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The Contribution of Neighborhood Characteristics to Psychological Symptom Severity in a Cohort of Injured Black Men

Journal of Racial and Ethnic Health Disparities (2022)Cite this article

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.

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References

  1. World Health Organization, World health statistics 2015. 2015: World Health Organization.

  2. Centers for Disease Control. Web-based Injury Statistics Query and Reporting System (WISQARS)[Online].(2015) National Center for Injury Prevention and Control, CDC (producer). 2020.

  3. Rhee P, et al. Increasing trauma deaths in the United States. Ann Surg. 2014;260(1):13–21.

    Article  PubMed  Google Scholar 

  4. Celso B, et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma Acute Care Surg. 2006;60(2):371–8.

    Article  Google Scholar 

  5. Ashley DW, et al. An analysis of the effectiveness of a state trauma system: treatment at designated trauma centers is associated with an increased probability of survival. J Trauma Acute Care Surg. 2015;78(4):706–14.

    Article  PubMed  Google Scholar 

  6. Bell TM, Vetor AN, Zarzaur BL. Prevalence and treatment of depression and posttraumatic stress disorder among trauma patients with non-neurological injuries. j trauma acute care surg. 2018;85(5):999.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wiseman TA, et al. Incidence of depression, anxiety and stress following traumatic injury: a longitudinal study. Scand j trauma, resuscitation emerg med. 2015;23(1):1–9.

    Article  Google Scholar 

  8. Richmond TS, et al. The effect of post-injury depression on return to pre-injury function: a prospective cohort study. Psychol Med. 2009;39(10):1709.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Vles WJ, et al. Prevalence and determinants of disabilities and return to work after major trauma. J Trauma Acute Care Surg. 2005;58(1):126–35.

    Article  Google Scholar 

  10. Jacoby SF, Shults J, Richmond TS. The effect of early psychological symptom severity on long-term functional recovery: a secondary analysis of data from a cohort study of minor injury patients. Int J Nurs Stud. 2017;65:54–61.

    Article  PubMed  Google Scholar 

  11. Alim TN, et al. Trauma, resilience, and recovery in a high-risk African-American population. Am J Psychiatry. 2008;165(12):1566–75.

    Article  PubMed  Google Scholar 

  12. Roberts AL, et al. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med. 2011;41(1):71.

    Article  CAS  PubMed  Google Scholar 

  13. Krieger N. Methods for the scientific study of discrimination and health: an ecosocial approach. Am J Public Health. 2012;102(5):936–44.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mair C, Roux AD, Galea S. Are neighbourhood characteristics associated with depressive symptoms? A review of evidence. J Epidemiol Community Health. 2008;62(11):940–6.

    CAS  PubMed  Google Scholar 

  15. Galea S, et al. Urban built environment and depression: a multilevel analysis. J Epidemiol Community Health. 2005;59(10):822–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Van den Berg AE, et al. Green space as a buffer between stressful life events and health. Soc Sci Med. 2010;70(8):1203–10.

    Article  PubMed  Google Scholar 

  17. Kubzansky LD, et al. Neighborhood contextual influences on depressive symptoms in the elderly. Am J Epidemiol. 2005;162(3):253–60.

    Article  PubMed  Google Scholar 

  18. Echeverría S, et al. Associations of neighborhood problems and neighborhood social cohesion with mental health and health behaviors: the Multi-Ethnic Study of Atherosclerosis. Health Place. 2008;14(4):853–65.

    Article  PubMed  Google Scholar 

  19. Fone D, et al. Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis. Int J Epidemiol. 2007;36(2):338–45.

    Article  PubMed  Google Scholar 

  20. Garvin E, et al. More than just an eyesore: local insights and solutions on vacant land and urban health. J Urban Health. 2013;90(3):412–26.

    Article  PubMed  Google Scholar 

  21. Geronimus AT. The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethn Dis. 1992;2(3):207–21.

    CAS  PubMed  Google Scholar 

  22. Stafford M, Chandola T, Marmot M. Association between fear of crime and mental health and physical functioning. Am J Public Health. 2007;97(11):2076–81.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Diez Roux AV, Mair C. Neighborhoods and health. 2010.

  24. Simons RL, et al. Discrimination, segregation, and chronic inflammation: testing the weathering explanation for the poor health of Black Americans. Dev Psychol. 2018;54(10):1993.

    Article  PubMed  PubMed Central  Google Scholar 

  25. White K, Borrell LN. Racial/ethnic residential segregation: framing the context of health risk and health disparities. Health Place. 2011;17(2):438–48.

    Article  PubMed  Google Scholar 

  26. Williams DR, Mohammed SA. Racism and health I: pathways and scientific evidence. Am Behav Sci. 2013;57(8):1152–73.

    Article  Google Scholar 

  27. Bailey ZD, et al. Structural racism and health inequities in the USA: evidence and interventions. The Lancet. 2017;389(10077):1453–63.

    Article  Google Scholar 

  28. Acevedo-Garcia D, et al. Future directions in residential segregation and health research: a multilevel approach. Am J Public Health. 2003;93(2):215–21.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Blevins CA, et al. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–98.

    Article  PubMed  Google Scholar 

  30. Rush AJ, et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiat. 2003;54(5):573–83.

    Article  PubMed  Google Scholar 

  31. Baker SP, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma Acute Care Surg. 1974;14(3):187–96.

    Article  CAS  Google Scholar 

  32. Centers for Disease Control. Recommended framework for E-code groupings for presenting mortality and morbidity data. 2008.

  33. Harman HH. Modern factor analysis. 1976: University of Chicago press.

  34. Akaike H. Factor analysis and AIC. In: Selected papers of hirotugu akaike. Springer; 1987. p. 371–86.

    Chapter  Google Scholar 

  35. Shults, J. and J.M. Hilbe, Quasi-least squares regression. 2014: CRC Press.

  36. Li H, Calder CA, Cressie N. Beyond Moran’s I: testing for spatial dependence based on the spatial autoregressive model. Geogr Anal. 2007;39(4):357–75.

    Article  Google Scholar 

  37. Lowe S, et al. Pathways from assaultive violence to post-traumatic stress, depression, and generalized anxiety symptoms through stressful life events: longitudinal mediation models. Psychol Med. 2017;47(14):2556–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Love J, Zatzick D. Screening and intervention for comorbid substance disorders, PTSD, depression, and suicide: a trauma center survey. Psychiatr Serv. 2014;65(7):918–23.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hillier AE. Redlining and the home owners’ loan corporation. J Urban Hist. 2003;29(4):394–420.

    Article  Google Scholar 

  40. Jacoby SF, et al. The enduring impact of historical and structural racism on urban violence in Philadelphia. Soc Sci Med. 2018;199:87–95.

    Article  PubMed  Google Scholar 

  41. Gee GC. A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Am j public health. 2008;98(Supplement_1):S48–56.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Houle JN, Light MT. The home foreclosure crisis and rising suicide rates, 2005 to 2010. Am J Public Health. 2014;104(6):1073–9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Libman K, Fields D, Saegert S. Housing and health: a social ecological perspective on the US foreclosure crisis. Hous Theory Soc. 2012;29(1):1–24.

    Article  Google Scholar 

  44. Warner C. On the move: incarceration, race, and residential mobility. Soc Sci Res. 2015;52:451–64.

    Article  PubMed  Google Scholar 

  45. Clear TR. Effects of high imprisonment rates on communities from crime and justice: a review of research, Volume 37, P 97–132, 2008, Michael Tonry, ed.-See NCJ-242161. 2008.

  46. Gibbons J, Barton MS, Reling TT. Do gentrifying neighbourhoods have less community? Evidence from Philadelphia. Urban Stud. 2020;57(6):1143–63.

    Article  Google Scholar 

  47. Ding L, Hwang J, Divringi E. Gentrification and residential mobility in Philadelphia. Reg Sci Urban Econ. 2016;61:38–51.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Marcuse P. Gentrification, abandonment, and displacement: connections, causes, and policy responses in New York City. Wash UJ Urb & Contemp L. 1985;28:195.

    Google Scholar 

  49. Flowerdew R, Manley DJ, Sabel CE. Neighbourhood effects on health: does it matter where you draw the boundaries? Soc Sci Med. 2008;66(6):1241–55.

    Article  PubMed  Google Scholar 

  50. Chaix B, et al. Neighbourhoods in eco-epidemiologic research: delimiting personal exposure areas. A response to Riva, Gauvin Apparicio and Brodeur. Soc sci med. 2009;69(9):1306–10.

    Article  PubMed  Google Scholar 

  51. Sampson RJ, Morenoff JD. Ecological perspectives on the neighborhood context of urban poverty: past and present. Neighborhood poverty. 1997;2:1–22.

    Google Scholar 

  52. Weden MM, Carpiano RM, Robert SA. Subjective and objective neighborhood characteristics and adult health. Soc Sci Med. 2008;66(6):1256–70.

    Article  PubMed  Google Scholar 

  53. Gong Y, et al. A systematic review of the relationship between objective measurements of the urban environment and psychological distress. Environ Int. 2016;96:48–57.

    Article  PubMed  Google Scholar 

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Funding

Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR013503 (PI: Richmond), the Office of Nursing Research (ONR) at the University of Pennsylvania School of Nursing, and the Hillman Scholars in Nursing Innovation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. University of Pennsylvania School of Nursing, Claire Fagin Hall, Room 418 Curie Blvd, Philadelphia, PA, 19104, USA

    Marta M. Bruce, Andrew J. Robinson & Therese S. Richmond

  2. Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Marta M. Bruce

  3. Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA

    Douglas J. Wiebe & Justine Shults

  4. Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Douglas J. Wiebe & Therese S. Richmond

Authors
  1. Marta M. Bruce
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  2. Andrew J. Robinson
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  3. Douglas J. Wiebe
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  4. Justine Shults
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  5. Therese S. Richmond
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Contributions

All authors contributed to the study conception and design. Dr. Bruce and Dr. Richmond conceptualized the study and acquired data for the study. Mr. Robinson oversaw data management and initial coding of data. Dr. Bruce analyzed data under the supervision of Dr. Richmond, Dr. Wiebe, and Dr. Shults. Dr. Bruce wrote the original draft of this manuscript. All authors reviewed, edited, and approved the final manuscript.

Corresponding author

Correspondence to Therese S. Richmond.

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Ethics Approval

This manuscript presents findings from a study approved by the University of Pennsylvania IRB.

Consent to Participate

Written informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

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Bruce, M.M., Robinson, A.J., Wiebe, D.J. et al. The Contribution of Neighborhood Characteristics to Psychological Symptom Severity in a Cohort of Injured Black Men. J. Racial and Ethnic Health Disparities (2022). https://doi.org/10.1007/s40615-022-01407-2

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  • DOI: https://doi.org/10.1007/s40615-022-01407-2