After Nasir Bari was shot in his chest and leg when he was 28, he saw the face of his shooter in everyone he passed on the street and in the grocery store.

“It’s him again,” Bari remembers thinking constantly.

The 2003 shooting was not the first nor last time Bari, who grew up in Oakland, California, confronted gun violence. At age 10, he saw a man who had been shot in the head and was lying on the ground. He lost friends and classmates to shootings. Decades later in 2019, Bari was driving when someone pulled up alongside him and began firing.

Amid all of the tragedy, he says he never had a place to go with the fear and sadness he dealt with daily. He’s also seen the same stress, trauma and paranoia that keep him from getting a full night’s rest in younger generations, especially men and teenage boys.

“In the hood, you don’t discuss being scared,” Bari, now 49, said. “But as a youngster, you’re consumed with these thoughts at all times. You’re playing these scenarios in your head day to day. Mentally, you’re a wreck.”

This has tremendous effects on the mental health of Black adults, new research shows.

Direct and indirect exposures to gun violence, like hearing gunshots near the home or the slaying of friends or classmates, can lead to “lifetime suicidal ideation and behavior” among Black adults, a February study conducted by researchers from Rutgers University and published in Jama Network Open, a journal from the American Medical Association, shows.

“Gun violence exposure, whether direct or living in a community where it happens, has implications for long-term stress and trauma,” said Daniel Semenza, the study’s lead researcher. “It does damage to some of the body’s most important systems.”

Suicide deaths in the US have steadily risen in the past two decades. Most of these deaths are by gun. Suicide deaths increased from 30,622 in 2001 to a peak of 48,344 in 2018, according to the US Centers for Disease Control and Prevention. They took a brief dip in 2019 and 2020 before nearly returning to their peak, with 48,183 deaths in 2021, the last year for which the CDC has released data.

Amid the recent ebbs and flows, the demographics of those who die from suicide have been changing. Native American people and white men still have higher suicide rates than any other racial and ethnic groups, but from 2018 to 2021, the rates among Black and Latino people rose by 19% and 6% respectively, according to the CDC. Among Black people, the most alarming increase was among 10- to 24-year-olds.

Semenza’s study is based on a survey of 3,015 Black adults aged 18 to 94. Black people are at high risk of experiencing multiple exposures to gun violence, which increases their risk of suicidal behaviors. For example, 12% of people in the study’s sample experienced three or more types of gun violence exposures. People who had been threatened with a gun or knew someone who had been shot and killed were most likely to have suicidal ideations and make attempts. Those who had been shot and survived reported making plans to take their life, the study says. “It’s the cumulative impact that’s important,” Semenza added.

He worked alongside three suicidologists on the study and emphasizes that his work does not show a causal relationship between exposure to gun violence and suicidal thoughts and actions, but hopes it can serve as a starting point on research into the topic.

“This signals that there are twin threats: interpersonal violence and the risk of self-directed violence,” he said. “Hurt people may be more likely to hurt themselves.”

Paris Davis is a violence-prevention worker with the Oakland non-profit Youth Alive, which offers programs for young gunshot wound survivors. Davis was shot in 2017 and has lost friends to suicide. Now, he’s helping Youth Alive to develop healing and therapeutic spaces that can educate people on how trauma affects their minds and bodies.

“Community violence has a different effect on all of us,” said Davis. “It takes a huge toll, and its indirect impact on communities is under-researched.”

Youth Alive runs one of the nation’s oldest hospital-based violence-intervention programs, which has staffers sit at the bedsides of people who have been shot and talk to them about what they need. In these settings, Davis said, he has seen people struggle with thoughts of suicide that only worsen over time if people don’t have someone to talk to about their fear and sadness.

“We have people caught in the crossfire walking down the street and now they’re paralyzed. How do you support that person?” he asked. “They’re already exposed to a lot of structural violence and then you add community violence and it’s overwhelming.”

Bari wasn’t injured in the 2019 shooting but says it provided the push he needed to sever himself from the life he was living in the streets. He now also works as a violence interrupter for Youth Alive and connects with gunshot wound survivors in the hospital, parents at their children’s murder scenes and those at the center of Oakland’s cycle of violence.

Although his work is often emotionally triggering – he says he’ll never forget the scream that came from a woman once she realized her teenage son had been shot and killed – he’s also found ways to manage those feelings before they push him back into the dark place he was in after being shot two decades ago.

“I feel like I’m an expert now,” said Bari, who has done at least a dozen hospital calls in his two years with Youth Alive. “With depression, I can give them my methods of dealing with it. My methods are what I needed. I tell them what I wish I would have heard.”

Semenza says that he and other scholars who approach gun violence through the lens of public health rather than criminology are trying to make up for nearly two decades of time lost to a freeze on CDC research funding. Since the ban on funding was lifted in 2018, knowledge of how exposure to gun violence puts people at higher risk of depression and substance abuse disorder has grown.

Eventually, he hopes to look at larger sample sizes that include Latino and Native American communities and understand how the work that people like Davis and Bari are doing affects survivors. All of this, he hopes, will lead to a better approach to the specific mental health challenges that gun violence can create and exacerbate.

“This is not just about a couple of places and a couple of cities. This is happening on a regular basis in every city in the US,” Semenza said of gun violence exposures. “This groundswell of research goes beyond one individual. It’s about combining evidence-based interventions. The programs can work but they have to be done right.”