Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2022 Dec;7(12):1289-1297. doi: 10.1016/j.bpsc.2022.08.009. Epub 2022 Sep 5.
Sexual minority youth (SMY) are 3 times more likely to experience depression than heterosexual peers. Minority stress theory posits that this association is explained by sexual orientation victimization, which acts as a stressor to impact depression. For those vulnerable to the effects of stress, victimization may worsen depression by altering activity in neural reward systems. This study examines whether neural reward systems moderate the influence of sexual orientation victimization, a common and distressing experience in SMY, on depression.
A total of 81 participants ages 15 to 22 years (41% SMY, 52% marginalized race) reported sexual orientation victimization, depression severity, and anhedonia severity, and underwent a monetary reward functional magnetic resonance imaging task. Significant activation to reward > neutral outcome (p < .05) was determined within a meta-analytically derived Neurosynth reward mask. A univariate linear model examined the impact of reward activation and identity on victimization-depression relationships.
SMY reported higher depression (p < .001), anhedonia (p = .03), and orientation victimization (p < .001) than heterosexual youth. The bilateral ventral striatum, medial prefrontal cortex (mPFC), anterior cingulate cortex, and right orbitofrontal cortex were significantly active to reward. mPFC activation moderated associations between sexual orientation victimization and depression (p = .03), with higher depression severity observed in those with a combination of higher mPFC activation and greater orientation victimization.
Sexual orientation victimization was related to depression but only in the context of higher mPFC activation, a pattern observed in depressed youth. These novel results provide evidence for neural reward sensitivity as a vulnerability factor for depression in SMY, suggesting mechanisms for disparities, and are a first step toward a clinical neuroscience understanding of minority stress in SMY.
性少数青年（SMY）患抑郁症的可能性是异性恋同龄人 的 3 倍。少数群体应激理论认为，这种关联可以通过性取向受迫害来解释，性取向受迫害是一种应激源，会影响抑郁症。对于那些容易受到压力影响的人来说，受迫害可能会通过改变神经奖励系统的活动来使抑郁症恶化。本研究旨在检验神经奖励系统是否会调节性取向受迫害（SMY 中常见且令人痛苦的经历）对抑郁症的影响，性取向受迫害会影响抑郁症。
共有 81 名年龄在 15 至 22 岁的参与者（41%为 SMY，52%为边缘种族）报告了性取向受迫害、抑郁严重程度和快感缺失严重程度，并进行了货币奖励功能磁共振成像任务。在元分析衍生的神经合成奖励掩模内确定了对奖励>中性结果的显著激活（p<0.05）。单变量线性模型检验了奖励激活和身份对受害-抑郁关系的影响。
SMY 报告的抑郁（p<0.001）、快感缺失（p=0.03）和性取向受迫害（p<0.001）均高于异性恋青年。双侧腹侧纹状体、内侧前额叶皮层（mPFC）、前扣带皮层和右侧眶额皮层对奖励有明显的激活。mPFC 的激活调节了性取向受迫害与抑郁之间的关联（p=0.03），在 mPFC 激活较高且性取向受迫害较大的个体中，观察到更高的抑郁严重程度。
性取向受迫害与抑郁有关，但仅在 mPFC 激活较高的情况下才会出现这种情况，这种模式在抑郁青年中观察到。这些新的结果为神经奖励敏感性作为 SMY 中抑郁的易感性因素提供了证据，表明了差异的机制，并为理解 SMY 中的少数群体应激的临床神经科学迈出了第一步。
