Traumatic Events, Neighborhood Conditions, and Changes in Depression Severity among Adult Detroit Residents.

Abstract

Depression is a leading cause of disability in the U.S., affecting 2-9% of the adult population each year. Although numerous studies have examined the social origins of depression, questions remain about the influence of traumatic events and neighborhood conditions on depressive symptoms. This dissertation uses data from the Detroit Neighborhood Health Study (DNHS) to examine (1) the effects of different types of recent traumatic events on changes in depression severity over a one-year period and whether individual characteristics like initial depression severity influence these relations; (2) the effects of prior traumatic events including childhood abuse on changes in current depression severity and responses to subsequent traumatic events; and (3) the effects of neighborhood disadvantage, crime, physical disorder, and social cohesion on exposure to traumatic events and changes in depression severity. The first analysis found higher increases in depression severity among those exposed to assaultive violence and other injuries and shocking experiences during follow-up, as well as those experiencing multiple traumatic events; associations were stronger among individuals with lower depression severity at baseline. The second analysis found positive associations between the number of lifetime traumatic events prior to baseline (especially childhood abuse events) and depression severity at follow-up, adjusting for baseline depression severity, traumatic event exposure during follow-up, and other potential confounders including prior psychopathology. Evidence for a stress sensitization effect was also found, such that individuals with a history of childhood abuse, prior assaultive violence, and greater total number of prior traumatic events exhibited greater depression severity than participants without such adverse histories when exposed to low numbers of recent traumatic events. The third analysis found only minimal associations between neighborhood conditions and traumatic event exposure. However, living in socioeconomically disadvantaged and less cohesive neighborhoods was positively associated with depression severity at follow-up, and modified relations between trauma exposure and depression severity. These findings confirm the influence of traumatic events and neighborhood conditions on depression severity and highlight the importance of considering the context in which traumatic events occur (including the individual’s prior history of depression, traumatic event exposure, and neighborhood environment) when assessing need for intervention after trauma exposure.