Citation

Fulton T, Lathan EC, Karkare MC, Guelfo A, Eghbalzad L, Ahluwalia V, Ely TD, Turner JA, Turner MD, Currier JM, Mekawi Y, Fani N. Biol. Psychiatry Cogn. Neurosci. Neuroimaging 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Society of Biological Psychiatry, Publisher Elsevier Publishing)

DOI

10.1016/j.bpsc.2023.07.006

PMID

37487958

Abstract

BACKGROUND: 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 Events and Symptom Scale for Civilians (MIESS-C). 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.

METHODS: Forty-eight adults aged 18-65 (M(age)=30.56, SD=11.93) completed the MIESS-C and an affective attentional control measure, the affective Stroop task (AS), during fMRI; the AS includes presentation of threat-relevant and neutral distractor stimuli. Voxel-wise functional connectivity of the bilateral amygdala was examined in response to threat-relevant vs neutral AS distractor trials.

RESULTS: Functional connectivity between the right amygdala and left postcentral gyrus/primary somatosensory cortex was positively correlated with MIESS-C exposure score (voxel-wise p<.001, cluster false discovery rate-corrected p<.05) in response to threat vs neutral AS distractor trials. Follow-up analyses revealed significant effects of race; Black but not White participants demonstrated this significant pattern of amygdala-left SSC connectivity.

CONCLUSIONS: 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.

Language: en

Keywords

trauma; moral injury; attention; civilians; functional connectivity