Marta M Bruce1,2, Andrew J Robinson1, Douglas J Wiebe3,4, Justine Shults3, Therese S Richmond5,6. 1. University of Pennsylvania School of Nursing, Claire Fagin Hall, Room 418 Curie Blvd, Philadelphia, PA, 19104, USA. 2. Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA. 3. Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA. 4. Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, 19104, USA. 5. University of Pennsylvania School of Nursing, Claire Fagin Hall, Room 418 Curie Blvd, Philadelphia, PA, 19104, USA. terryr@nursing.upenn.edu. 6. Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, 19104, USA. terryr@nursing.upenn.edu.
Abstract
BACKGROUND: Traumatic injury is not evenly distributed by race and class in the USA. Black men are marginalized in the society, often reside in disadvantaged neighborhoods, and are at higher risk for injury mortality and ongoing physical and psychological problems following injury. Post-traumatic stress disorder (PTSD) and depressive symptom severity are among several problematic and disabling conditions faced by injury survivors. While much research has examined individual factors that lead to increased post-injury psychological symptom severity, the contribution of the social and physical environment has been relatively understudied. OBJECTIVE: To examine the contribution of neighborhood characteristics to PTSD and depressive symptom severity in Black men following traumatic injury. DESIGN: Prospective cohort study. Participant data were linked via GIS to neighborhood characteristics (constructs established by factor analysis) to spatially model factors associated with increased post-injury psychological symptom severity using a GEE regression analysis, adjusting for injury mechanism and severity, age, and insurance. PARTICIPANTS: Four hundred fifty-one adult Black males hospitalized for traumatic injury. RESULTS: The 4 constructs were neighborhood disconnectedness, concentrated disadvantage/deprivation, crime/violence/vacancy, and race/ethnicity. High depressive and PTSD symptom severity was reported by 36.8% and 30.4% of participants, respectively. Higher PTSD symptom severity was associated with crime/violence/vacancy, and higher depressive symptom severity was associated with neighborhood disconnectedness. PTSD and depressive symptom severity were associated with intentional injury mechanisms and Medicaid/no insurance. Higher injury severity was associated with depressive symptoms. CONCLUSION: Neighborhood characteristics are associated with psychological symptom severity after injury.
BACKGROUND: Traumatic injury is not evenly distributed by race and class in the USA. Black men are marginalized in the society, often reside in disadvantaged neighborhoods, and are at higher risk for injury mortality and ongoing physical and psychological problems following injury. Post-traumatic stress disorder (PTSD) and depressive symptom severity are among several problematic and disabling conditions faced by injury survivors. While much research has examined individual factors that lead to increased post-injury psychological symptom severity, the contribution of the social and physical environment has been relatively understudied. OBJECTIVE: To examine the contribution of neighborhood characteristics to PTSD and depressive symptom severity in Black men following traumatic injury. DESIGN: Prospective cohort study. Participant data were linked via GIS to neighborhood characteristics (constructs established by factor analysis) to spatially model factors associated with increased post-injury psychological symptom severity using a GEE regression analysis, adjusting for injury mechanism and severity, age, and insurance. PARTICIPANTS: Four hundred fifty-one adult Black males hospitalized for traumatic injury. RESULTS: The 4 constructs were neighborhood disconnectedness, concentrated disadvantage/deprivation, crime/violence/vacancy, and race/ethnicity. High depressive and PTSD symptom severity was reported by 36.8% and 30.4% of participants, respectively. Higher PTSD symptom severity was associated with crime/violence/vacancy, and higher depressive symptom severity was associated with neighborhood disconnectedness. PTSD and depressive symptom severity were associated with intentional injury mechanisms and Medicaid/no insurance. Higher injury severity was associated with depressive symptoms. CONCLUSION: Neighborhood characteristics are associated with psychological symptom severity after injury.
Authors: Dennis W Ashley; Etienne E Pracht; Regina S Medeiros; Elizabeth V Atkins; Elizabeth G NeSmith; Tracy J Johns; Jeffrey M Nicholas Journal: J Trauma Acute Care Surg Date: 2015-04 Impact factor: 3.313
Authors: Tanya N Alim; Adriana Feder; Ruth Elaine Graves; Yanping Wang; James Weaver; Maren Westphal; Angelique Alonso; Notalelomwan U Aigbogun; Bruce W Smith; John T Doucette; Thomas A Mellman; William B Lawson; Dennis S Charney Journal: Am J Psychiatry Date: 2008-11-17 Impact factor: 18.112
Authors: T S Richmond; J D Amsterdam; W Guo; T Ackerson; V Gracias; K M Robinson; J E Hollander Journal: Psychol Med Date: 2009-03-02 Impact factor: 7.723