Moral injury, race-related stress and post-traumatic stress disorder in a trauma-exposed Black population.

BACKGROUND: Race-related stress (RRS) is an unrecognized source of moral injury (MI)-or the emotional and/or spiritual suffering that may emerge after exposure to events that violate deeply held beliefs. Additionally, MI has not been explored as a mechanism of risk for post-traumatic stress disorder (PTSD) in trauma-exposed civilians. We examined relations among exposure to potentially morally injurious events (moral injury exposure, MIE), related distress (moral injury distress, MID), and RRS in Black Americans. Potential indirect associations between RRS and PTSD symptoms via MID were also examined. METHODS: Black Americans (n = 228; 90.4% female; Mage = 31.6 years. SDage = 12.8 years) recruited from an ongoing study of trauma completed measures assessing civilian MIE and MID, RRS, and PTSD. Bivariate correlations were conducted with MIE and MID, and mediation analysis with MID, to examine the role of MI in the relationship between RRS and PTSD symptom severity. RESULTS: MIE was significantly correlated with cultural (r = 0.27), individual (r = 0.29), and institutional (r = 0.25) RRS; MID also correlated with cultural (r = 0.31), individual (r = 0.31), and institutional (r = 0.26) RRS (ps < 0.001). We found an indirect effect of RRS on PTSD symptoms via MID (ß = 0.10, p < 0.005). CONCLUSIONS: All types of RRS were associated with facets of MI, which mediated the relationship between RRS and current PTSD symptoms. MI may be a potential mechanism through which RRS increases the risk for PTSD in Black individuals.

Feasibility and acceptability of a virtual mindfulness intervention for Black adults with PTSD and depression: Randomized controlled trial.

Mindfulness-based cognitive therapy (MBCT) offers promise as a group-based intervention to alleviate posttraumatic stress disorder (PTSD) and depression symptoms in traumatized Black adults. Given the high level of barriers that exist for low-income Black adults, virtual delivery of MBCT may be helpful. This pilot randomized controlled trial assessed feasibility and acceptability of an adapted 8-week virtual MBCT group intervention for Black adults screening positive for PTSD and depression. Forty-six participants (89.3% women) recruited from an urban safety net hospital were randomized to MBCT or waitlist control (WLC). Overall feasibility was fair (70%); however, completion rates were higher for WLC than MBCT (90% vs. 54%). Group acceptability was high across quantitative and qualitative measures for study completers. Perceived barriers to psychological treatment were high (>9). While showing potential via improved coping skills and positive health changes, this intervention's success hinges on mitigating engagement barriers for future delivery; additional studies are warranted.

Understanding the Relationship Between Gender Representation in County Government and Perinatal Outcomes to Black, White, and Hispanic Birthing People in Georgia.

Objective: To characterize the association between percent of county-level elected officials who were female-presenting and perinatal outcomes in Georgia and variation by individual race, 2020-2021. Materials and Methods: We gathered data on the gender composition of county-level elected officials for all Georgia counties (n = 159) in 2022 and calculated the percent of female elected officials (percent female, 0-100). We linked this to data from 2020 to 2021 birth certificates (n = 238,795) to identify preterm birth (PTB, <37 weeks), low birthweight (LBW, <2500 grams), hypertensive disorders of pregnancy, and cesarean delivery. We fit multilevel log binomial models with generalized estimating equations, with percent female as the primary independent variable. We adjusted for individual and county-level potential confounders and individual race/ethnicity as an effect modifier. Results: County median percent female elected officials was 22.2% (interquartile range: 15.5). Overall, 14.6% of births were PTB and 10.1% LBW. A 15 percentage point increase in percent female elected officials was associated with lower risk of hypertensive disorders of pregnancy for white (adjusted risk ratio [RR]: 0.94, 95% confidence interval [CI]: 0.88-0.99), and possibly Hispanic (adjusted RR: 0.95, 95% CI: 0.89-1.0) and non-Hispanic other (adjusted RR: 0.94 (0.87-1.01), but not black birthing people (adjusted RR: 1.0, 95% CI: 0.95-1.05). There was not a clear pattern for PTB, birthweight, or cesarean delivery. Conclusion: Greater female representation in county government was associated with improved maternal health for some racial/ethnic groups in Georgia.

The neurophysiological consequences of racism-related stressors in Black Americans.

Racism-related stressors, from experiences of both implicit and explicit racial discrimination to systemic socioeconomic disadvantage, have a cumulative impact on Black Americans' health. The present narrative review synthesizes peripheral (neuroendocrine and inflammation markers), psychophysiological (heart-rate variability, skin conductance), and neuroimaging (structural and functional) findings that demonstrate unique associations with racism-related stress. Emerging evidence reveals how racism-related stressors contribute to differential physiological and neural responses and may have distinct impacts on regions involved with threat and social processing. Ultimately, the neurophysiological effects of racism-related stress may confer biological susceptibility to stress and trauma-related disorders. We note critical gaps in the literature on the neurophysiological impact of racism-related stress and outline additional research that is needed on the multifactorial interactions between racism and mental health. A clearer understanding of the interactions between racism-related stress, neurophysiology, and stress- and trauma-related disorders is critical for preventative efforts, biomarker discovery, and selection of effective clinical treatments for Black Americans.

Genetic risk for hospitalization of African American patients with severe mental illness reveals HLA loci.

Background: Mood disorders such as major depressive and bipolar disorders, along with posttraumatic stress disorder (PTSD), schizophrenia (SCZ), and other psychotic disorders, constitute serious mental illnesses (SMI) and often lead to inpatient psychiatric care for adults. Risk factors associated with increased hospitalization rate in SMI (H-SMI) are largely unknown but likely involve a combination of genetic, environmental, and socio-behavioral factors. We performed a genome-wide association study in an African American cohort to identify possible genes associated with hospitalization due to SMI (H-SMI). Methods: Patients hospitalized for psychiatric disorders (H-SMI; n=690) were compared with demographically matched controls (n=4467). Quality control and imputation of genome-wide data were performed following the Psychiatric Genetic Consortium (PGC)-PTSD guidelines. Imputation of the Human Leukocyte Antigen (HLA) locus was performed using the HIBAG package. Results: Genome-wide association analysis revealed a genome-wide significant association at 6p22.1 locus in the ubiquitin D (UBD/FAT10) gene (rs362514, p=9.43x10-9) and around the HLA locus. Heritability of H-SMI (14.6%) was comparable to other psychiatric disorders (4% to 45%). We observed a nominally significant association with 2 HLA alleles: HLA-A*23:01 (OR=1.04, p=2.3x10-3) and HLA-C*06:02 (OR=1.04, p=1.5x10-3). Two other genes (VSP13D and TSPAN9), possibly associated with immune response, were found to be associated with H-SMI using gene-based analyses. Conclusion: We observed a strong association between H-SMI and a locus that has been consistently and strongly associated with SCZ in multiple studies (6p21.32-p22.1), possibly indicating an involvement of the immune system and the immune response in the development of severe transdiagnostic SMI.

Opioid Use After First Opioid Prescription in Children With Sickle Cell Disease.

This cohort study assesses the level of opioid use, number of vaso-occlusive crises, and days' supply of opioids among opioid-naive pediatric patients.

What's next for the field of multigenerational mental health? The need for deep behavioral phenotyping via a prenatal mental health registry.

From its inception, development and psychopathology theorists have sought to uncover the earliest forms of risk for mental health challenges in children, to prevent the development of more severe, intractable manifestations of psychopathology. Large familial risk registries have advanced our understanding of early, potentially modifiable factors that could prevent or mitigate the expression of challenging symptoms of neurodevelopmental conditions, and similar registries have been proposed to advance understanding of ADHD and related phenotypes. Data from single-site studies, largely focused on perinatal exposure to maternal mood disorders, reveal that a robust predictor of child psychopathology is parental psychopathology. However, early developmental trajectories of psychopathology risk may be better captured using transdiagnostic approaches in pregnancy, capturing the full range of mental health symptoms. We describe here the need for a parental mental health registry that begins prenatally that includes deep behavioral phenotyping across a range of transdiagnostic indicators of mental health risk to prevent psychopathology in children. This registry has the potential to uncover pathways to psychopathology risk in childhood and support the discovery of novel mechanisms to be targeted for prevention and intervention.

Association of white matter hyperintensities and clinical vascular burden with depressive symptoms in Black older adults.

OBJECTIVES: Black older adults have a higher vascular burden compared to non-Hispanic White (NHW) older adults, which may put them at risk for a form of depression known as vascular depression (VaDep). The literature examining VaDep in Black older adults is sparse. The current study addressed this important gap by examining whether vascular burden was associated with depressive symptoms in Black older adults. METHODS: Participants included 113 Black older adults from the Healthy Brain Project, a substudy of the Health, Aging, and Body Composition Study. In multiple regression analyses, clinical vascular burden (sum of vascular conditions) and white matter hyperintensity (WMH) volume predicted depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale, controlling for demographic variables. Follow-up analyses compared the associations in the Black subsample and in 179 NHW older adults. RESULTS: Higher total WMH volume, but not clinically-defined vascular burden, predicted higher concurrent depressive symptoms and higher average depressive symptoms over 4 years. Similar associations were found between uncinate fasciculus (UF) WMHs and concurrent depressive symptoms and between superior longitudinal fasciculus WMHs and average depressive symptoms. The association between depressive symptoms and UF WMH was stronger in Black compared to NHW individuals. CONCLUSION: This research is consistent with the VaDep hypothesis and extends it to Black older adults, a group that has historically been underrepresented in the literature. Results highlight WMH in the UF as particularly relevant to depressive symptoms in Black older adults and suggest this group may be particularly vulnerable to the negative effects of WMH.

How well does the Index of Race-Related Stress-brief function in a trauma-exposed Black community sample? An item response theory examination of discrimination and difficulty parameters.

BACKGROUND: Race-related stress negatively impacts the mental health of Black Americans to a greater degree than other racialized groups. Additionally, trauma exposure is associated with more severe levels of posttraumatic stress disorder for individuals who also experience race-related stress. Therefore, an accurate assessment of race-related stress in a trauma-exposed sample of Black Americans is necessary to ensure the validity and reliability of empirical findings regarding race-related stress and intervention efficacy. The Index of Race-Related Stress (IRRS) is one of the most commonly used measures to assess race-related stress among Black Americans. Due to a lack of psychometric support for the abbreviated version of IRRS-brief (IRRS-B) on a trauma-exposed sample of Black Americans, our study aims to address this gap in literature. METHOD: We used item response theory (IRT) to assess item difficulty, discrimination, and factor structure in a sample of trauma-exposed Black Americans (n = 226). We employed a multidimensional graded response model with corresponding items loaded on to the three previously established factors of the IRRS. RESULTS: The most discriminating items asked about observing harsh treatment of Black individuals, experiencing less courtesy in establishments, and being stared at as though you do not belong. The item with the lowest difficulty described negative media representation of Black individuals while the item with the highest difficulty described lack of positive media portrayals of Black Americans. DISCUSSION: These results indicate that items varied considerably in the degree to which they adequately captured race-related stress. Future research should use IRT with newly worded questions to further improve the assessment of race-related stress in Black Americans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

C-reactive protein moderates associations between racial discrimination and ventromedial prefrontal cortex activation during attention to threat in Black American women.

Prior research has shown that racial discrimination (RD) impacts activation in threat network regions, including the ventromedial prefrontal cortex (vmPFC) and middle occipital cortex during attention to threat-relevant stimuli. However, little is known about the biological mechanisms that may modulate these effects; inflammation may be a pathway linking RD and threat network activation. As such, the current study aimed to explore whether systemic inflammation, measured by C-reactive protein (CRP) levels, may moderate the relationship between RD and activation in the vmPFC and middle occipital cortex during attention to threat. Blood samples for inflammatory marker (CRP) assays were obtained from forty Black American women (mean [SD] age, 39.93 [9.97] years; range, 22-58 years) recruited from an ongoing trauma study; participants also viewed threat-relevant stimuli as part of an attention task during fMRI. We found that CRP moderated the relationship between RD and vmPFC activation during attention to threat, such that participants with relatively higher concentrations of CRP ( ≥ 23.97 mg/L) demonstrated significant positive associations between RD and vmPFC activation [ß = 0.18, CI (0.04, 0.32), t = 2.65, p = 0.01]. No significant associations were observed for participants who showed moderate (10.89 mg/L) or low (0.20 mg/L) CRP concentrations. CRP did not moderate the relationship between RD and middle occipital cortex activation. Our data present a mechanism through which RD may influence immune system activation and, in turn, threat network activation. Inflammation may contribute to brain health vulnerabilities in Black Americans via its effects on threat circuits; this merits further investigation in large-scale studies.

Political representation and perinatal outcomes to Black, White, and Hispanic people in Georgia: a cross-sectional study.

PURPOSE: Our goal was to estimate differences in perinatal outcomes by racial differences in political representation, a measure of structural racism. METHODS: We gathered data on the racial composition of county-level elected officials for all counties in Georgia (n = 159) in 2022. We subtracted the percent of non-White elected officials from the percent of non-White residents to calculate the "representation difference," with greater positive values indicating a larger disparity. We linked this to data from 2020-2021 birth certificates (n = 238,795) on outcomes (preterm birth, <37 weeks, low birthweight birth <2500 g, birthweight, hypertensive disorders of pregnancy, cesarean delivery). We fit log binomial and linear models with generalized estimating equations, stratified by individual race/ethnicity and including individual and county covariates. RESULTS: Median representation difference was 17.5% points (interquartile range: 17.2). A 25-percentile point increase in representation difference was associated with a greater risk of hypertensive disorders of pregnancy [White: adjusted risk ratio (RR): 1.12, 95% confidence interval (CI): (1.05, 1.2), Black: 1.06, 95% CI: (0.95, 1.17), other: 1.14, 95% CI: (1.0, 1.3), Hispanic: 1.19, 95% CI: (1.07, 1.32)] and lower mean birthweight for Black birthing people [adjusted beta -15.3, 95% CI: (-25.5, -7.4)]. CONCLUSIONS: Parity in political representation may be associated with healthier environments.

Infant epigenetic aging moderates the link between Black maternal childhood trauma and offspring symptoms of psychopathology.

Although offspring of women exposed to childhood trauma exhibit elevated rates of psychopathology, many children demonstrate resilience to these intergenerational impacts. Among the variety of factors that likely contribute to resilience, epigenetic processes have been suggested to play an important role. The current study used a prospective design to test the novel hypothesis that offspring epigenetic aging - a measure of methylation differences that are associated with infant health outcomes - moderates the relationship between maternal exposure to childhood adversity and offspring symptomatology. Maternal childhood adversity was self-reported during pregnancy via the ACEs survey and the CTQ, which assessed total childhood trauma as well as maltreatment subtypes (i.e., emotional, physical, and sexual abuse). Offspring blood samples were collected at or shortly after birth and assayed on a DNA methylation microarray, and offspring symptomatology was assessed with the CBCL/1.5-5 when offspring were 2-4 years old. Results indicated that maternal childhood trauma, particularly sexual abuse, was predictive of offspring symptoms (ps = 0.003-0.03). However, the associations between maternal sexual abuse and offspring symptomatology were significantly attenuated in offspring with accelerated epigenetic aging. These findings further our understanding of how epigenetic processes may contribute to and attenuate the intergenerational link between stress and psychopathology.

Introduction to the Special Section on the International Society for Traumatic Stress Studies 38th Annual Meeting: Trauma as a transdiagnostic risk factor across the lifespan.

This article serves as an introduction to the special section in the Journal of Traumatic Stress related to the 38th annual meeting of the International Society for Traumatic Stress Studies, held in Atlanta, Georgia (USA) in November 2022. The theme of this meeting, "Trauma as a Transdiagnostic Risk Factor Across the Lifespan," provided an opportunity to recognize the far-reaching impact of trauma and how traumatic experiences can become embedded into the mind, body, and societal spirit. This introductory article outlines the importance of harnessing multiple perspectives to address these wide-ranging sequelae of trauma and provides an overview of the series of contributions to the special section.

Indirect effect of race-related stress on traumatic stress and depression symptoms via subjective social status in a Black community sample.

Experiencing racism is linked to lower subjective social status (SSS), defined as one's perception of their position in society. SSS is influenced by power, prestige, and objective socioeconomic status (SES). Previous findings suggest that race-related stress may be related to adverse mental health outcomes through SSS in Black Americans, a population that has been deeply affected by continuing legacies of oppression. The current study examines the indirect association between race-related stress and posttraumatic stress disorder (PTSD) and depression symptoms through SSS in a community sample of largely trauma-exposed Black Americans (N = 173). Hierarchical regression analyses indicated that overall race-related stress significantly predicted lower SSS, higher PTSD symptoms, and higher depression symptoms. Analyses also revealed indirect effects of cultural race-related stress on PTSD and depression symptoms through SSS after controlling for SES. Results suggest that the experience of race-related stress, particularly cultural race-related stress, which involves the degradation and disparagement of one's culture and worldview, is associated with more severe PTSD and depression symptoms potentially due to these experiences decreasing Black Americans' SSS. Findings support the need for systemic intervention strategies to disrupt the cultural oppression of Black Americans and improve the societal value and mental health of this population.

Shift-and-persist coping and health among rural African American adolescents.

This study examines whether shift-and-persist coping, a coping strategy defined by accepting challenges and remaining hopeful for the future, is associated with psychosocial and physical health and/or moderates the effects of contextual stress (i.e., racial discrimination, financial strain) on health among African American adolescents living in the rural Southeastern United States. Participants (N = 299, 56% boys, Mage = 12.91) completed measures of shift-and-persist coping, contextual stress, and psychosocial and physical health. Shift-and-persist coping was generally associated with better health but did not buffer the effects of contextual stress. Results suggest that shift-and-persist coping may serve as a source of resilience among African American adolescents living in a context where many experience heightened contextual stress.

Intergenerational Transmission of Depression: Examining the Roles of Racism and Trauma Among Black Mothers and Youth.

OBJECTIVE: Racism is a multifaceted system of oppression that disproportionately harms Black mothers and children across the lifespan. Despite reliable evidence that racism is associated with worse mental health outcomes (eg, increased depressive symptoms), less is known about potential intergenerational effects of Black mothers' experiences of racism on children's mental health, as well as how traumatic experiences influence these pathways. In this cross-sectional quantitative study, we aimed (1) to replicate the finding that maternal experiences of racism are associated with both maternal and child depression; (2) to identify whether maternal experiences of racism are indirectly associated with child depression via the effect of maternal depression; and (3) to test whether the indirect effect of racism on child depression via maternal depression is conditioned on maternal trauma. METHOD: Black mothers and their children (N = 148 dyads) were recruited from an urban hospital and were interviewed about their experiences of racism, trauma, and mental health symptoms. The mothers' average age was 35.16 years (SD = 8.75) and the children's average age was 10.03 years (SD = 1.51). RESULTS: First, we found that maternal experiences of racism were associated with more severe maternal depression (r = 0.37, p < .01) as well as more severe child depression (r = 0.19, p = .02). Second, we found that maternal experiences of racism were indirectly associated with child depression through the effect of maternal depression (ab = 0.76, 95% CI = 0.26, 1.37). Third, we found that maternal trauma exposure moderated this indirect effect such that, at relatively lower levels of maternal trauma exposure, the indirect effect of maternal experiences of racism on child depression was nonsignificant (ωlow = -0.05, 95% CI = -0.50, 0.45), whereas at relatively higher levels of maternal trauma exposure, the indirect effect of maternal experiences of racism on child depression was statistically significant (ωhigh= .65, 95% CI = 0.21, 1.15). CONCLUSION: These findings suggest that the indirect effect of maternal experiences of racism on child depression through the effect of maternal depression depends on the degree of maternal trauma exposure. This study advances the literature by shedding light on key processes that can explain the intergenerational effects of racism as well as contextual factors that can exacerbate racism's downstream consequences across generations.

Intersections of oppression: Examining the interactive effect of racial discrimination and neighborhood poverty on PTSD symptoms in Black women.

Black Americans living in urban environments are disproportionately impacted by posttraumatic stress disorder (PTSD). Both racial discrimination and neighborhood poverty are factors that contribute to this health disparity. However, studies focused on the intersection of these two oppressive systems on PTSD symptoms are lacking. To address this gap in the literature, we assessed the interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms in an urban sample of trauma-exposed Black women (N = 300). Simple moderation analysis was used to assess the main and interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms. The overall model significantly predicted PTSD symptoms, with a main effect of racial discrimination (B = 1.87, p = .009) and neighborhood poverty rate (B = 0.29, p = .008), independent of prior trauma exposure and percentage of Black residents in the zip code. More frequent experiences of racial discrimination and higher rates of neighborhood poverty both predicted higher PTSD symptoms. There was also a trending interaction of racial discrimination and neighborhood poverty (B = -0.05, p = .054), where the effect of neighborhood poverty on PTSD symptoms was only present for those who reported fewer experiences of racial discrimination. Our results suggest that people who have experienced more instances of racial discrimination show high levels of PTSD symptoms regardless of neighborhood poverty rates and highlight the importance of considering multiple levels of oppression that Black individuals face while diagnosing and treating stress-related psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Strengthening couple functioning promotes resilience to COVID-19-related stressors among Black Americans.

The COVID-19 pandemic resulted in substantial hardship for Black Americans, leading to increased stress and mental health difficulties. We used longitudinal data from the Protecting Strong African American Families (ProSAAF) intervention study to test the hypothesis that improved couple functioning following ProSAAF participation would serve as a constructed resilience resource during the pandemic, buffering the impact of elevated pandemic-related stressors on change in depressive symptoms. We found that COVID-19-related stress predicted change in depressive symptoms from prepandemic to during the pandemic, that ProSAAF predicted improved couple functioning, and that positive change in couple functioning buffered the impact of pandemic stressors on change in depressive symptoms. These effects resulted in a significant indirect buffering effect of ProSAAF on the association between COVID-19-related stress and change in depressive symptoms through its effects on change in couple functioning. The results suggest that relationship intervention may increase resilience to unanticipated community-wide stress and promote mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure.

Considerable racial/ethnic disparities persist in exposure to life stressors and socioeconomic resources that can directly affect threat neurocircuitry, particularly the amygdala, that partially mediates susceptibility to adverse posttraumatic outcomes. Limited work to date, however, has investigated potential racial/ethnic variability in amygdala reactivity or connectivity that may in turn be related to outcomes such as post-traumatic stress disorder (PTSD). Participants from the AURORA study (n = 283), a multisite longitudinal study of trauma outcomes, completed functional magnetic resonance imaging and psychophysiology within approximately two-weeks of trauma exposure. Seed-based amygdala connectivity and amygdala reactivity during passive viewing of fearful and neutral faces were assessed during fMRI. Physiological activity was assessed during Pavlovian threat conditioning. Participants also reported the severity of posttraumatic symptoms 3 and 6 months after trauma. Black individuals showed lower baseline skin conductance levels and startle compared to White individuals, but no differences were observed in physiological reactions to threat. Further, Hispanic and Black participants showed greater amygdala connectivity to regions including the dorsolateral prefrontal cortex (PFC), dorsal anterior cingulate cortex, insula, and cerebellum compared to White participants. No differences were observed in amygdala reactivity to threat. Amygdala connectivity was associated with 3-month PTSD symptoms, but the associations differed by racial/ethnic group and were partly driven by group differences in structural inequities. The present findings suggest variability in tonic neurophysiological arousal in the early aftermath of trauma between racial/ethnic groups, driven by structural inequality, impacts neural processes that mediate susceptibility to later PTSD symptoms.

Impact of cardiovascular risk factors on the relationships of physical activity with mood and cognitive function in a diverse sample.

Physical activity has well-known benefits for older adults' mood and cognitive functioning; however, it is not clear whether risk factors for cardiovascular disease (CVD) affect the relationships of physical activity with these health outcomes among diverse older adults. This study investigated the impact of CVD risk burden on the relationships among self-reported physical activity, mood, and cognitive functioning in a diverse sample of 62 adults age 45 and older. We found that higher physical activity was associated with better attention and verbal working memory at lower CVD risk, but with worse attention and verbal working memory at higher CVD risk levels. Thus, higher CVD risk might limit the effectiveness of exercise interventions for mood and cognitive functioning. Future studies are needed to further clarify individual differences that impact the relationships among physical activity, CVD risk, and cognitive outcomes.