Neighborhood Resources Associated With Psychological Trajectories and Neural Reactivity to Reward After Trauma
Authors: Webb E. Kate , Stevens Jennifer S. , Ely Timothy D. , Lebois Lauren A. M. , van Rooij Sanne J H. , Bruce Steven E. , House Stacey L. , Beaudoin Francesca L. , An Xinming , Neylan Thomas C. , Clifford Gari D. , Linnstaedt Sarah D. , Germine Laura T. , Bollen Kenneth A. , Rauch Scott L. , Haran John P. , Storrow Alan B. , Lewandowski Christopher , Musey Paul I. , Hendry Phyllis L. , Sheikh Sophia , Jones Christopher W. , Punches Brittany E. , Swor Robert A. , Murty Vishnu P. , Hudak Lauren A. , Pascual Jose L. , Seamon Mark J. , Datner Elizabeth M. , Pearson Claire , Peak David A. , Domeier Robert M. , Rathlev Niels K. , O’Neil Brian J. , Sergot Paulina , Sanchez Leon D. , Joormann Jutta , Pizzagalli Diego A. , Harte Steven E. , Kessler Ronald C. , Koenen Karestan C. , Ressler Kerry J. , McLean Samuel A. , Harnett Nathaniel G. 
Published: July 2024

ImportanceResearch on resilience after trauma has often focused on individual-level factors (eg, ability to cope with adversity) and overlooked influential neighborhood-level factors that may help mitigate the development of posttraumatic stress disorder (PTSD).ObjectiveTo investigate whether an interaction between residential greenspace and self-reported individual resources was associated with a resilient PTSD trajectory (ie, low/no symptoms) and to test if the association between greenspace and PTSD trajectory was mediated by neural reactivity to reward.Design, Setting, and ParticipantsAs part of a longitudinal cohort study, trauma survivors were recruited from emergency departments across the US. Two weeks after trauma, a subset of participants underwent functional magnetic resonance imaging during a monetary reward task. Study data were analyzed from January to November 2023.ExposuresResidential greenspace within a 100-m buffer of each participant’s home address was derived from satellite imagery and quantified using the Normalized Difference Vegetation Index and perceived individual resources measured by the Connor-Davidson Resilience Scale (CD-RISC).Main Outcome and MeasuresPTSD symptom severity measured at 2 weeks, 8 weeks, 3 months, and 6 months after trauma. Neural responses to monetary reward in reward-related regions (ie, amygdala, nucleus accumbens, orbitofrontal cortex) was a secondary outcome. Covariates included both geocoded (eg, area deprivation index) and self-reported characteristics (eg, childhood maltreatment, income).ResultsIn 2597 trauma survivors (mean [SD] age, 36.5 [13.4] years; 1637 female [63%]; 1304 non-Hispanic Black [50.2%], 289 Hispanic [11.1%], 901 non-Hispanic White [34.7%], 93 non-Hispanic other race [3.6%], and 10 missing/unreported [0.4%]), 6 PTSD trajectories (resilient, nonremitting high, nonremitting moderate, slow recovery, rapid recovery, delayed) were identified through latent-class mixed-effect modeling. Multinominal logistic regressions revealed that for individuals with higher CD-RISC scores, greenspace was associated with a greater likelihood of assignment in a resilient trajectory compared with nonremitting high (Wald z test = −3.92; P &amp;lt; .001), nonremitting moderate (Wald z test = −2.24; P = .03), or slow recovery (Wald z test = −2.27; P = .02) classes. Greenspace was also associated with greater neural reactivity to reward in the amygdala (n = 288; t277 = 2.83; adjusted P value = 0.02); however, reward reactivity did not differ by PTSD trajectory.Conclusions and RelevanceIn this cohort study, greenspace and self-reported individual resources were significantly associated with PTSD trajectories. These findings suggest that factors at multiple ecological levels may contribute to the likelihood of resiliency to PTSD after trauma.