Racial Discrimination and Fear-Based Symptoms: Links to Avoidance Behavior and Hippocampal Activity in Black Youth

Racial discrimination (RD) increases the risk of fear-based disorders, such as anxiety and posttraumatic stress disorder (PTSD), and alters activity in brain regions important for fear extinction in adults. However, little is known about these associations in adolescence-a key period for the emergence of these disorders-especially among Black youth, who frequently experience RD. This study examined RD's links to anxiety, PTSD symptoms, fear extinction, and brain activity in 54 Black youth (54% female; M ± SD age = 13 ± 2.27 years). Participants completed questionnaires and an fMRI-based Pavlovian fear extinction task. Conditioned fear was measured via skin conductance responses (SCRs), behavioral avoidance, and self-reported fear. Neural activation was examined in the amygdala, hippocampus, and anterior cingulate cortex. Regressions examined associations between RD, symptoms, conditioned fear, and brain activity during extinction. Higher RD was linked to higher anxiety and PTSD symptoms, as well as differential patterns of behavioral avoidance. There were no effects of RD on SCRs or self-reported fear. RD was associated with greater right hippocampal activity to the threat cue relative to the safety cue, and hippocampal activity had an indirect effect on the link between RD and behavioral avoidance. RD-related differences in avoidance behavior and hippocampal activity are associated with fear-based symptoms in Black adolescents, highlighting potential pathways for further investigation.