New ways of understanding neighbourhood violence

Women and girls are disproportionally exposed to violence and abuse and are more likely to live in poverty, leading to poor mental health. For International Women’s Day 2024 we asked TRUUD PhD candidate Cat Papastravrou about her quest to bring new ways of understanding neighbourhood violence and how it affects our mental health.

 

What are you working on?

The (working) title of my PhD is the “Understanding the Impact of Neighbourhood Violence as a Mental Health Determinant”, but within violence I’m including things such as harassment, verbal abuse, a ‘heavy police presence’ as well as more traditional forms of violence such as physical assault, or violent crime.

I’m trying to understand how experiences of violence and harassment in neighbourhoods might not only directly impact people’s mental health, but also have a wider range of impacts by making people scared in their neighbourhoods and unwilling to spend time in public spaces. The idea is that this might cut people off from all sorts of things we know are important not just for mental health, but health more broadly, such as community, connection, exercise, and being able to access health services which relates to TRUUD’s mission to reduce non- communicable diseases in urban places.

Why choose neighbourhood violence to examine mental health?

My background is in domestic abuse and mental health research, and through that I’ve become interested in the idea of complex trauma. As opposed to a one-off traumatic exposure, complex trauma occurs after multiple events, usually involving interpersonal threats or harm, and has a huge range of emotional, relational, and identity-related impacts in a much broader way what is associated with ‘post-traumatic stress disorder’ (PTSD) symptoms.

Although typically it’s thought to relate to things which have happened in childhood and adolescence, research has also tied complex trauma to adult survivors of domestic abuse. Given how important neighbourhoods are for relationships, community, and (for adolescents especially) development and identity formation, I am curious whether a similar pattern of difficulties might emerge if people had repeated negative experiences of this kind within their neighbourhood. My project examines the impacts of neighbourhood violence and harassment using complex trauma framework, at both sub-clinical and clinical levels.

On a more personal note, I still feel incredibly anxious about specific places and cities due to negative experiences some years ago, but I had the privilege of moving elsewhere. For many people, especially those in social housing, this isn’t an option – with my research I wanted to highlight the significance of this to their mental health. Things that might seem like comparatively ‘low-level’ exposures, such as sexual harassment on your street, for example, have the capacity to cause significant harms when they are cumulative, particularly for those who have experienced other forms of trauma.

Why are neighbourhoods important for the health and wellbeing of women and girls?

A key reason why women and girls’ mental health is worse than male populations is that they are exposed to much higher levels of violence and abuse and are more likely to live in poverty. The focus in most research on the impact of neighbourhood violence tends to be on physical assault which disproportionately affects men who are much more likely to be physically assaulted by a stranger than women. For women, their highest risk of violence, including sexual violence is from an intimate partner.

However, women often experience the most fear about going out in their neighbourhoods, particularly after dark, and often avoid parks and other public spaces as a result. Although most women have not experienced physical or sexual assault perpetrated by a stranger, most have experienced forms of sexual harassment, and have been made to feel scared by the actions of others in neighbourhood spaces. I believe that there’s a huge research gap here – most of this trauma occurs at the sub-clinical level (i.e. women don’t tend to receive a PTSD diagnosis for being street-harassed), but can still have a huge impact on their mental health, how they feel in their neighbourhood, how they engage with their neighbourhood, and could lead to other mental health issues (such as depression, generalised anxiety disorder, and psychosis), all of which have social isolation as a risk factor.

How’s it going so far? What are your main tasks for this academic year?

It’s been really interesting putting this project together, and I’ve had to do lots of thinking and reading, which is such a joy in doing this as a PhD – having time for that! At the moment I’m trying to finish off a systematic review which looks at what the existing literature says about the impact of what I’ve called ‘persistent’ (i.e. happens more than once) exposure to neighbourhood violence. However, it’s slow progress, as there are more than 16,000 papers included, and most of them (even the ones I’ve included) don’t’ really look at what I’m interested in, because they tend to focus on mental health diagnosis. There’s more hope for some of the qualitative ones, particularly those which look at the specific experiences of marginalised groups such as women, LGBT+ people, people of colour, and disabled people – and I’m excited to synthesise some of those findings.

I’m incredibly fortunate in having just been awarded some Consortium Innovation Fund (CIF) money, through TRUUD (and UKPRP), which has boosted my ambitions for my final PhD project. I will work with public contributors (from Hartcliffe and Withywood in south Bristol) to explore different ways of mapping emotions to understand the impact of neighbourhood violence as a mental health determinant and evaluate the neighbourhood emotion maps that have been generated from this. I think emotions are key, because often emotions are significantly impacted by exposure to violence, abuse or harassment and go on to affect lots of other important health determinants, particularly emotions like fear. This is going to be my main focus, from now until the end of the PhD by Autumn 2025, and I’m really excited to get started with it.

Who do you hope will use the findings?

My systematic reviews revealed that health research tends to focus on residents’ formal diagnoses, with much of the interesting qualitative studies coming from sociology, anthropology and other disciplines. I’d like researchers to think in wider terms about how violence can impact people’s mental health and use non-diagnostic frameworks,such as complex trauma. I hope my work will influence this new way of thinking about neighbourhood violence.

The biggest impact I’d love to see from my PhD, is in how mental health services, social services, charities and other support agencies work with people in the community who are isolated and might be scared to leave their homes as a result of experiencing neighbourhood violence and harassment. I previously worked as a care-coordinator in a community mental health team, and a big part of our work was trying to get people, mostly women, back out into the community, after often long periods of being unable to leave their homes. However, the Cognitive Behavioural Therapy-based frameworks we were instructed to work within were often limited in a) their neglect of trauma, and b) their lack of specificity – if someone is anxious about leaving the house, this might not just be a symptom of ‘general’ anxiety, but about their experiences immediately outside their house. I would love to see the development of new evaluations of interventions that meet the needs of this particular population.