Background Traumatic injury is not evenly distributed across race and class in America. Black men are marginalized in society, often live in disadvantaged neighborhoods, and are at higher risk for injury mortality and ongoing physical and psychological problems following injury, including post-traumatic stress disorder (PTSD) and depression. While much research has examined individual factors associated with increased post-injury psychological symptoms, the contribution of the social and physical environment has been relatively-understudied.
Purpose The purpose was to examine the contribution of neighborhood characteristics to PTSD and depressive symptom severity in Black men following serious injury.
Methods A secondary analysis of 451 seriously injured men living in Philadelphia were drawn from a prospective cohort study. Study participants were linked by a geographic information system (GIS) to characteristics in their neighborhood in order to spatially model the factors that contribute to increased psychological symptom severity at 3 months post-injury. Factor analysis identified underlying constructs of 32 neighborhood predictors, which were entered in a generalized estimating equation (GEE) regression analysis. Covariates included mechanism of injury, severity of injury, age, and health insurance.
Results Neighborhood characteristics loaded onto 4 constructs: neighborhood disconnectedness; concentrated disadvantage; crime, violence, and vacancy; and race/ethnicity. Higher PTSD symptom severity was reported by 36.8% and associated with neighborhood crime, violence, and vacancy, and higher depressive symptom severity was reported by 30.4% and associated with neighborhood disconnectedness. Both PTSD and depressive symptoms were associated with intentional mechanisms of injury, such as gunshot wounds, stabbing, and assault; and with having Medicaid or no insurance. Higher severity of injury was associated with depressive symptoms.
Conclusions Findings suggest that neighborhood characteristics such as neighborhood disconnectedness and crime, violence, and vacancy have measurable associations with psychological symptoms after injury. The evidence supports the need for interventions to improve post-injury mental health by modifying the urban environment.
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