Associations of Violence Exposure and Psychological Trauma with Healthcare Trust

Community and police violence are prevalent in the United States and are often associated with downstream psychosocial impacts. Although substantial research has documented the psychological impacts of violence, including trauma and post-traumatic stress disorder, fewer studies have explored potential associations with healthcare trust. Survey data were drawn from 504 adults residing in two epicenters of violent crime in Chicago, Illinois. We measured healthcare trust using the Healthcare Relationship (HCR) Trust Scale (11-55 points) and violence exposure using the Brief Trauma Questionnaire, which includes distinction between a traumatic and non-traumatic exposure. We modeled healthcare trust as a function of non-traumatic and traumatic exposures to violence, adjusting for sociodemographic characteristics. Overall, 71.03% of study participants were female, 74.60% were Black/African American, and mean age was 59.47. Median HCR Trust was 51 (interquartile range 14-55). We found that traumatic police stops for those with and without post-traumatic stress disorder were associated with a reduction in the respectful communication domain of healthcare trust, while non-traumatic police stops were not associated with healthcare trust. Other types of violence exposure (non-traumatic and traumatic) were not associated with healthcare trust in fully adjusted models, except for participants with PTSD who had traumatic community violence exposures. Our findings raise concern that psychological trauma could be an important contributor to the erosion of trust in healthcare institutions among patients.