In Philadelphia, a striking number of Black men hospitalized for serious injuries experience post-traumatic stress disorder (PTSD) or depression in the months that follow. 

 A recent study by Penn LDI Senior Fellows Therese Richmond and Sara Jacoby, with Associate Fellow Augustine Cassis Obeng Boateng, explores how life events—including adverse childhood experiences (ACEs) and the areas where people grow up and live as adults—influence recovery outcomes after serious physical trauma. 

Drawing on existing data from more than 400 Black men hospitalized for injuries in the Philadelphia area, the researchers examined how self-reported ACEs and both perceived (i.e., subjective) and objective neighborhood characteristics were linked with health three months after hospital discharge. The study assessed post-injury PTSD and depression—as well as other outcomes, including sleep quality, self-reported health status, return to work, and changes in substance use. 

The researchers found that higher levels of ACEs and higher perceived neighborhood disorder—during both childhood and adulthood—were strong predictors of PTSD and depression symptom severity. Perceived neighborhood disorder also contributed to sleep disturbances and declines in post-injury health status. By contrast, objective indicators of neighborhood disadvantage, such as census tract and crime data, were not consistently associated with post-injury mental health outcomes.

This research underscores the need for programs and policies beyond the hospital doors that consider the patient’s early experiences and neighborhood perceptions as factors that shape recovery long before and after the experience of an injury itself.

Read our conversation with Senior Fellows Richmond and Jacoby below to learn more.

Why study how childhood trauma and neighborhoods affect recovery from injury?

Richmond and Jacoby: Recovery from traumatic injury is complex. One of the limitations in our field is that a physical injury is often treated as an isolated health and clinical event. We were motivated to look at the broader life course experiences that affect how individuals respond physically and psychologically to an injury event.

What is your most important finding on the link between trauma, environment, PTSD, and depression in Black men?

Richmond and Jacoby: We found that a greater number of ACEs, higher perceived neighborhood disorder in childhood and adulthood, injuries due to violence, more severe injuries, and poor pre-injury mental and physical health predicted PTSD symptom severity after injury. The findings were generally similar for post-injury depression severity.

We objectively measured neighborhood socioecological order or disorder (as opposed to participant perceptions) by overlaying sociodemographic census tract data and police-recorded-derived crime data onto the census tracts where men resided at the time of their injury. We also used historical census data to determine where men resided during adolescence. Surprisingly, the objective measures of disadvantage were not associated with post-injury PTSD and depression. However, perceptions of neighborhood disorder were associated with these outcomes. It may be that while more “objective” and quantifiable, the former kinds of socioecological data do not capture nuanced and situationally important understandings of the meaning of neighborhood life and its influence on injury recovery.

How was your trauma and recovery study designed, and what limitations should readers know about?

Richmond and Jacoby: This was a secondary analysis of a prospective cohort study of 414 men who self-identified as Black and had been hospitalized for a serious traumatic injury—about half from violence and half from unintentional (e.g., cars, falls) causes. We chose to reanalyze the data from the study because previous analyses had not considered the impact of ACEs and their interplay with the socioecological factors that surrounded participants in their childhood and adulthood. 

As with any secondary analysis, a limitation is that the original study was not specifically designed to answer the research questions we posed in this analysis. Broader limitations are that in this and the original study, the men who participated lived in the context of the greater Philadelphia metropolitan area and do not represent all urban-dwelling Black men who experience serious traumatic injuries. The original study also used the earliest validated version of the ACE scale, which, in more recent years, has been expanded to include a broader set of ACEs, including community-level stressors that might be applicable in settings like Philadelphia. There is, in fact, a Philadelphia ACE survey, but participants were not asked to respond to the expanded and specific ACE categories that it includes.

What policy changes could help Black men affected by ACEs and neighborhood disorder?

Richmond and Jacoby: Our findings reinforce the importance of interventions that prevent ACEs and injuries before they occur and that optimize recovery after injury. These results highlight the need to move beyond individual-level, clinical responses and toward upstream strategies that address the broader conditions shaping health—especially in communities historically impacted by structural racism and disinvestment. This work also emphasizes the criticality of policies and programs that focus on the drivers of socioecological disadvantage—for example, through investment in under- and disinvested urban environments, the promotion of safe and resourced neighborhood life, and the inclusion of community perspectives in shaping recovery supports.

What are the next steps in applying this research to improve recovery among Black men?

Richmond and Jacoby: We are working with individuals who reside and provide services in these communities not just to share our findings but to engage them in conceptualizing how these findings might alter current approaches to intervening to reduce ACEs, improve neighborhoods, and optimize injury recovery.

---

The study, “The Contribution of Adverse Childhood Experiences and Neighborhood Characteristics on Outcomes Experienced by Urban Dwelling Black Men After Serious Traumatic Injury,” was published on January 22, 2025, in the Journal of Urban Health. Authors include Therese S. Richmond, Ryan Quinn, Anna Duan, Christopher N. Morrison, Nancy Kassam-Adams, Augustine Cassis Obeng Boateng, and Sara F. Jacoby.

---

Author

---