Investigating the Neurobiology of Minority Stress-related Moral Injury with fMRI

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BackgroundSexual and gender minorities (SGMs) face unique, chronic stressors and trauma connected to their stigmatized identities, contributing to disproportionately high rates of mental health conditions. Emerging research suggests that these identity-based minority stressors may function as morally injurious events. Here, we aimed to identify the neural correlates of SGM-based moral injury to better understand the biological processes associated with minority stress exposure and downstream trauma-related symptoms that can burden SGM communities. MethodsOur sample included n=39 SGM participants with diverse racial and ethnic identities. We collected functional magnetic resonance imaging data while participants recalled two autobiographical memories via personalized scripts – one morally injurious event related to their SGM identity and one neutral event. Here, we conducted paired sample t-tests exploring neural activation patterns during moral injury memory recall as compared to neutral memory recall [p-family wise error (FWE)-corrected < .05]. Participants completed a battery of questionnaires assessing minority stress, trauma exposure, and trauma-related symptoms, whereby linear regression analyses were conducted to explore associations with neural activation data. ResultsWe found increased activation in the left anterior and right posterior insula (i.e., nodes of the salience network) during moral injury as compared to neutral memory recall. Additionally, we uncovered a negative correlation between minority stress exposure and activity within the ventromedial prefrontal cortex (i.e., a major default mode network hub) during moral injury as compared to neutral memory recall. Minority stress exposure was found to be significantly associated with trauma symptom severity. ConclusionsOur findings of provide preliminary evidence linking identity-based moral injury to disruptions in large-scale brain networks implicated in threat detection, self-referential processing, and emotion. Importantly, this work highlights potential neural targets for trauma-informed interventions aimed at addressing moral injury-related symptoms that disproportionately affect SGM communities.

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