Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 1;81(11):1090-1100.
doi: 10.1001/jamapsychiatry.2024.2148.

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

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

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

E Kate Webb et al. JAMA Psychiatry. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Webb reported receiving grants from Harvard Data Science Initiative Postdoctoral Fellow Research Fund, the National Institute of Mental Health (NIMH), and the Phyllis and Jerome Lyle Rappaport Mental Health Research Scholars Award during the conduct of the study. Dr Stevens reported receiving grants from the NIMH during the conduct of the study. Dr Lebois reported receiving grants from the NIMH and the Julia Kasparian Fund for Neuroscience Research outside the submitted work. Drs House, Beaudoin, and An reported receiving grants from the NIMH during the conduct of the study. Dr Germine reported having a financial interest in Intelerad Medical Systems outside the submitted work and membership on the board of directors of the Many Brains Project. Dr Rauch reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study; secretary fees from Society of Biol Psychiatry; royalties from Oxford University Press, American Psychiatric Publishing Inc, and Springer Publishing; advisory board fees from Community Psych/Mindpath Health and National Association of Behavioral Healthcare; and nonfinancial advisory service support from Anxiety and Depression Association of America and National Network of Depression Centers outside the submitted work. Dr Lewandowski reported receiving grants from the NIH during the conduct of the study. Dr Hendry reported receiving grants from the University of North Carolina–Chapel Hill/NIMH during the conduct of the study. Dr Jones reported receiving grants from the NIH during the conduct of the study. Dr Pascual reported receiving fees for multiple remaining medicolegal consultations. Dr Datner reported serving as a medical advisor and a member of the board of directors for Cayaba Care, an organization that provides services to underserved pregnant women. Dr Joormann reported receiving consultant fees from Janssen Pharmaceuticals outside the submitted work. Dr Pizzagalli reported receiving personal fees from Boehringer Ingelheim, Compass Pathways, Engrail Therapeutics, Neumora Therapeutics, Neurocrine Biosciences, Neuroscience Software, Otsuka Pharmaceuticals, Sage Therapeutics, and Takeda Pharmaceuticals; stock options from Compass Pathways, Engrail Therapeutics, Neumora Therapeutics, Neuroscience Software; and grants from Millennium Pharmaceuticals outside the submitted work. Dr Harte reported receiving grants from the NIH, Arbor Medical Innovations, Aptinyx; being a member of Arbor Medical Innovations; and personal fees from Memorial Sloan Kettering, Dana Farber Cancer Institute, Indian University, and Wayne State University outside the submitted work. Dr Kessler reported receiving consultant fees from Cambridge Health Alliance, Canandaigua VA Medical Center, Holmusk, Partners Healthcare, RallyPoint Networks, Sage Therapeutics; stock options from Cerebral, Mirah, PYM (Prepare Your Mind), Roga Sciences; and grants from the NIMH during the conduct of the study. Dr Ressler reported receiving consulting and/or advisory board fees from Jazz Pharmaceuticals, Sage Therapeutics, Senseye, Bionomics, and Boehringer Ingelheim outside the submitted work. Dr McLean reported receiving consulting fees from Walter Reed Army Institute for Research, Arbor Medical Innovations, and BioXcel Therapeutics outside the submitted work. Dr Harnett reported receiving grants from the NIMH and Brain Behavior Research Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Results of Latent-Class Mixed-Effect Modeling
The largest classes were the resilient (1318 [50.8%]), nonremitting moderate (734 [28.3%]), and nonremitting high (244 [9.4%]) trajectories, whereas the smallest classes were the delayed (108 [4.2%]), slow recovery (67 [2.6%]) and the rapid recovery (126 [4.9%]) groups. The solid black line represents the clinically significant cutoff for the Posttraumatic Stress Disorder Symptom Checklist for DSM-5 (total score = 32).
Figure 2.
Figure 2.. Association Between Neighborhood and Individual Resources and Posttraumatic Stress Disorder Trajectory Assignment
There was a significant association between greenspace and Connor-Davidson Resilience Scale (CD-RISC) scores on class assignment, such that individuals reporting higher levels of perceived internal resources with higher residential greenspace had an even greater likelihood of assignment in the resilient trajectory compared with the nonremitting high, nonremitting moderate, and slow recovery classes.
Figure 3.
Figure 3.. Greenspace and Neural Responses to Reward
Greater residential greenspace was associated with neural responses to reward in the amygdala (A) but not in the nucleus accumbens (B) or orbitofrontal cortex (C) after adjusting for sex at birth, Connor-Davidson Resilience Scale, Injury Severity Score, age, income, area deprivation index, marital status, Life Events Checklist for DSM-5, and childhood maltreatment. These are marginal effects plots depicting predicted values of neural responses across normalized difference vegetation index (NDVI) values (shaded line: 95% CIs for the marginal effects; data points: observed data; P values are Holm-Bonferroni adjusted. aAdjusted P < .05.
See this image and copyright information in PMC

References

    1. McLean SA, Ressler K, Koenen KC, et al. . The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Mol Psychiatry. 2020;25(2):283-296. doi:10.1038/s41380-019-0581-3 - DOI - PMC - PubMed
    1. Krieger N. Epidemiology and the People’s Health: Theory and Context. Oxford University Press; 2011. doi:10.1093/acprof:oso/9780195383874.001.0001 - DOI
    1. Denckla CA, Cicchetti D, Kubzansky LD, et al. . Psychological resilience: an update on definitions, a critical appraisal, and research recommendations. Eur J Psychotraumatol. 2020;11(1):1822064. doi:10.1080/20008198.2020.1822064 - DOI - PMC - PubMed
    1. Southwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda R. Resilience definitions, theory, and challenges: interdisciplinary perspectives. Eur J Psychotraumatol. 2014;5. doi:10.3402/ejpt.v5.25338 - DOI - PMC - PubMed
    1. Sippel L, Pietrzak R, Charney D, Mayes L, Southwick S. How does social support enhance resilience in the trauma-exposed individual? Ecol Soc. 2015;20(4):10. doi:10.5751/ES-07832-200410 - DOI