Study Finds Young Victims of Violence Receive Little Or No Psychosocial Counseling

BUFFALO, N.Y. -- An adolescent who attempts suicide and a youth who sustains a gunshot wound both are traumatized by the experience and could benefit from psychological counseling, most experts would agree.

In reality, one youth typically will get help and the other will not.

Results of a study led by a University at Buffalo psychiatrist show that 93 percent of youthful suicide attempters received some type of psychosocial assessment in the hospital, compared to 49 percent of young victims of violence.

Sixty-one percent of young suicide attempters were scheduled for follow-up with a psychosocial service provider after leaving the hospital, compared to only 10 percent of youthful victims of violence.

The study also showed that injured girls received significantly more psychosocial counseling than boys. Fewer than half of the injured boys were assessed for psychosocial functioning in the hospital and almost none were referred for follow-up counseling.

The study results were published in the July issue of Psychiatric Services.

While the study was conducted at San Francisco General Hospital, Miriam Shuchman, M.D., UB assistant professor of psychiatry and lead author on the study, said the situation is similar in most hospitals nationwide.

"Kids who have been shot at are probably the most stressed and scared they've ever been in their lives," she said. "The physical wounds may heal quickly, but the memory of what happened is likely to linger in some way. We know how to deal with that. These kids should be talking to someone about it."

She added: "Adolescents who are injured violently typically are not receiving counseling. A few programs have been established since this study was completed. They are usually run by someone in the hospital with a personal commitment to working with these kids." (See related story enclosed.)

Shuchman's study analyzed treatment records of 59 adolescents under the age of 18 who were hospitalized for gunshot wounds, stabbings or assaults during 1991, and 28 adolescents of comparable age admitted during the same time after suicide attempts. The mean age was 15 years in both groups.

Gunshot wounds accounted for 61 percent of the violent injuries, and more than three-quarters of the victims were males. Sixty-one percent were black, 20 percent were Asian/Pacific Islanders and the remainder were white or Hispanic.

The majority of suicide attempters were female, predominately of Hispanic and Asian descent. Drug overdose was the attempted suicide method of choice.

Young people who try to kill themselves routinely are offered psychiatric assessments and consultations in the hospital, Shuchman said. In this study, the hospital charts of 93 percent of suicide attempters contained comments about mood or interpersonal functioning, and 96 percent contained notes from a psychiatrist, psychiatric nurse, counselor or social worker. Sixty-one percent were referred for out-patient follow-up.

A review of hospital records of the young victims of violence found that 49 percent showed evidence of psychosocial assessment, and 58 percent contained notes from a consultation. Only 9 percent of these youths were referred for out-patient counseling.

Patients not scheduled for consultation or follow-up included a 15-year-old boy assaulted by youths wielding axes who was described as "angry" and "anxious;" a 17-year-old male shooting victim described as "anxious" and "upset;" and "a 15-year-old girl who was physically assaulted and thrown from a car and who was described by the emergency room resident as 'extremely combative and screaming.'"

Adolescents who end up in a trauma center are by definition a high-risk population, Shuchman said, and are obvious targets for counseling.

"We know that people who are injured violently are likely to be injured again. While these kids are in the hospital, we have a chance to find out why they were in a bad situation in the first place. Frequently it's alcohol or drug abuse. It's a perfect time to intervene, in hopes it won't happen again."

Shuchman suggests that gender differences in treatment may result from the fact that females traditionally are more willing to admit they need counseling after an injury, or because girls tend to be more traumatized by violent experience than boys. She noted that health-care providers may consider black youths who have been stabbed or shot to be particularly dangerous, a bias that could influence their decision to refer these adolescents for psychosocial services.

Shuchman said future research in this area should lead to a minimum standard of psychosocial intervention for young victims of violence.

Other investigators on the study were Kathrine H. Silbernagle, M.D., of the University of Washington, and Margaret A. Chesney, Ph.D., and Sylvia Villarreal, M.D., both of the University of California at San Francisco.