Interaction of perceived social support and childhood maltreatment on limbic responsivity towards negative emotional stimuli in healthy individuals

Perceived social support is a key protective factor for physical and psychological health, associated with lower allostatic load and reduced stress responses. Neuroimaging work links greater perceived social support to structural and functional characteristics in limbic and related regions (e.g., larger amygdala and posterior cingulate volumes, lower resting-state amygdala and insula activity). In contrast, childhood maltreatment (CM) is a robust risk factor for mental disorders (e.g., MDD, PTSD) and is associated with reduced hippocampal volumes and increased limbic reactivity to negative stimuli, with effects observable from childhood onward. Prior findings suggest social support may buffer adverse outcomes of CM, but evidence across developmental stages and imaging modalities is mixed, with some work indicating buffering primarily in early childhood and potentially diminishing thereafter. Adults with CM may also experience reduced social support and altered social perception, potentially limiting buffering effects later in life. The present study examined how perceived social support and CM interactively relate to limbic activity during negative emotional face processing in healthy adults. Focusing on the amygdala and hippocampus given their roles in emotion processing and relevance to CM and social support, the authors hypothesized: (1) CM would be positively associated with limbic activity; (2) perceived social support would be negatively associated with limbic activity; and (3) CM would moderate the association between perceived social support and limbic activity.

The paper integrates literature within the introduction. Key points: (1) Perceived social support relates to better health and reduced stress, with neural correlates including larger limbic-related gray matter volumes and reduced amygdala/insula activity. (2) CM is linked to elevated risk for MDD and PTSD, reduced hippocampal volume, and heightened limbic responses to negative stimuli; these effects emerge early and mirror patterns seen in clinical populations. (3) Evidence on social support buffering neural consequences of CM is heterogeneous across ages: some studies show buffering irrespective of adversity in children, while others indicate protective effects primarily in non-maltreated individuals or dependent on CM level or subtype. (4) Adult studies suggest complex, modality-dependent interactions among CM, social support, and brain structure/function, warranting targeted tests of interaction effects in healthy adults.

Design and participants: Data from the Münster Neuroimaging Cohort (MNC). Initially N=212 healthy adults (18–65 years) recruited 2013–2019 via public notices/newspapers. Exclusion: any lifetime mental disorder (SCID-I DSM-IV), neurological abnormalities, traumatic head injury, chronic medical diseases, organic mental disorders, dementia, psychotropic medication, MRI contraindications. All completed fMRI, SCID-I, Childhood Trauma Questionnaire (CTQ), and Social Support Questionnaire (FSOZU-K-22). Grouping: Participants were split using Walker et al. cut-offs: CM group if at least one CTQ subscale ≥ cut-off (n=65), non-CM (nCM) if all subscales below (n=147). Because groups differed in depressive symptoms (BDI-I), 1:1 matching on BDI-I was performed (MatchIt), yielding final N=130 (65 CM, 65 nCM) with no BDI difference. Ethics: Helsinki Declaration; approved by University of Münster ethics committee (2007-307-f-5); informed consent and reimbursement provided. fMRI paradigm and acquisition: Negative emotion face processing task widely used in prior work with four blocks of fearful/angry faces and five blocks of a sensorimotor control task (circles/ellipses). T2* functional images acquired on a 3T Philips Gyroscan Intera scanner. Preprocessing with SPM8 (details in Supplementary 2). Statistical analyses (behavioral): SPSS v25. Pearson correlation between CTQ total and FSOZU-K-22 total in N=130 to assess their relationship. Statistical analyses (fMRI): Analyses in SPM12 v7771 using an ROI approach for the bilateral amygdala-hippocampus complex (AHC). ROI mask created with WFU PickAtlas per AAL atlas (bilateral amygdala + hippocampus). Age and sex included as covariates of no interest. Multiple-comparisons correction via TFCE (Jena TFCE toolbox v232) with 5000 permutations, FWE-corrected p<0.05 at cluster level; minimum cluster size k ≥ 10 voxels (ROI). Primary dimensional regressions tested associations of (1) CTQ total and (2) FSOZU-K-22 total with AHC activity during negative emotion processing in the full sample (N=130). A social support (FSOZU-K-22) × group (CM vs nCM) ANCOVA tested interaction effects on AHC activity, with main effects and post hocs. Exploratory whole-brain ANCOVA used the same model with k ≥ 100 voxels. Robustness checks included models controlling for perceived stress and analyses in the unmatched sample (nCM=147 vs CM=65). Moderation analyses also examined CM as a continuous variable and CM subtypes (abuse vs neglect).

- Perceived social support vs CM: Significant negative correlation between FSOZU-K-22 total and CTQ total (r = −0.293, p < 0.001). - CTQ association with AHC activity: Higher CTQ scores associated with higher bilateral AHC activity during negative emotion processing. Left AHC: x = −30, y = −28, z = −14, TFCE(126) = 473.87, T = 4.66, k = 903, pFWE = 0.006, r = 0.239. Right AHC: x = 38, y = 28, z = 8, TFCE(126) = 414.95, T = 4.66, k = 757, pFWE = 0.009, r = 0.216. - Perceived social support association: Trend-level negative association with left AHC activity: x = −22, y = −12, z = −18, TFCE(126) = 133.63, T = 3.59, pFWE = 0.050, r = −0.136. - Social support × group interaction (ROI): Significant interaction in bilateral AHC. Left: x = −26, y = −36, z = −2, TFCE(1,124) = 4033.90, F = 8.97, k = 217, pFWE = 0.024, ηp2 = 0.089; Left: x = −28, y = −8, z = −24, TFCE(1,124) = 3066.00, F = 12.33, k = 62, pFWE = 0.019, ηp2 = 0.070; Right: x = 16, y = −36, z = 8, TFCE(1,124) = 23703.43, F = 23.84, k = 646, pFWE = 0.005, ηp2 = 0.070. Post hoc: In nCM group, higher perceived social support associated with lower bilateral AHC activity (Left: x = −28, y = −8, z = −24, TFCE(124) = 231.28, T = 4.05, k = 504, pFWE = 0.021, r = −0.429; Right: x = 14, y = −38, z = 8, TFCE(124) = 325.67, T = 4.27, k = 591, pFWE = 0.010, r = −0.411). No significant association in CM group (pFWE = 0.420). Main effect of perceived social support in left AHC (x = −22, y = −12, z = −18, TFCE(1,124) = 4517.64, F = 13.15, k = 107, pFWE = 0.029). No main effect of group (pFWE > 0.99). - Whole-brain exploratory: Significant social support × group interaction in clusters including hippocampus, parahippocampal gyrus, temporal gyri, and amygdala (all pFWE ≤ 0.046), driven by negative association with perceived social support in nCM (all pFWE ≤ 0.048), none in CM (pFWE = 0.464). No significant whole-brain main effects of group or perceived social support (pFWE ≥ 0.056). - Robustness: Results replicated when including covariates (perceived stress), in unmatched sample (n=212), and when modeling CM continuously. Moderation by CM was significant; abuse subtype drove the moderation, not neglect.

Findings demonstrate that CM moderates the relationship between perceived social support and limbic responsivity to negative emotional faces in healthy adults. Consistent with hypotheses, CM was positively associated with AHC activity. Perceived social support related to lower limbic activity, but this buffering effect was evident only in individuals without CM (or with lower CM on continuous analyses). In those with CM—particularly higher levels or abuse subtype—the protective association was absent, and continuous analyses suggested a possible positive trend between perceived social support and limbic activity at high CM levels. Potential mechanisms include lasting neurobiological alterations from CM during sensitive developmental periods, altered social perception and heightened threat sensitivity, and reduced social skills or confidence in receiving support, which may diminish or even reverse the benefits of support. Results align with studies showing protective effects of support on hippocampal volume primarily in non-maltreated individuals and suggest that the timing and type of CM (abuse vs neglect) may differentially impact emotion-processing circuitry. Despite examining a resilient, healthy adult sample and controlling for perceived stress and depressive symptoms, the interaction persisted, underscoring its robustness. The work refines understanding of when and for whom social support may buffer neural responses to negative emotion, with implications for tailoring interventions to individuals with CM histories.

The study shows that in healthy adults, perceived social support is linked to reduced limbic (amygdala-hippocampus) activity during negative emotion processing only in those without or with lower levels of childhood maltreatment. Individuals with CM, particularly with abuse experiences, do not exhibit this neural buffering effect. CM independently associates with heightened limbic activity. These findings suggest CM alters how social support influences emotion-related neural circuits and underscore the need for preventive and therapeutic strategies focused on enhancing social support perception, coping skills, and self-esteem in those with CM. Future research should adopt longitudinal and developmental designs, include clinical populations, parse types and timing of CM and social support (perceived vs received), and examine connectivity and regulatory networks to clarify mechanisms and causal pathways.

- Sample: Healthy adults only; findings may not generalize to clinical populations or younger cohorts. The sample skews older, potentially reflecting greater resilience; age was controlled but residual effects are possible. - Measurement of CM and social support: CTQ is retrospective and subject to recall bias; although it demonstrates temporal stability, detailed timing/frequency were not captured. FSOZU-K-22 short form precluded analysis of specific support subtypes and measured perceived, not received, support. - Grouping: Dichotomizing CM (female-derived cut-offs) may lead to information loss and heterogeneity; cut-offs may not optimally fit mixed-gender samples. However, dimensional analyses converged with main results. - Design: Cross-sectional; causal inferences cannot be made. - Task/modality scope: Focus on limbic activity to negative faces; did not assess resting activity, connectivity, or differentiate support types, which may limit detection of broader social support effects.