Neighborhood characteristics, trauma, and the risk of post-traumatic stress disorder in New York City

Purpose Neighborhood characteristics have been associated with morbidity and mortality in multiple studies; however, there is relatively little work on the relation between neighborhood characteristics and mental health. We assessed the longitudinal relation between neighborhood characteristics and the risk of traumatic event experiences and post-traumatic stress disorder (PTSD) in 59 neighborhoods in New York City. Methods We used data from a representative population cohort study (with three assessments) that followed residents of New York City by telephone between March 2002 and September 2003. The neighborhood characteristics were: median income, income distribution, environmental disorder, quality of housing, and neighborhood violence. We used five separate multilevel generalized estimating equation (GEE) models to assess the relations between neighborhood characteristics and PTSD. Results 1570 New York City residents were recruited in the cohort at baseline, and 1355 could be matched to their neighborhood of residence. Of these, 1120 (79.8%) completed at least two of the three interviews and provided the 3034 person-visits that were included in the analysis (female, 55.6%; white, 38.1%; African American, 25.1%; Latino, 26.0%; mean age, 41.7). Living in neighborhoods characterized by low income (P = 0.003), income inequality (P = 0.008), environmental disorder (P = 0.002), deteriorated housing (P = 0.03), and neighborhood violence (P = 0.009) was associated with risk of PTSD in multivariable models adjusting for individual traumatic event exposure, and ongoing stressors. After also adjusting for individual-level characteristics and social resources, only income inequality (P = 0.02) was still associated with risk of PTSD. Conclusion Characteristics of neighborhoods may increase the risk of PTSD independent of the risk of recurrent trauma. Other mechanisms (e.g., increased vulnerability to traumas) may be important in explaining the relation between neighborhood characteristics and PTSD. Individual-level factors, such as social support and race or ethnicity, which may affect vulnerability, likely mediate the relation between neighborhood characteristics and PTSD.