Postoperative complications and symptoms of anxiety and depression in patients with gastric and esophageal cancer: a retrospective cohort study.

CONTEXT: Gastric and oesophageal cancers are common. They are also expected to increase in incidence in the next few years and are characterized by poor prognosis. Surprisingly, whereas the incidence of severe anxiety and depression is high in patients with gastric and oesophageal cancers, the influence of symptoms of depression and anxiety on postoperative complications has barely been explored. METHODS: In a retrospective study based on a prospectively collected database, 629 cancer patients were enrolled. Symptoms of depression and anxiety (Hospital Anxiety and Depression Scale scores) and sociodemographic and medical information were collected immediately after diagnosis and before any treatment. The surgical approach (i.e. gastrectomy or oesophagectomy) and postoperative complications according to the Clavien-Dindo classification were collected after surgery. RESULTS: After controlling for known medical predictors (i.e. surgical strategy, alcohol and tobacco consumption, American Society of Anaesthesiologists classification physical status score) of postoperative complications, no effect of symptoms of depression or anxiety was detected. DISCUSSION: The observed results are surprising given the literature. However, several potential arguments can be put forwards regarding methods and measures, controlling variables, and conceptual distinctions. Despite the absence of significant results, this topic should be more deeply investigated by applying methodological and conceptual adjustments.

Happy thus survivor? A systematic review and meta-analysis on the association between cancer survival and positive states, emotions, and traits.

OBJECTIVES: Traditionally, the literature investigating patient-reported outcomes in relation to cancer survival focused on negative factors such as distress. Meta-analyses in this field have provided a clear identification of negative affect that reduce cancer survival (e.g., depression). Nevertheless, positive psychological factors and especially positive affect might be equally crucial for cancer survival but have been neglected so far. While studies in this domain have been conducted, they remain less numerous and have produced mixed results. METHODS: A pre-registered systematic review and meta-analysis (https://osf.io/jtw7x) aimed at identifying the positive affect linked to mortality in cancers were conducted. Four databases (Pubmed, PsycINFO, Embase, and Cochrane Library) were searched to find longitudinal studies linking positive affect to survival in cancers. Two reviewers completed each stage of the study selection process, the data extraction, and the Quality in Prognosis Studies risk of bias assessments. RESULTS: Twenty-four studies involving 822,789 patients were included based on the 2462 references identified. The meta-analysis reveals that positive affect is associated with longer survival (Hazard Ratio [HR] = 0.91; 95% CI [0.86, 0.96], z = -3.58, p < 0.001) and lower mortality (Odd Ratio [OR] = 0.59; 95% CI [0.45, 0.78], z = -3.70, p < 0.001). Sub-group analyses indicated that the main predictors of survival are emotional and physical well-being, optimism, and vitality. CONCLUSION: This work emphasizes the need to consider the role of affective mechanisms in patients with cancer, including their levels of well-being or optimism to provide the most favorable conditions for survival. Therefore, stronger and continuous effort to improve patients' positive affect could be particularly beneficial for their life expectancy.

Greater self-oriented and socially prescribed perfectionism in severe alcohol use disorder.

BACKGROUND: Perfectionistic individuals present exaggerated performance standards, generating a constant search for flawlessness and a high tendency to self-criticize. Dominant models distinguish three dimensions of perfectionism: namely, self-oriented, socially prescribed and other-oriented. Perfectionism constitutes a vulnerability factor for psychopathological disorders, but its role in severe alcohol use disorder (SAUD) remains unexplored. METHODS: Sixty-five recently detoxified patients with SAUD and 65 matched controls completed a perfectionism questionnaire (the Hewitt Multidimensional Perfectionism Scale), together with measures of psychopathology. RESULTS: SAUD was associated with greater self-oriented and socially prescribed perfectionism, with no group differences on other-oriented perfectionism. This differential pattern persisted when controlling for depression and anxiety levels, and there was no correlation with alcohol consumption. CONCLUSION: This specific perfectionistic profile is consistent with those of previous studies showing lower self-evaluation (e.g., higher self-blame and reduced self-esteem) and impaired social cognition (e.g., unrealistic social standards and greater social isolation) in SAUD. In view of its potential role in the development and maintenance of SAUD, perfectionism may constitute a valuable treatment target in patients with this disorder.

Longitudinal Assessment of Alcohol Consumption throughout the First COVID-19 Lockdown: Contribution of Age and Pre-Pandemic Drinking Patterns.

INTRODUCTION: The COVID-19 outbreak and the related lockdown measures have raised concerns regarding mental health, including alcohol misuse. Preliminary studies investigated alcohol consumption at the early stages of lockdown, but no longitudinal data regarding its evolution during and after the first lockdown are currently available. METHODS: We investigated changes in alcohol consumption among a convenience sample of 1,693 French-speaking Belgian adults using a 3-stage longitudinal online survey. All participants reported their consumption at different stages of lockdown: before lockdown onset (retrospectively, T0), at 2 different times during lockdown (T1 and T2), and after lockdown offset (T3). We also measured socio-demographic variables and the harmfulness of drinking patterns before lockdown. RESULTS: A mixed model with negative binomial distribution indicated that participants decreased their alcohol consumption after lockdown onset and returned to their initial alcohol consumption after lockdown offset. Younger individuals (18-30 years old) were more likely to decrease their consumption during the lockdown period (T1 and T2) than the periods preceding or following lockdown (T0 and T3), especially if they presented hazardous or problematic drinking patterns before lockdown. We only observed a rebound effect after lockdown offset among young moderate drinkers. All participants kept stable their alcohol consumption during lockdown (T1 and T2). CONCLUSIONS: Lockdown onset and offset constitute key periods for alcohol consumption changes during the COVID-19 crisis, particularly in youth and in individuals with hazardous or problematic drinking patterns.

Stigmatization and dehumanization perceptions towards psychiatric patients among nurses: A path-analysis approach.

BACKGROUND: People with mental illness are stigmatized and dehumanized, which contributes to disorders' maintenance. Dehumanization is associated with abuse/neglect and should thus be evaluated among healthcare workers. We compared nurses' stigmatizing/dehumanizing perceptions of people with psychiatric versus non-psychiatric disorders. We also investigated the impact of social contact's quality/frequency and identified the determinants of dehumanization. METHODS: French-speaking hospitals and nurses' associations were contacted to disseminate the survey among their employees or members. Three hundred thirty-six nurses reported their perceptions of one among three clinical populations (people with severe alcohol use disorder, schizophrenia, or cardiovascular disease). Nurses' perception of patients was evaluated through stigmatization, dehumanization, quality of contacts, structural discrimination, and evaluation of patients' life, pain, consent, and diagnostic overshadowing. Nurses' well-being was evaluated through their own perception of being dehumanized by superiors and their burnout, depression, anxiety, and stress levels. RESULTS: Nurses stigmatized and dehumanized people with a psychiatric disorder more than people without a psychiatric disorder. Nurses dehumanized patients more if they felt dehumanized by their hierarchical superiors and less if they had qualitative contacts with patients. CONCLUSIONS: Stigmatization and dehumanization are widespread among nurses in psychiatry, which advocates for less stigmatizing practices in healthcare settings. We propose concrete perspectives to reduce stigma/dehumanization among nurses.

Self-dehumanisation in severe alcohol use disorder: Links with self-stigma and environmental satisfaction.

Metadehumanisation (i.e., the perception of being considered as less than human by others) is proposed to be widespread in stigmatised populations, such as people with severe alcohol use disorder (SAUD). However, the relations between metadehumanisation, self-dehumanisation (i.e., the self-perception of being less than human), and stigmatisation (i.e., the negative taint applied to some groups) remain unexplored. The aim of this research is thus to investigate the relations between these processes. Metadehumanisation, self-dehumanisation, self-stigma (and its subdimensions) and environmental satisfaction were assessed in 120 inpatients with SAUD and analysed in a mediational model. Stigma awareness was positively associated with metadehumanisation, whereas environmental satisfaction was negatively associated with metadehumanisation. Stigma's application to the self was associated with increased self-dehumanisation. Self-stigma and self-dehumanisation are closely intertwined phenomena. Self-dehumanisation seems to follow a multi-step process suggesting that some steps, such as dehumanisation awareness, are missing from current models of dehumanisation.

Metadehumanization, fundamental needs and coping strategies: A comparison of drinkers at low versus high risk of alcohol use disorder.

The interpersonal difficulties documented in chronic excessive drinking might foster the progression toward severe alcohol use disorder (SAUD). Characterizing these interpersonal difficulties and their commonalities with patients already presenting a diagnosed SAUD is needed to develop targeted prophylactic interventions. Patients with SAUD present metadehumanization (i.e., the perception of being considered as less than human by others), which is associated with deleterious consequences (e.g., reduced fundamental needs satisfaction, increased negative emotions, reduced self-esteem, disrupted coping strategies) involved in the persistence of this disorder. No study has investigated metadehumanization among individuals not diagnosed with SAUD but at high risk of alcohol use disorder. We measured metadehumanization, emotions, self-esteem, coping strategies, and fundamental needs threat among such high-risk drinkers (N = 86; AUDIT score higher than 15), and matched low-risk drinkers (N = 100, AUDIT score <8). Compared to low-risk drinkers, high-risk drinkers felt more dehumanized and reported increased fundamental needs threat, negative emotions, anxiety, depression, and more frequent use of both adaptive and maladaptive coping strategies, including alcohol use. Mediation analyses controlling for anxiety/depression revealed that the differences in emotions and coping strategies were explained by metadehumanization and fundamental needs threat. Despite not being diagnosed with SAUD and being untreated, high-risk drinkers are more similar to patients with SAUD than to low-risk drinkers. In view of its links with factors favoring SAUD, metadehumanization should be considered in experimental studies among high-risk drinkers and treated by specific interventions.

Suicidal ideations and self-dehumanization in recently detoxified patients with severe alcohol use disorder: an experimental exploration through joint explicit-implicit measures.

BACKGROUND: Metadehumanization (the feeling of being considered as less than human by others) is a pervasive phenomenon in psychiatric states, notably promoting self-dehumanization and suicide antecedents. However, its role in suicidal ideations among patients with addictive disorders remains unexplored. We thus investigated the involvement of metadehumanization/self-dehumanization in suicidal ideations and suicidal thoughts interference in severe alcohol use disorder. METHODS: We measured metadehumanization, suicidal ideations, and desire for social contact through questionnaires among 35 recently detoxified patients with severe alcohol use disorder (26 males). We measured animalistic/mechanistic self-dehumanization using an Implicit Association Task, and suicidal thoughts interference using a Stroop Task with suicide-related words. We performed regression analyses while controlling for depression/anxiety. RESULTS: Animalistic self-dehumanization was positively associated with suicidal thoughts interference and with decreased desire for social interactions, such link being absent for metadehumanization or mechanistic self-dehumanization. CONCLUSIONS: This link between self-dehumanization and suicide-related factors suggests that a reduced sense of belonging to humanity is associated with self-harm antecedents. Results also emphasize the importance of using indirect measures to investigate sensitive variables, such as self-dehumanization and suicidal thoughts.

Metadehumanization and Self-dehumanization are Linked to Reduced Drinking Refusal Self-Efficacy and Increased Anxiety and Depression Symptoms in Patients with Severe Alcohol Use Disorder.

Metadehumanization, the perception of being treated as less than a human by others, is a pervasive phenomenon in intergroup relations. It is dissociated from stigmatization or stereotypes, and it has been recently identified as a critical process in severe alcohol use disorders (SAUD). Metadehumanization is associated with a wide array of negative consequences for the victim, including negative emotions, aversive self-awareness, cognitive deconstruction, and psychosomatic strains, which are related to anxiety and depression. This study aims to investigate if metadehumanization occurring among patients with SAUD is associated with clinical factors involved in the maintenance of the disease, namely symptoms of depression or anxiety and drinking refusal self-efficacy. A cross-sectional study was conducted among 120 patients with SAUD. Self-reported questionnaires measured metadehumanization, self-dehumanization (i.e., the feeling of being less than a human), anxiety, depression, drinking refusal self-efficacy, and demographics. Metadehumanization was significantly associated with self-dehumanization, anxiety, depression, and drinking refusal self-efficacy. Additionally, path analyses showed that self-dehumanization mediated the links between metadehumanization and clinical variables. These results indicate that metadehumanization and self-dehumanization could be essential factors to consider during SAUD treatment, as they are associated with increased psychiatric symptoms and reduced drinking refusal self-efficacy.

Alcohol consumption changes following COVID-19 lockdown among French-speaking Belgian individuals at risk for alcohol use disorder.

We investigated changes in alcohol consumption following the COVID-19 lockdown among French-speaking Belgian individuals at risk for severe alcohol use disorder. Participants (N = 299) at risk for alcohol use disorder (AUD, i.e., score higher than 19 at the Alcohol Use Disorder Identification Test), and 299 moderate drinkers (MOD, i.e., score lower than 8) individually matched for age, gender and education provided self-reports of alcohol consumption changes (i.e., number of alcohol units consumed during a typical week before and during lockdown). AUD were more likely (91.31%) than MOD (71.57%) to modify their consumption following lockdown (p < 0.0001). They were more likely to decrease (65.89% vs. 35.12%, p < 0.0001) and less likely to increase (25.42% vs. 36.45%, p = 0.004) their consumption than MOD. Analyses of post-pre lockdown differences in alcohol consumption showed that AUD presented a stronger decrease than MOD (-13.97 units/week vs. -0.07, p < 0.0001). Among individuals who decreased consumption, AUD decreased more (-27.92 vs. -2.74, p < 0.0001) than MOD. Among those who increased consumption, AUD increased more (17.32 vs. 2.44, p < 0.0001) than MOD. We thus observed sharp consumption increases or conversely abrupt decreases in individuals at high risk of alcohol use disorder, underscoring the need to develop prophylactic interventions for this population during such sanitary crises, to avoid brutal changes of the alcohol consumption pattern. Efforts should be made to mitigate consumption increases but also to favor progressive rather than sudden decreases in order to prevent damaging withdrawal symptoms.

Examining the role of fundamental psychological needs in the development of metadehumanization: A multi-population approach.

In the present paper, we investigate dehumanization processes from a victim perspective. We propose that dehumanization experiences, that is metadehumanization, arise from people's feelings that their fundamental human needs are thwarted and that such experiences influence their emotions, self-esteem, and coping strategies. Our model is put at test in three contexts involving different types of dehumanization victims: Women (Study 1a, N = 349), patients with severe alcohol use disorder (Study 1b, N = 120), and employees in organizations (Study 1c, N = 347). Our integrated model of metadehumanization, which considers both its antecedents and consequences, proved stable across contexts and populations and therefore helps building bridges between different psychological disciplines in which dehumanization occurs.

Prior drinking motives predict alcohol consumption during the COVID-19 lockdown: A cross-sectional online survey among Belgian college students.

The global outbreak of coronavirus disease 2019 (COVID-19) and the resulting lockdown measures have raised concerns regarding their effect on alcohol consumption. We investigated alcohol use during lockdown in a population of college students, usually characterized by social and heavy drinking. We also tested the predictive role of pre-lockdown drinking motives on alcohol consumption during lockdown. We collected data from 1951 French-speaking Belgian students during the lockdown period (April 1st - May 3rd, 2020) through a cross-sectional online survey. Participants self-reported their daily alcohol consumption (1) during a typical week in normal circumstances (i.e., before lockdown), and (2) since lockdown onset. We also assessed drinking motives and severity of alcohol use before lockdown. Our findings showed that 68.2% of the sample reported a lower alcohol consumption during lockdown compared to before lockdown, 17.2% conversely reporting a higher consumption. Enhancement, social and coping motives were all associated with heavy drinking before lockdown. Enhancement and social motives predicted lower alcohol consumption during lockdown among heavy drinkers. Conversely, coping motives, as well as social motives among low drinkers, predicted higher consumption during lockdown. Conformity motives, as well as enhancement motives among low and moderate drinkers, did not predict alcohol consumption before or during lockdown. Overall, several pre-lockdown drinking motives reliably predicted alcohol consumption during lockdown and could thus be used to identify at-risk populations and to tailor intervention programs on alcohol misuse during sanitary crises.

Alcohol consumption changes during the first COVID-19 lockdown: an online population survey in a convenience sample of French-speaking Belgian residents.

An online survey among French-speaking Belgians (N=7711) investigated self-reported changes in alcohol consumption during the first COVID-19-related lockdown (March 17th - May 4th 2020). Population-weighted estimates indicated that 31.37% of the population increased consumption during lockdown, 30.32% decreased consumption and 38.31% reported unchanged consumption. The magnitude of change was higher for "decreasers" than "increasers", resulting in a slight reduction in overall consumption. A multiple regression analysis revealed that age, occupational status, number of cohabitants, perceived alcohol accessibility, drinking motivations and previous consumption predicted consumption changes. The lockdown was thus associated with consumption modifications among French-speaking Belgians, without a prevailing direction of change.

Emotional processes in binge drinking: A systematic review and perspective.

Binge drinking is a widespread alcohol consumption pattern commonly engaged by youth. Here, we present the first systematic review of emotional processes in relation to binge drinking. Capitalizing on a theoretical model describing three emotional processing steps (emotional appraisal/identification, emotional response, emotional regulation) and following PRISMA guidelines, we considered all identified human studies exploring emotional abilities among binge drinkers. A literature search was conducted in PubMed, Scopus, and PsychINFO, and a standardized methodological quality assessment was performed for each study. The main findings offered by the 43 studies included are: 1) regarding emotional appraisal/identification, binge drinking is related to heightened negative emotional states, including greater severity of depressive and anxiety symptoms, and have difficulties in recognizing emotional cues expressed by others; 2) regarding emotional response, binge drinkers exhibit diminished emotional response compared with non-binge drinkers; 3) regarding emotional regulation, no experimental data currently support impaired emotion regulation in binge drinking. Variability in the identification and measurement of binge drinking habits across studies limits conclusions. Nevertheless, current findings establish the relevance of emotional processes in binge drinking and set the stage for new research perspectives to identify the nature and extent of emotional impairments in the onset and maintenance of excessive alcohol use.

Metadehumanization in severe alcohol-use disorders: Links with fundamental needs and clinical outcomes.

BACKGROUND: Dehumanization, i.e., the denial of one's humanity, has important consequences for social interactions. Earlier works mainly studied the dehumanizer's perspective, neglecting victims and particularly psychiatric populations. This study's goal is thus to investigate if patients with severe alcohol-use disorders (SAUD) feel dehumanized by others and to reveal factors linked to metadehumanization. METHODS: A cross-sectional study in 120 patients with SAUD as diagnosed by their psychiatrist using DSM-IV criteria. RESULTS: Participants reported significant levels of metadehumanization, which were directly or indirectly linked to fundamental needs threat (γ = 0.41, p < .001), decreased positive emotions (indirect effect = -0.11, p < .05), reduced self-esteem (indirect effect = -0.16, p < .01), reduced use of functional coping strategies focused on the search of social support (γ = -0.20, p < .05), and increased use of dysfunctional coping strategies (indirect effect = 0.15, p < .01) such as excessive alcohol use (indirect effect = 0.10, p < .05). CONCLUSIONS: Patients feel dehumanized by others, an experience linked to important deleterious consequences for patients' wellbeing and treatment.

Dehumanization of psychiatric patients: Experimental and clinical implications in severe alcohol-use disorders.

Dehumanization, defined as the denial of one's membership to humanity, is a process repeatedly reported in extreme contexts (e.g., genocides) but also in everyday life interactions. Some antecedents of dehumanizing experiences (e.g., social exclusion, negative stereotypes) have been reported among patients presenting psychiatric disorders, but dehumanization's experience remains completely unexplored in addictive disorders. We propose a theoretical model and research agenda to overcome this limitation and to improve our understanding of dehumanization's experience in psychiatry, with a special focus on alcohol-related disorders. We also propose much-needed clinical avenues to reduce dehumanization in clinical contexts, centrally by (1) improving dehumanization awareness among medical workers; (2) reducing the need for healthcare workers to use dehumanization to alleviate professional exhaustion; and (3) optimizing medical training to increase empathy toward patients. Finally, some additional improvements are proposed to promote patient's choices, comfort, dignity, and ultimately humanity in hospitals.