York nursing Professor Joan Samuels-Dennis wants to know how violence and violence-related stressors impact mental health over time. As the lead on a Toronto Mental Health Study, she is surveying income-assisted adults in both prioritized and non-prioritized areas of Toronto.
The research team is looking to pinpoint the most significant factors in the presence, persistence and progression of Post-Traumatic Stress Disorder (PTSD), but also if if occurs equally in men and women across neighbourhoods.
With researchers from York, the University of Western Ontario, St. Michael’s Hospital and the City of Toronto’s Employment & Social Services division, Samuels-Dennis has targeted two areas – the Black Creek community, which she says is under-resourced, especially when it comes to mental health services, and the Kingsview/Westway area in Etobicoke, which is not under-resourced.
In addition, the research team is also hoping to discover the role played by a person’s personal strength and support system, as well as the resources in the community, 
in mitigating the effects of violence on mental health.
Right: Joan Samuels-Dennis
“One of the things we worry about is the absence of a social support network among these folks,” says Samuels-Dennis.
Previous research has shown the highest rate of PTSD to be among homeless and income-assisted females, says Samuels-Dennis. In Toronto, 30 per cent of income-assisted females suffer with full-blown PTSD. What is unknown is whether this holds true for men or how many income-assisted males have experienced either a violent or non-violent trauma. Up until now, no studies have looked at the incidence of PTSD in income-assisted males. Research is also needed to understand how to best help people recover from PTSD.
PTSD is a chronic psychological response to trauma, where a person continually re-experiences the traumatic event or tragic experience, has a strong urge to avoid all situations, people or things associated with the trauma or feels numb, and always feels aroused or hypersensitive.
“We’re asking questions like what kinds of violent and non-violent traumas have they experienced – car accidents, violence. When it comes to violent trauma, those folks are the ones who need more intervention for PTSD,” says Samuels-Dennis. Child abuse, a violent death, an unexpected death or intimate partner violence, “once you experience these kinds of traumatic events, you’re more likely to experience depression, anxiety or PTSD.” As much as 60 per cent of trauma survivors are likely to develop a mental-health problem.
Women are twice as likely as men to develop PTSD, and people who experience a violent trauma are more likely to develop PTSD than people who experience a non-violent trauma. After experiencing a violent trauma, as many as 78 per cent of females and 65 per cent of males are likely to develop PTSD.
Preliminary survey results show that 49 per cent of respondents have experienced child abuse, 48 per cent knew someone who died a violent or unexpected death, and 48 per cent have experienced intimate partner violence. Another 26 per cent say it’s somewhat difficult to access health-care providers. Fifteen per cent has been diagnosed with PSTD and 30 per cent with a major depressive disorder.
Samuels-Dennis hopes the study will provide insight into how violent traumas influence mental well-being and show how the lack of resources significantly impacts the mental health of income-assisted adults, leading to an increase in supports.
“I think what we’re going to see is that violence actually leads people into welfare, not the other way around. I think people become so mentally and socially unwell because of the violence they experienced that they aren’t able to function as well.” In the preliminary survey data, 32 per cent said they were badly beaten by a stranger, 38 per cent said they’d been raped, 40 per cent said they’d been mugged, held up or threatened with a weapon.
Strain in their personal relationships also has a huge impact on their mental health, she says. Previous research has found that interpersonal conflict has the highest impact on people’s mental well-being. Another piece of the puzzle is the impact of being a refugee on people’s mental health. In the preliminary survey data, 28 per cent said they were refugees.
Samuels-Dennis would also like to know how empowered the person was before the violence and does violence reduce the ability to be resilient or empowered. “This personal resource piece will be what will surprise me.”
This study will use data collected three times over the next three years to document the prevalence of PTSD among a sample of 600 income-assisted adults living in Toronto. The survey, which takes 30 to 45 minutes, is expected to continue until October.
For more information, visit the Toronto Mental Health Study website. For a list of co-investigators and their bios, click here.