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Original Investigation
July 28, 2021

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

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
  • 2Department of Psychology, Georgia State University, Atlanta
  • 3Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
  • 4Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
  • 5Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
JAMA Psychiatry. 2021;78(9):1005-1012. doi:10.1001/jamapsychiatry.2021.1480
Key Points

Question  Are experiences of racial discrimination associated with neural response patterns throughout the brain during attention to threat cues?

Findings  This cross-sectional study of 55 Black women in the US found that those with more racial discrimination experiences showed proportionally greater response in brain regions associated with threat vigilance and regulation of threat response.

Meaning  This study suggests that heightened activation in brain regions associated with threat vigilance and regulation of threat response may disproportionately encumber and drain these resources over time, serving to enhance vulnerability for race-related health disparities.


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 Participants  A 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.

Results  In 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 inhibition and visual attention. Frequent racism experienced by Black individuals may potentiate attentional and regulatory responses to trauma-relevant stressors and lead to heightened modulation of regulatory resources. This may represent an important neurobiological pathway for race-related health disparities.

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