Symptom severity, neighborhood crime, and neural correlates of reappraisal in patients with major depression and social anxiety.

BACKGROUND

Cognitive reappraisal deficits are a transdiagnostic risk factor for major depressive disorder (MDD) and social anxiety disorder (SAD) and are observed in patients with these disorders at the neural level. Preliminary research suggests less activation of prefrontal regions during reappraisal (vs. viewing) of negative stimuli associates with overall symptom severity in patients with MDD or SAD, however, this is not reliably observed across studies. Consistent with research showing that reappraisal may only be adaptive when employed to cope with uncontrollable adversity, this study sought to examine whether neighborhood-level adversity (i.e. socioeconomic disadvantage, crime) moderated the relation between internalizing symptom severity and neural correlates of reappraisal.

METHODS

This study included patients with a current diagnosis of MDD (n = 51) or SAD (n = 39). Patients completed measures of symptom severity as well as an emotion regulation task while in the scanner to assess neural activation during reappraisal. Patients' addresses were geocoded to assess neighborhood socioeconomic disadvantage and crime.

RESULTS

Results indicated that greater symptom severity was associated with decreased activation of key prefrontal regions underlying reappraisal, but only for patients living in neighborhoods characterized by high levels of personal (i.e. violent) crime. Unexpectedly, the opposite was found for patients living in low-crime neighborhoods, such that greater symptom severity was associated with increased neural activation during reappraisal (vs. viewing) of negative stimuli.

CONCLUSIONS

Findings highlight the critical importance of considering patients' neighborhood contexts when evaluating associations between symptom severity and neural correlates of reappraisal in patients with internalizing disorders.