• Therese S Richmond, Ryan Quinn, Anna Duan, Christopher N Morrison, Nancy Kassam-Adams, Augustine Cassis Obeng Boateng, and Sara F Jacoby.
• School of Nursing, University of Pennsylvania, 418 Curie Blvd, Fagin Hall 330, Philadelphia, PA, 19104, USA. terryr@nursing.upenn.edu.
• J Urban Health. 2025 Jan 22.

AbstractDepression and post-traumatic stress disorder (PTSD) are serious consequences of physical injuries. Stress associated with living in urban neighborhoods with socioecological disadvantages and the cumulative burdens of adverse childhood experiences (ACEs) can lead to poorer psychological outcomes. Limited research has explored how ACEs and socioecological environmental exposures in childhood and adulthood, together, impact post-injury outcomes. This study assessed the relative contributions of ACEs and neighborhood exposures during childhood and adulthood on post-injury outcomes among Black men in Philadelphia. We used data from a prospective cohort of 414 Black men from the Philadelphia region, aged ≥ 18 years, who sustained acute physical injuries requiring hospitalization. Primary outcomes were post-injury PTSD and depression. Secondary outcomes were sleep quality, self-reported health status, changes in substance use, and return to work. The study used perceived and objective measures of neighborhood characteristics and self-reported ACEs to model their relative impact on outcomes 3 months after hospital discharge. Higher levels of ACEs and higher perceived neighborhood disorder during childhood and adulthood were significant predictors of PTSD and depression symptom severity. Perceived neighborhood disorder contributed to sleep disturbances and decline in post-injury health. Census/administrative objective measures of neighborhood disadvantage did not show consistent associations with post-injury outcomes. Findings suggest that both ACEs and subjective perception of neighborhood environments are critical factors influencing post-injury recovery in urban Black men. Interventions to improve post-injury outcomes should consider preventing ACEs and addressing the tangible conditions of neighborhoods and residents' perceptions of their surroundings to promote health equity and injury recovery.© 2025. The Author(s).

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