/treat/specific/ptsd_child_teens.asp#one
Quinn, K., Pacella, M. L., Dickson‐Gomez, J., & Nydegger, L. A. (2017). Childhood adversity and the continued exposure to trauma and violence among adolescent gang members. American journal of community psychology, 59(1-2), 36-49.
Williamson, J. (2006). The disarmament, demobilization and reintegration of child soldiers: social and psychological transformation in Sierra Leone. Intervention, 4(3), 185-205.
Nydegger, L.A., Quinn, K., Walsh, J.L., Pacella‐LaBarbara, M.L. and Dickson‐Gomez, J. (2019), Polytraumatization, Mental Health, and Delinquency Among Adolescent Gang Members. JOURNAL OF TRAUMATIC STRESS. doi:10.1002/jts.22473
Questions for Discussion:
- What types of programs can we offer clinicians, educators, and health care providers to overcome barriers and increase the level of comfort with working with adolescent gang members?
- Why are our conceptualizations of gang members and traumatized youth so different? What are the consequences of this? How might we work to change the image society has of gang members?
- What types of systems and policy-level interventions might be most effective at reducing trauma among at-risk youth, and how can we work to implement them and make them available to those who need it the most?
About the Author:
Maria Pacella-LaBarbara, PhD is a Research Assistant Professor of Emergency Medicine at the University of Pittsburgh. She is a health psychologist specializing in methods to improve mental and physical health outcomes after traumatic stress exposure. The goal of her multidisciplinary research is to identify targets for psychological intervention to reduce and prevent posttraumatic and post-injury sequalae.