Fulton Travis, Lathan Emma C, Karkare Maya C, Guelfo Alfonsina, Eghbalzad Leyla, Ahluwalia Vishwadeep, Ely Timothy D, Turner Jessica A, Turner Matthew D, Currier Joseph M, Mekawi Yara, Fani Negar
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Molecular and Systems Pharmacology PhD Program, Emory University, Atlanta, Georgia.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2024 Jan;9(1):112-120. doi: 10.1016/j.bpsc.2023.07.006. Epub 2023 Jul 23.
Moral injury references emotional and spiritual/existential suffering that may emerge following psychological trauma. Despite being linked to adverse mental health outcomes, little is known about the neurophysiological mechanisms of this phenomenon. In this study, we examined neural correlates of moral injury exposure and distress using the Moral Injury Exposure and Symptom Scale for Civilians. We also examined potential moderation of these effects by race (Black vs. White individuals) given the likely intersection of race-related stress with moral injury.
Forty-eight adults ages 18 to 65 years (mean age = 30.56, SD = 11.93) completed the Moral Injury Exposure and Symptom Scale for Civilians and an affective attentional control measure, the affective Stroop task (AS), during functional magnetic resonance imaging; the AS includes presentation of threat-relevant and neutral distractor stimuli. Voxelwise functional connectivity of the bilateral amygdala was examined in response to threat-relevant versus neutral AS distractor trials.
Functional connectivity between the right amygdala and left postcentral gyrus/primary somatosensory cortex was positively correlated with the Moral Injury Exposure and Symptom Scale for Civilians exposure score (voxelwise p < .001, cluster false discovery rate-corrected p < .05) in response to threat versus neutral AS distractor trials. Follow-up analyses revealed significant effects of race; Black but not White participants demonstrated this significant pattern of amygdala-left somatosensory cortex connectivity.
Increased exposure to potentially morally injurious events may lead to emotion-somatosensory pathway disruptions during attention to threat-relevant stimuli. These effects may be most potent for individuals who have experienced multilayered exposure to morally injurious events, including racial trauma. Moral injury appears to have a distinct neurobiological signature that involves abnormalities in connectivity of emotion-somatosensory paths, which may be amplified by race-related stress.
道德伤害指心理创伤后可能出现的情感、精神/存在性痛苦。尽管与不良心理健康结果相关，但对这一现象的神经生理机制知之甚少。在本研究中，我们使用平民道德伤害暴露与症状量表，研究了道德伤害暴露与痛苦的神经关联。鉴于与种族相关的压力可能与道德伤害相互交织，我们还研究了种族（黑人与白人个体）对这些影响的潜在调节作用。
48名年龄在18至65岁之间的成年人（平均年龄 = 30.56，标准差 = 11.93）在功能磁共振成像期间完成了平民道德伤害暴露与症状量表以及一项情感注意力控制测量——情感斯特鲁普任务（AS）；AS包括呈现与威胁相关和中性的干扰刺激。针对与威胁相关和中性的AS干扰试验，检查了双侧杏仁核的体素功能连接。
在针对威胁与中性的AS干扰试验中，右侧杏仁核与左侧中央后回/初级体感皮层之间的功能连接与平民道德伤害暴露与症状量表的暴露得分呈正相关（体素水平p <.001，簇错误发现率校正后p <.05）。后续分析揭示了种族的显著影响；只有黑人参与者表现出这种杏仁核 - 左侧体感皮层连接的显著模式，白人参与者未表现出。
增加对潜在道德伤害事件的暴露可能会导致在关注与威胁相关的刺激时情绪 - 体感通路中断。对于经历过包括种族创伤在内的多层道德伤害事件暴露的个体，这些影响可能最为显著。道德伤害似乎具有独特的神经生物学特征，涉及情绪 - 体感通路连接异常，这可能会因与种族相关的压力而加剧。
