Association of Racial Discrimination With Neural Response to Threat in Black Women in the US Exposed to Trauma

Abstract

IMPORTANCE Racial discrimination has a clear impact on health-related outcomes, but little is known about how discriminatory experiences are associated with neural response patterns to emotionally salient cues, which likely mediates these outcomes.OBJECTIVE To examine associations of discriminatory experiences with brainwide response to threat-relevant cues in trauma-exposed US Black women as they engage in an attentionally demanding task. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study was conducted from May 1, 2014, to July 1, 2019, among 55 trauma-exposed US Black women to examine associations of racial discrimination experiences with patterns of neural response and behavior to trauma-relevant images in an affective attentional control task. Posttraumatic stress disorder (PTSD) symptoms and trauma exposure were entered as covariates to isolate variance associated with experiences of racial discrimination.EXPOSURES Varying levels of trauma, PTSD symptoms, and experiences of racial discrimination.MAIN OUTCOMES AND MEASURES Experiences of Discrimination Questionnaire (EOD) (range, 0-9) for count of the number of situations for which each participant reported having unfair treatment for a racial reason. Experiences of trauma and PTSD symptoms were assessed with the Traumatic Events Inventory (TEI) (number of times the person was exposed to trauma; score range, 0-112) and PTSD Symptom Scale (PSS) (score range, 0-51). Response to trauma-relevant vs neutral distractor cues were assessed via functional magnetic resonance imaging during performance of an affective Stroop (attentional control) task. Statistical analyses were conducted at a whole-brain, voxelwise level with familywise error correction. RESULTSIn this study of 55 Black women in the US (mean [SD] age, 37.7 [10.7] years; range, 21-61 years), participants reported a mean (SD) TEI frequency of 33.0 (18.8) and showed moderate levels of current PTSD symptoms (mean [SD] PSS score, 15.4 [12.9]). Mean (SD) EOD scores were 2.35 (2.44) and were moderately correlated with current PTSD symptoms (PSS total: r = 0.36; P=.009) but not with age (r = 0.20; P = .15) or TEI frequency (r = -0.02; P = .89). During attention to trauma-relevant vs neutral images, more experiences of racial discrimination were associated with significantly greater response in nodes of emotion regulation and fear inhibition (ventromedial prefrontal cortex) and visual attention (middle occipital cortex) networks, even after accounting for trauma and severity of PTSD symptoms (brainwide familywise error corrected; r = 0.33 for ventromedial prefrontal cortex; P = .02). Racial discrimination was also associated with affective Stroop task performance; errors on trials with threat-relevant stimuli were negatively correlated with experiences of racial discrimination (r = −0.41; P = .003).CONCLUSIONS AND RELEVANCE These findings suggest that experiences of racial discrimination associate with disproportionately greater response in brain regions associated with emotion regulation and fear inhibiti...

Racial Discrimination and Resting-State Functional Connectivity of Salience Network Nodes in Trauma-Exposed Black Adults in the United States

“…Consistent with the limited existing work 31 , 32 , 33 on the associations between racial discrimination and the brain, in this study we found these experiences were associated with alterations in functional connectivity in individuals exposed to trauma. Taken together, this accumulating evidence emphasizes the gravity of racism as a public health crisis.…”

“… 62 Attempting to use and maintain coping strategies to combat racism may be associated with increased demands on psychosocial resources (ie, cognitive and affective processes 11 ), thereby leading to neural vulnerabilities or an increased biological sensitivity exploited by acute trauma. 39 Supporting this theory are findings from Fani et al 32 : in Black women with trauma exposure, more experiences of racial discrimination were significantly associated with greater activation of visual regions and the ventromedial prefrontal cortex (a node in the SN) during trauma-relevant images compared with neutral images.…”

“…These findings replicated recent work, demonstrating experiences of discrimination are associated with increased connectivity between threat-activated brain regions, particularly those responsible for initial processing of salient stimuli. 31 , 32 , 33 …”

“…Although the neurobiology of threat-related processes has received considerable attention, these scientific advancements (with few exceptions) have largely ignored the stressful experiences specific to racially and ethnically marginalized groups. 30 , 31 , 32 , 33 There remain many questions regarding the neural consequences of chronic racial discrimination and the biological pathways between these experiences and health outcomes. One plausible pathway is that ongoing exposure to racially charged situations presents imminent social, emotional, and/or physical threats.…”

Prevalence, Severity and Burden of Post-Traumatic Stress Disorder in Black Men and Women Across the Adult Life span

“…Pre-trauma exposure to racial discrimination is associated with increased risk for PTSD in Black adults following a traumatic event (Bird et al, 2021). Experiences of discrimination contribute to neurobiolologic changes in emotion regulation (Fani et al, 2021), adding to the severity of PTSD (Mekawi et al, 2020(Mekawi et al, , 2021. There is also evidence that PTSD is a mediating pathway through which racial discrimination contributes to Black-White disparities in cardiovascularrelated conditions (Gavin et al, 2021).…”