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

description: <p>Importance: Research 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). Objective: To 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 Participants: As 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. Exposures: Residential 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 Measures: PTSD 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). Results: In 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&thinsp;=&thinsp;-3.92; P&thinsp;&lt;&thinsp;.001), nonremitting moderate (Wald z test&thinsp;=&thinsp;-2.24; P&thinsp;=&thinsp;.03), or slow recovery (Wald z test&thinsp;=&thinsp;-2.27; P&thinsp;=&thinsp;.02) classes. Greenspace was also associated with greater neural reactivity to reward in the amygdala (n&thinsp;=&thinsp;288; t277&thinsp;=&thinsp;2.83; adjusted P value&thinsp;=&thinsp;0.02); however, reward reactivity did not differ by PTSD trajectory. Conclusions and Relevance: In 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.</p>