Social interaction anxiety, social phobia, and cognitive control: controlled reactions to facial affect during an emotional face flanker task

Trait social anxiety may predict differences in the cognitive control of emotional distraction when emotional face discrimination is required. This effect can be investigated using an emotional face flanker task. This study addresses an important research gap, as previous studies did not separate the effects of trait social interaction anxiety from the effects of trait social phobia upon emotional face flanker task performance. In this laboratory based behavioural experiment, the 87 participants (mean age 24.3) were university students or staff recruited via departmental adverts. We used an emotional (happy versus fearful) face flanker task, and assessed sub-clinical social anxiety with the SIAS/SPS. Elevated trait social phobia was related to an increased reaction time (RT) congruency effect, whereas trait social interaction anxiety was not. Elevated trait social interaction anxiety was related to a decreased happy face RT advantage for central target faces, but the effect of trait social phobia was very weak. Trait social interaction anxiety and trait social phobia may predict subtle differences when the cognitive control of reactions to emotional facial expressions is required

The effects of social anxiety on emotional face discrimination and its modulation by mouth salience

People high in social anxiety experience fear of social situations due to the likelihood of social evaluation. Whereas happy faces are generally processed very quickly, this effect is impaired by high social anxiety. Mouth regions are implicated during emotional face processing, therefore differences in mouth salience might affect how social anxiety relates to emotional face discrimination. We designed an emotional facial expression recognition task to reveal how varying levels of subclinical social anxiety (measured by questionnaire) related to the discrimination of happy and fearful faces, and of happy and angry faces. We also categorised the facial expressions by the salience of the mouth region (i.e. high [open mouth] vs. low [closed mouth]). In a sample of 90 participants higher social anxiety (relative to lower social anxiety) was associated with a reduced happy face reaction time advantage. However, this effect was mainly driven by the faces with less salient closed mouths. Our results are consistent with theories of anxiety that incorporate an oversensitive valence evaluation system

STAI-Anxiety and STAI-Depression Revisited

The State-Trait Anxiety Inventory (STAI) is widely used to measure anxiety in academic, psychiatric, and medical settings. However, it has been proposed that the trait scale does not measure pure anxiety but contains subscales that measure either anxiety or depression. As this may have implications for the interpretation of research, we investigated the differential correlates of these two subscales. Participants (N = 171; Mage = 23.6 years) completed measures of attentional control (attentional focusing; attentional shifting), behavioral approach sensitivity (BAS), trait anger, and interpersonal fear. STAI-anxiety was predicted by interpersonal fear, and trait anger when STAI-depression was held constant. By contrast, STAI-depression was predicted by BAS and attentional shifting when STAI-anxiety was held constant. To further illustrate the functional significance of these results, we reanalyzed a published study that originally showed that total STAI scores predicted affective cognitive control in the emotional face Stroop task. Results showed that STAI-anxiety and STAI-depression differentially predicted the cognitive control of distraction. The significance of our results is discussed in relation to interpreting the STAI in academic and neuropsychiatric/clinical settings

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa