Racial Differences in Psychiatric Symptoms, Maladaptive Eating, and Lifestyle Behaviors After Bariatric Surgery

There are several psychological and behavioral factors associated with poorer outcomes following bariatric surgery, yet it is unknown whether and how these factors may differ by race. In this cross-sectional study, individuals who underwent bariatric surgery from 2018 to 2021 and up to 4 years post-surgery were invited to complete an online survey. Psychiatric symptoms, maladaptive eating patterns, self-monitoring behaviors, and exercise frequency were examined. Participants (N = 733) were 87% women, 63% White, with a mean age of 44 years. Analyses of covariance demonstrated that White individuals endorsed greater anxiety symptoms (p =.01) and emotional eating due to depression (p = .01), whereas Black individuals endorsed greater depression severity (p = .02). Logistic regression analyses demonstrated that White individuals were more likely to experience loss of control eating (OR= 1.7, p = .002), grazing (OR= 2.53, p <.001), and regular self-weighing (OR= 1.41, p <.001) than Black individuals, and were less likely to skip meals (OR= .61, p = .04), or partake in nighttime eating (OR= .40, p <.001). There were no racial differences in binge eating, emotional eating due to anxiety or frustration, use of a food diary, or exercise. Thus, depressive symptoms, skipping meals, and nighttime eating may be important, modifiable intervention targets to optimize the benefits of bariatric surgery and promote equitable outcomes.

Utility of phosphatidylethanol testing as an objective measure of alcohol use during the preoperative evaluation for bariatric surgery

BACKGROUND

The risk of alcohol use disorder increases after bariatric surgery. Preoperative alcohol use is a risk factor, and this is evaluated during the routine preoperative psychosocial evaluation. However, it is not clear whether patients accurately report their alcohol use.

OBJECTIVE

To determine whether an objective measure of alcohol use, phosphatidylethanol (PEth) testing, offers utility beyond self-reported alcohol use during the preoperative evaluation for bariatric surgery.

SETTING

Single healthcare system.

METHODS

PEth testing was included as part of the routine laboratory work for 139 patients undergoing evaluation for bariatric surgery. PEth testing results were compared with self-reported alcohol use and scores on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) questionnaire obtained during the preoperative psychosocial evaluation. PEth testing results were categorized into abstinent, light use, moderate use, or heavy use. There were 85 patients who completed both PEth testing and a preoperative psychosocial evaluation.

RESULTS

There were 25 participants (29.4%) who had a positive PEth test; about half had moderate or heavy use values (15.3% of the total sample). The majority of participants with a positive PEth test (82.6%) denied recent alcohol use. Of those with PEth values indicating moderate or heavy use, 61.5% did not have an elevated AUDIT-C score.

CONCLUSIONS

Patients appeared to underreport their alcohol use during the preoperative psychosocial evaluation. There appears to be utility for routine PEth testing as part of the evaluation process to identify those with risky drinking patterns. Patients with preoperative risky drinking could be educated about their risk and/or referred to programs to mitigate the development of preoperative alcohol misuse.

Event-related brain correlates of associative learning without awareness

Controversy exists about whether associative learning occurs without awareness. In an earlier study using subthreshold (subliminal) stimuli, we reported evidence that such learning could occur as measured by event-related brain potentials [ERP; Cons. Cognit. 6 (1997) 519]. In the present study, we extend these findings by changing several aspects of the methodology in order to provide a more stringent test of this effect and to examine its generality. We used two matched words (murder and cancer) as conditional stimuli (CS); a 100 dB white noise blast as unconditional stimulus (US); a CS-US interval of 3 s; and a full-factorial design with CSs counterbalanced. The conditioning-acquisition phase occurred when the CSs were perceptually unconscious, as confirmed by a subsequent behavioral task. The conditioning-acquisition and postconditioning-extinction phases were examined for ERP evidence of associative learning. The clearest and strongest evidence for associative learning without awareness was observed in the ERP component measures (up to 1 s, poststimulus) in the postconditioning-extinction phase. The CS+ was significantly more positive than the CS- in the P3b-LP component region, which is highly consistent with the results of our earlier study. Differences also were observed in the P1-P2 components. In an unexpected finding, we observed a significant positive slow potential shift for the CS+ in the region between 1 and 3 s poststimulus. We discuss these results and their implications for our understanding of associative learning and awareness.

Subliminal visual oddball stimuli evoke a P300 component

OBJECTIVE

To provide evidence that a P300 component can be elicited by subliminal stimuli in an oddball paradigm.

METHODS

The words LEFT and RIGHT were presented in a frequent-rare ratio (80-20%), counterbalanced between subjects. Stimuli were presented at the objective detection threshold (d'=0, via unmasked 1 ms presentations), a stringent measure for detecting any conscious perception.

RESULTS

A significantly larger amplitude component was found for rare vs. frequent stimulus presentations across electrodes Fz, Cz, and Pz using both a broad 200-900 ms window (F(1,27)=5.75, P<0.012, eta(2)=0.18; one-tailed), and a more narrow 400-760 ms window defined using principal component analysis (F(1,27)=10.10, P<0.002, eta(2)=0.27; one-tailed). No significant component latency effects were found. An analysis of the conscious perception index (d') and the oddball effect (rare-frequent amplitude difference) revealed a negative relationship, further supporting the contention that conscious perception does not account for the finding, and suggesting that any conscious stimulus detection may inhibit this subliminal effect.

CONCLUSIONS

Results provide evidence that an endogenous component can be elicited by undetectable subliminal stimuli in an oddball paradigm. Implications are discussed for comparing conscious and unconscious information processing, unconscious learning, and the measurement of ERPs to subliminal stimuli.

The primary process and the unconscious: experimental evidence supporting two psychoanalytic presuppositions

The authors report on two experiments designed to test an important feature of the primary process: unconscious categorisation by attributes rather than by relations. These experiments were designed to provide support, independently of the clinical situation, for the presupposition of a psychological unconscious and for the presupposition that unconscious mentation is organised along primary-process lines. Their results were encouraging. They found that (1) unconscious similarity judgements could be made; and (2) these judgements were based on attributes (a primary-process mechanism) rather than relationships (a secondary-process mechanism). This independent evidence, obtained in controlled experimental studies supporting two fundamental psychoanalytic presuppositions, should be welcome news to psychoanalysts, given the continuing criticism from many quarters that basic psychoanalytic ideas lack independent validation. This paper begins with an overview of the primary processes with a special focus on the role of categorisation by attribute, the particular aspect of primary process explored in this study. Next a brief history of previous empirical investigations of primary process is given, following which the current experiments are presented.

Music absorption and hypnotizability

The present study investigated differences between high (N = 15), medium (N = 20), and low (N = 16) hypnotizable Ss' involvement in imaginative versus nonimaginative music. Ss were first screened for hypnotizability with the Harvard Group Scale of Hypnotic Susceptibility, Form A (Shor & E. Orne, 1962). In a second session presented as a study of music appreciation, Ss listened to classical music of high and low rated music imaginativeness. Ss' involvement was indexed by absorption, imagery elaboration reported in open-ended essays, and reaction time to a pure tone. High hypnotizable Ss reported more absorption than low hypnotizable Ss, regardless of the imaginativeness level of the music. Ss reported more imagery elaboration in the imaginative than in the low imaginative passages. High hypnotizable Ss tended to differ in their imagery elaboration in response to the imaginative passages but not in response to the nonimaginative passages. Reaction time results were nonsignificant. No sex differences were found. Medium hypnotizable Ss were indistinguishable from both high and low hypnotizable Ss. The findings are generally compatible with J. R. Hilgard's (1970, 1974) construct of imaginative involvement.

Goal-directed fantasy, hypnotic susceptibility, and expectancies

We conducted an initial screening session in which hypnosis was presented as a "test of imagination" and administered with other imagination measures. In a second session, we instructed high- and low-hypnotizable subjects to imagine along with suggestions but to resist responding to motoric suggestions. Subjects received either instructions to use goal-directed fantasies (GDFs) or no facilitative instructions. Sizable individual difference effects were secured. Hypnotizable subjects exhibited more suggestion-related movements and reported greater involuntariness than did low-hypnotizable subjects. With GDF instructions, low- and high-hypnotizable subjects reported equivalent GDF absorption and frequencies. However, hypnotizable subjects exhibited greater responsiveness and reported greater involuntariness than did those low in hypnotizability, even when their GDFs were equivalent. Thus, no support was generated for the hypotheses that sustained, elaborated suggestion-related imagery mediates response to suggestion (Arnold, 1946) or that absorption in suggestions is of particular importance for low-hypnotizable subjects (Zamansky & Clark, 1986). Our finding that measures of response expectancy paralelled responding and reports of nonvolition support the hypothesis that expectancies mediate the relation between imagination, involuntariness, and responding (Kirsch, 1985; Spanos, 1982). Hypnotizable imagining subjects in the study discussed here exhibited greater responsiveness than a comparable sample of subjects did in a previous countersuggestion study (Lynn, Nash, Rhue, Frauman, & Stanley, 1983) in which no attempt was made to foster an association between imagining and involuntary responding in the initial screening session.

Goal-directed fantasy, hypnotic susceptibility, and expectancies

We conducted an initial screening session in which hypnosis was presented as a "test of imagination" and administered with other imagination measures. In a second session, we instructed high- and low-hypnotizable subjects to imagine along with suggestions but to resist responding to motoric suggestions. Subjects received either instructions to use goal-directed fantasies (GDFs) or no facilitative instructions. Sizable individual difference effects were secured. Hypnotizable subjects exhibited more suggestion-related movements and reported greater involuntariness than did low-hypnotizable subjects. With GDF instructions, low- and high-hypnotizable subjects reported equivalent GDF absorption and frequencies. However, hypnotizable subjects exhibited greater responsiveness and reported greater involuntariness than did those low in hypnotizability, even when their GDFs were equivalent. Thus, no support was generated for the hypotheses that sustained, elaborated suggestion-related imagery mediates response to suggestion (Arnold, 1946) or that absorption in suggestions is of particular importance for low-hypnotizable subjects (Zamansky & Clark, 1986). Our finding that measures of response expectancy paralelled responding and reports of nonvolition support the hypothesis that expectancies mediate the relation between imagination, involuntariness, and responding (Kirsch, 1985; Spanos, 1982). Hypnotizable imagining subjects in the study discussed here exhibited greater responsiveness than a comparable sample of subjects did in a previous countersuggestion study (Lynn, Nash, Rhue, Frauman, & Stanley, 1983) in which no attempt was made to foster an association between imagining and involuntary responding in the initial screening session.

Inhibition and enhancement of Friend leukemia virus by pyran copolymer

Inhibition or enhancement of Friend leukemia virus disease could be produced by treatment of mice with the immunopotentiator, pyran copolymer. The result depended on the route of inoculation of the drug. Prophylactic administration of the drug i.p. retarded splenomegaly, reduced splenic foci, and increased survival time of mice infected with Friend leukemia virus. Conversely, when the same dose and regimen of pyran was administered i.v., splenomegaly was enhanced, splenic foci were increased, and survival time was decreased. Histopathological examination of the spleens of mice revealed that i.p. pyran administration caused a marked increase in the splenic marginal zone with some increase in erythropoiesis in the red pulp, while i.v. pyran administration did not markedly change the splenic marginal zone but caused an early and sustained increase in erythropoiesis in the red pulp.