Anabolic-Androgenic Steroids and Aggression in Humans: Experimental Studies, Subgroups, and Longitudinal Risk

Anabolic-androgenic steroid (AAS) use is a global public health concern. However, the relationship between AAS use and its psychological side effects, specifically aggression needs further elucidation. Results from experimental studies on this topic are inconsistent. Moreover, no previous study has examined patterns of aggression and psychological distress among male and female AAS users. Finally, although some studies have examined risk factors of AAS use in cross-sectional samples, there is a dearth of longitudinal studies on prevalence and risk factors for AAS use, particularly aggression, from late adolescence to early adulthood. Three studies were conducted to shed light on the aforementioned gaps in the literature. The aim of the first study was to systematically review and meta-analyse results from human randomized controlled trials (RCTs) on the effect of AAS administration on aggression. The second study aimed to investigate the patterns of aggression and psychological distress among AAS users among male and female AAS users. The third study aimed to examine the prevalence of AAS use, and longitudinal risk factors for AAS use intent, especially physical and verbal aggression, from late adolescence to early adulthood. A systematic review and meta-analysis was conducted to accomplish the first study’s aim. Twelve RCTs comprising a total of 562 healthy males were identified and included in the meta-analysis after systematic searches of MEDLINE, PsycINFO, ISI Web of Science, ProQuest, Google Scholar, and the Cochrane Library. The Q-statistic and I2 index were utilized to assess heterogeneity. Additionally, to achieve the aim of the second study, a cross-sectional survey was conducted on 206 AAS users (females = 58.30%) in Iran. Participants’ ages ranged from 14 to 56 (M = 26.86, SD = 7.12). Data was collected from Tehran, Iran. The questionnaire comprised questions on demographics, AAS use, aggression and psychological distress. A multigroup latent class analysis (MLCA) was conducted to elucidate patterns of aggression and psychological distress among this sample. Measurement invariance examined sex-specificity of identified patterns of aggression and psychological distress. Moreover, to accomplish the aim of the third study, a longitudinal study of the prevalence of AAS use, and risk factors of AAS use intent, particularly the role of physical and verbal aggression from age 18 to 19 was conducted in Norway. At the first wave, 1,333 18-year-olds (females = 58.9%) completed a questionnaire containing demographic, AAS use and intent, other substance (alcohol, cigarette, and snus) use, aggression, anxiety, and depression. At age 19 (N = 1277, females = 61.7%), they completed the same set of questionnaires. To analyse the data descriptive statistics, correlations, and hierarchical multiple regression were utilized Results of the first study, after excluding an outlier, indicated that AAS administration is associated with a small increase in self-reported aggression using a random-effects model. This result was replicated when restricting the analysis to the effect of acute AAS administration on self-reported aggression under a fixed-effect model. For the second study, the MLCA identified five subgroups of AAS users. The first and smallest subgroup (7.63%) comprised highly aggressive and moderately distressed users. The second subgroup (18.64%) consisted of moderately aggressive and distressed users. The third subgroup (22.95%) was composed of users with moderate levels of direct aggression (physical and verbal aggression) as well as distress, and mild levels of indirect aggression (anger and hostility). The fourth subgroup (11.71%) was made up of users with mild levels of direct aggression and moderate levels of indirect aggression and psychological distress. Finally, the fifth and largest subgroup (39.06%) encompassed users with low levels of aggression and mild levels of psychological distress. Results from measurement invariance analysis indicated that a homogenous five-class solution is the best model for both sexes. However, sex was significantly associated with the probability of belongingness to subgroups with members of the highly aggressive and moderately distressed subgroup more likely to be male users whereas members of the fifth subgroup were more likely to be female. Results of the third study indicated an AAS use prevalence of 1 person at age 18 to 4 persons at age 19. AAS use intent, being male, living alone, and actual AAS use at age 18 were predictive risk factors of AAS use intent at age 19. From age 18 to 19, physical aggression and verbal aggression decreased significantly in both sexes and, did not predict AAS use intent at age 19. Altogether, it can be inferred from the above results that AAS administration increases aggression in RCTs. Additionally, the above results provide evidence of the idiosyncratic patterns of aggression and psychological distress among male and female AAS users, and denote the lack of prospective associations between physical or verbal aggression and AAS use intent from ages 18 to 19. Findings from these studies contribute to the evidence base on AAS use and aggression. Potential applications of these findings in future research, policymaking and public health interventions is also discussed.Doktorgradsavhandlin

Aggression and Psychological Distress in Male and Female Anabolic-Androgenic Steroid Users: A Multigroup Latent Class Analysis

The relationship between anabolic-androgenic steroid (AAS) use and aggression and psychological distress requires further elucidation. No previous study has examined whether the latent patterns of aggression and psychological distress are the same in male and female AAS users. Multigroup latent class analysis (MLCA) can be used to classify individuals into groups based on their responses on a set of variables, and to investigate measurement invariance across subgroups. We therefore conducted a MLCA to identify discrete subgroups of aggression and psychological distress in AAS users, and used measurement invariance to examine whether the identified subgroups can be applied to both sexes. We also examined the relationship between sex and subgroup belongingness. The sample comprised 206 AAS users (females = 58.30%) aged 14–56 (mean = 26.86, SD = 7.12) years. They completed questionnaires assessing demographics, AAS use, aggression, and psychological distress. Based on the MLCA, five subgroups were identified: high aggression moderate distress users (HAMoD: 07.63%), moderate aggression distress users (18.64%), moderate direct aggression-mild indirect aggression moderate distress users (22.95%), mild direct aggression-moderate indirect aggression-distress users (11.71%), and low aggression mild distress users (LAMiD: 39.06%). Although a homogenous five-class solution was the best model for both sexes, sex was significantly associated with the probability of subgroup membership. In particular, members of the HAMoD subgroup were more likely to be male whereas members of the LAMiD subgroup were more likely to be female. Our study provides novel empirical evidence of the idiosyncratic patterns of aggression and psychological distress among male and female AAS users.publishedVersio

Aggression and Anabolic-Androgenic Steroid Use Intent in Adolescents: A Longitudinal Study

Background: There is a dearth of longitudinal studies on risk factors for anabolic–androgenic steroid (AAS) use and intent. Objectives: We conducted a longitudinal investigation of factors associated with AAS use intent from age 18 to 19, examining particularly the role of physical and verbal aggression. A sample of Norwegians completed questionnaires containing demographic, AAS use and intent, other addictions, aggression, and health measures at ages 18 (N = 1333, females = 58.9%) and 19 (N = 1277, females = 61.7%). The data were analyzed using descriptive statistics, correlations, and hierarchical multiple regression. Results: Results show that AAS use prevalence increased from 1 person at age 18 to 4 persons at age 19. Intent to use AAS, being male, living alone, and AAS use (all at 18 years) were associated with higher AAS use intent at 19 years. We found no associations between physical or verbal aggression and AAS use intent from ages 18 to 19. Conclusions: Our findings indicate temporal stability in AAS use intent, as well as the influence of demographic and health factors on AAS use intent from ages 18 to 19. Implications of findings for practice and future research are discussed.acceptedVersio

Anabolic-androgenic steroid administration increases self-reported aggression in healthy males: a systematic review and meta-analysis of experimental studies

Rationale Aggression and irritability are notable psychiatric side effects of anabolic-androgenic steroid (AAS) use. However, no previous study has systematically reviewed and quantitatively synthesized effects reported by experimental studies on this topic. Objective We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effect of AAS administration on self-reported and observer-reported aggression. Methods Twelve RCTs comprising a total of 562 healthy males were identified through systematic searches of MEDLINE, PsycInfo, ISI Web of Science, ProQuest, Google Scholar, and the Cochrane Library. Results After excluding one outlier, AAS administration was associated with an increase in self-reported aggression under a random-effects model, albeit small (Hedges’ g = 0.171, 95% CI: 0.029–0.312, k = 11, p = .018), and when restricting the analysis to the effect of acute AAS administration on self-reported aggression under a fixed-effect model (g = 0.291, 95% CI: 0.014–0.524, p = .014). However, the above effects were neither replicated in the analysis of observer-reported aggression nor after restricting the analysis to the effects of the administration of higher (over 500 mg) and long-term (3 days to 14 weeks) doses. Conclusions The present meta-analysis provides evidence of an increase, although small, in self-reported aggression in healthy males following AAS administration in RCTs. Ecologically rational RCTs are warranted to better explore the effect of AAS administration on aggression in humans

Heterosexual women rate perceived anabolic steroid-using men as less attractive for long-term romantic relationships

Background: Physical attractiveness is a major motive for anabolic-androgenic steroid (AAS) use. Since majority of AAS users are men, we investigated heterosexual women’s ratings of the physical, sexual and romantic attractiveness of AAS-using and non-using men. Methods: A sample of 112 AAS-non-using heterosexual women (age range: 15–81, M = 29.61 years) was randomized to two independent conditions: food (n = 50) and AAS (n = 62). After exposure to a vignette (varied in AAS use or food consumption) and the target image of a moderately muscular man (same across conditions), participants in both conditions rated their respective target on physical, short-term sexual, and long-term romantic attractiveness. We compared ratings of the two targets using an independent t-test. Results: Compared to the non-using target, the AAS-using target received lower ratings (t = −2.61, p < .05, Cohen’s d = 0.50) on long-term romantic attractiveness. Conclusion: Heterosexual women rate perceived AAS-using men as less attractive for long-term romantic relationships. Preventive and harm reduction interventions may benefit from highlighting this finding.publishedVersio

The Relationship Between Gambling Problems and the Five-Factor Model of Personality: A Systematic Review and Meta-Analysis

Objectives: The aim of the present meta-analysis was to synthesize results from the association between problem gambling (PG) and dimensions of the five factor model of personality and to identify potential moderators (gambling diagnosis: yes/no, comorbidity: yes/no and trait assessment: four or fewer items vs. five items or more) of these associations in meta-regressions. Methods: Searches were conducted in six databases; Medline, Web of Science, PsychInfo, Google Scholar, OpenGrey, and Cochrane Library (conducted on February, 22, 2021). Included studies: (1) reported a relationship between PG and at least one of the personality traits in the five-factor model, (2) contained information of zero-order correlations or sufficient data for such calculations, and (3) were original articles published in any European language. Case-studies, qualitative studies, and reviews were excluded. All articles were independently screened by two authors. Final agreement was reached through discussion or by consulting a third author. Risk of bias of the included studies was assessed by the Newcastle-Ottawa Scale. Data were synthesized using a random effects model. Results: In total 28 studies, comprising 20,587 participants, were included. The correlations between PG and the traits were as follows: Neuroticism: 0.273 (95% CI = 0.182, 0.358), conscientiousness −0.296 (95% CI = −0.400, −0.185), agreeableness −0.163 (95% CI = −0.223, −0.101), openness −0.219 (95% CI = −0.308, −0.127), and extroversion −0.083 (95% CI = −0.120, −0.046). For all meta-analyses the between study heterogeneity was significant. Presence of gambling diagnosis was the only moderator that significantly explained between-study variance showing a more negative correlation to extroversion when participants had a gambling diagnosis compared to when this was not the case. Discussion: The results indicated some publication bias. Correcting for this by a trim-and-fill procedure showed however that the findings were consistent. Clinicians and researchers should be aware of the associations between personality traits and PG. Previous studies have for example showed neuroticism to be related to treatment relapse, low scores on conscientiousness to predict treatment drop-out and agreeableness to reduce risk of treatment drop-out.publishedVersio

Functionality of the Crosswise Model for Assessing Sensitive or Transgressive Behavior: A Systematic Review and Meta-Analysis

Tools for reliable assessment of socially sensitive or transgressive behavior warrant constant development. Among them, the Crosswise Model (CM) has gained considerable attention. We systematically reviewed and meta-analyzed empirical applications of CM and addressed a gap for quality assessment of indirect estimation models. Guided by the PRISMA protocol, we identified 45 empirical studies from electronic database and reference searches. Thirty of these were comparative validation studies (CVS) comparing CM and direct question (DQ) estimates. Six prevalence studies exclusively used CM. One was a qualitative study. Behavior investigated were substance use and misuse (k = 13), academic misconduct (k = 8), and corruption, tax evasion, and theft (k = 7) among others. Majority of studies (k = 39) applied the “more is better” hypothesis. Thirty-five studies relied on birthday distribution and 22 of these used P = 0.25 for the non-sensitive item. Overall, 11 studies were assessed as high-, 31 as moderate-, and two as low quality (excluding the qualitative study). The effect of non-compliance was assessed in eight studies. From mixed CVS results, the meta-analysis indicates that CM outperforms DQ on the “more is better” validation criterion, and increasingly so with higher behavior sensitivity. However, little difference was observed between DQ and CM estimates for items with DQ prevalence estimate around 50%. Based on empirical evidence available to date, our study provides support for the superiority of CM to DQ in assessing sensitive/transgressive behavior. Despite some limitations, CM is a valuable and promising tool for population level investigation.publishedVersio

Association between problem gambling and personality traits: a longitudinal study among the general Norwegian population

ObjectiveThe present study investigates the longitudinal relationship between problematic gambling (PG) and the five factor model’s personality traits using autoregressive cross-lagged models.MethodsThe data used in the current study was collected by a national survey in 2013 (n = 10,081) and a follow-up study (n = 5,848) in 2015. PG was measured using Canadian Problem Gambling Index (CPGI) while personality was assessed using Mini-International Personality Item Pool (MINI-IPIP). Participants who completed the CPGI and all the personality items during both waves (n = 2,702) were analysed.ResultsThe results show that neuroticism had positive cross-lagged associations with CPGI. In contrast, conscientiousness and agreeableness in 2013 were found to have inverse cross-lagged effect on CPGI in 2015. Finally, openness and extraversion did not have any cross-lagged associations with CPGI.ConclusionPG poses serious negative implications for the involved individuals as well as their associated close social circle. Hence, it is important to understand predictors of PG for prevention purposes. Personality traits are one of the influential frameworks for examining uncontrolled psychopathological behaviors like PG. The study findings offer significant theoretical as well as practical implications

Climate anxiety, wellbeing and pro-environmental action: correlates of negative emotional responses to climate change in 32 countries

This study explored the correlates of climate anxiety in a diverse range of national contexts. We analysed cross-sectional data gathered in 32 countries (N = 12,246). Our results show that climate anxiety is positively related to rate of exposure to information about climate change impacts, the amount of attention people pay to climate change information, and perceived descriptive norms about emotional responding to climate change. Climate anxiety was also positively linked to pro-environmental behaviours and negatively linked to mental wellbeing. Notably, climate anxiety had a significant inverse association with mental wellbeing in 31 out of 32 countries. In contrast, it had a significant association with pro-environmental behaviour in 24 countries, and with environmental activism in 12 countries. Our findings highlight contextual boundaries to engagement in environmental action as an antidote to climate anxiety, and the broad international significance of considering negative climate-related emotions as a plausible threat to wellbeing

Negative emotions about climate change are related to insomnia symptoms and mental health : Cross-sectional evidence from 25 countries

Climate change threatens mental health via increasing exposure to the social and economic disruptions created by extreme weather and large-scale climatic events, as well as through the anxiety associated with recognising the existential threat posed by the climate crisis. Considering the growing levels of climate change awareness across the world, negative emotions like anxiety and worry about climate-related risks are a potentially pervasive conduit for the adverse impacts of climate change on mental health. In this study, we examined how negative climate-related emotions relate to sleep and mental health among a diverse non-representative sample of individuals recruited from 25 countries, as well as a Norwegian nationally-representative sample. Overall, we found that negative climate-related emotions are positively associated with insomnia symptoms and negatively related to self-rated mental health in most countries. Our findings suggest that climate-related psychological stressors are significantly linked with mental health in many countries and draw attention to the need for cross-disciplinary research aimed at achieving rigorous empirical assessments of the unique challenge posed to mental health by negative emotional responses to climate change.Peer reviewe