Richmond Therese S, Quinn Ryan, Duan Anna, Morrison Christopher N, Kassam-Adams Nancy, Boateng Augustine Cassis Obeng, Jacoby Sara F
School of Nursing, University of Pennsylvania, 418 Curie Blvd, Fagin Hall 330, Philadelphia, PA, 19104, USA.
Penn Injury Science Center, University of Pennsylvania, Philadelphia, USA.
J Urban Health. 2025 Feb;102(1):165-176. doi: 10.1007/s11524-024-00956-7. Epub 2025 Jan 22.
Depression and post-traumatic stress disorder (PTSD) are serious consequences of physical injuries. Stress associated with living in urban neighborhoods with socioecological disadvantages and the cumulative burdens of adverse childhood experiences (ACEs) can lead to poorer psychological outcomes. Limited research has explored how ACEs and socioecological environmental exposures in childhood and adulthood, together, impact post-injury outcomes. This study assessed the relative contributions of ACEs and neighborhood exposures during childhood and adulthood on post-injury outcomes among Black men in Philadelphia. We used data from a prospective cohort of 414 Black men from the Philadelphia region, aged ≥ 18 years, who sustained acute physical injuries requiring hospitalization. Primary outcomes were post-injury PTSD and depression. Secondary outcomes were sleep quality, self-reported health status, changes in substance use, and return to work. The study used perceived and objective measures of neighborhood characteristics and self-reported ACEs to model their relative impact on outcomes 3 months after hospital discharge. Higher levels of ACEs and higher perceived neighborhood disorder during childhood and adulthood were significant predictors of PTSD and depression symptom severity. Perceived neighborhood disorder contributed to sleep disturbances and decline in post-injury health. Census/administrative objective measures of neighborhood disadvantage did not show consistent associations with post-injury outcomes. Findings suggest that both ACEs and subjective perception of neighborhood environments are critical factors influencing post-injury recovery in urban Black men. Interventions to improve post-injury outcomes should consider preventing ACEs and addressing the tangible conditions of neighborhoods and residents' perceptions of their surroundings to promote health equity and injury recovery.
抑郁症和创伤后应激障碍（PTSD）是身体损伤的严重后果。生活在具有社会生态劣势的城市社区所带来的压力以及童年不良经历（ACEs）的累积负担可能导致更差的心理结果。有限的研究探讨了童年和成年期的ACEs与社会生态环境暴露如何共同影响受伤后的结果。本研究评估了童年和成年期的ACEs以及社区暴露对费城黑人男性受伤后结果的相对贡献。我们使用了来自费城地区414名年龄≥18岁的黑人男性前瞻性队列的数据，这些男性遭受了需要住院治疗的急性身体损伤。主要结果是受伤后的PTSD和抑郁症。次要结果是睡眠质量、自我报告的健康状况、物质使用的变化以及重返工作岗位。该研究使用了对社区特征的感知和客观测量以及自我报告的ACEs来模拟它们对出院后3个月结果的相对影响。童年和成年期较高水平的ACEs以及较高的社区无序感知是PTSD和抑郁症状严重程度的重要预测因素。社区无序感知导致睡眠障碍和受伤后健康状况下降。人口普查/行政层面的社区劣势客观测量结果与受伤后结果没有一致的关联。研究结果表明，ACEs和对社区环境的主观感知都是影响城市黑人男性受伤后恢复的关键因素。改善受伤后结果的干预措施应考虑预防ACEs，并解决社区的实际状况以及居民对周围环境的感知，以促进健康公平和受伤恢复。
