Neighborhood Resources Associated With Psychological Trajectories and Neural Reactivity to Reward After Trauma

Published in JAMA Psychiatry. Here is a link to the article.

Regenstrief Institute authors: Paul I. Musey, M.D., M.S.

Abstract
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 = -3.92; P < .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 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.

Authors:

E Kate Webb ^1 2, Jennifer S Stevens ³, Timothy D Ely ³, Lauren A M Lebois ^1 2, Sanne J H van Rooij ³, Steven E Bruce ⁴, Stacey L House ⁵, Francesca L Beaudoin ^6 7, Xinming An ⁸, Thomas C Neylan ⁹, Gari D Clifford ^10 11, Sarah D Linnstaedt ⁸, Laura T Germine ^1 12 13, Kenneth A Bollen ^14 15, Scott L Rauch ^1 12 16, John P Haran ¹⁷, Alan B Storrow ¹⁸, Christopher Lewandowski ¹⁹, Paul I Musey Jr ²⁰, Phyllis L Hendry ²¹, Sophia Sheikh ²¹, Christopher W Jones ²², Brittany E Punches ^23 24, Robert A Swor ²⁵, Vishnu P Murty ²⁶, Lauren A Hudak ²⁷, Jose L Pascual ^28 29, Mark J Seamon ^29 30, Elizabeth M Datner ^31 32, Claire Pearson ³³, David A Peak ³⁴, Robert M Domeier ³⁵, Niels K Rathlev ³⁶, Brian J O’Neil ³⁷, Paulina Sergot ³⁸, Leon D Sanchez ^39 40, Jutta Joormann ⁴¹, Diego A Pizzagalli ^1 2, Steven E Harte ^42 43, Ronald C Kessler ⁴⁴, Karestan C Koenen ⁴⁵, Kerry J Ressler ^1 2, Samuel A McLean ^46 47, Nathaniel G Harnett ^1 2

Affiliations

¹Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

²Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts.

³Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.

⁴Department of Psychological Sciences, University of Missouri-St Louis, St Louis.

⁵Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri.

⁶Department of Epidemiology, Brown University, Providence, Rhode Island.

⁷Department of Emergency Medicine, Brown University, Providence, Rhode Island.

⁸Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill.

⁹Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco.

¹⁰Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia.

¹¹Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta.

¹²Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.

¹³The Many Brains Project, Belmont, Massachusetts.

¹⁴Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill.

¹⁵Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill.

¹⁶Department of Psychiatry, McLean Hospital, Belmont, Massachusetts.

¹⁷Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester.

¹⁸Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

¹⁹Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.

²⁰Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis.

²¹Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville.

²²Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey.

²³Department of Emergency Medicine, Ohio State University College of Medicine, Columbus.

²⁴Ohio State University College of Nursing, Columbus.

²⁵Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan.

²⁶Department of Psychology, Temple University, Philadelphia, Pennsylvania.

²⁷Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.

²⁸Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia.

²⁹Perelman School of Medicine, University of Pennsylvania, Philadelphia.

³⁰Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia.

³¹Department of Emergency Medicine, Jefferson Einstein Hospital, Jefferson Health, Philadelphia, Pennsylvania.

³²Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

³³Department of Emergency Medicine, Wayne State University, Ascension St John Hospital, Detroit, Michigan.

³⁴Department of Emergency Medicine, Massachusetts General Hospital, Boston.

³⁵Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, Michigan.

³⁶Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield.

³⁷Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, Michigan.

³⁸Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas.

³⁹Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.

⁴⁰Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.

⁴¹Department of Psychology, Yale University, New Haven, Connecticut.

⁴²Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.

⁴³Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor.

⁴⁴Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.

⁴⁵Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.

⁴⁶Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill.

⁴⁷Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill.