Neighborhood-Level Factors in the Development and Treatment of Trauma and Stress-Related Disorders

Purpose of Review: Community- and neighborhood-level factors are important, but understudied, influences on trauma-related disorders and their treatment. In this review, we describe how neighborhood factors are evaluated including through aggregate measures, geospatially derived indices, and individual assessments. Recent Findings: Prior work suggests that neighborhood factors, particularly broadly defined neighborhood disadvantage, contribute to changes in threat-related neurobiology. Overall, neighborhood-level factors like community violence, access to greenspace, and air pollution levels, among others, are related to changes in brain development and potentially damaging differences in threat-related neurobiology including function and structure of the prefrontal cortex, amygdala, and hippocampus. These areas are also commonly dysregulated in trauma-related disorders, like PTSD, and are therefore intervention targets. Summary: We conclude by emphasizing why neighborhood factors should be included in treatment considerations as they may inhibit access and efficacy for their patients. Community disadvantages interact with trauma symptoms which may require more targeted treatment. Clinicians should be mindful of their own assumptions about treatment protocols, specifically when patients reside in disadvantaged neighborhoods or have other burdens that they must endure in addition to trauma-related symptoms. More work is needed on how neighborhood factors directly alter treatment trajectory and brain function. We implore future researchers and clinicians to further consider neighborhood factors in the treatment plans of their patients with trauma-related disorders.

Duke Scholars

Author Kate Webb Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...