Sex Differences in Emotion Recognition and Emotional Inferencing Following Severe Traumatic Brain Injury

Assessing the perception of emotional prosody in healthy ageing

BACKGROUND

Emotional prosody is the reflection of emotion types such as happiness, sadness, fear and anger in the speaker's tone of voice. Accurately perceiving, interpreting and expressing emotional prosody is an inseparable part of successful communication and social interaction. There are few studies on emotional prosody, which is crucial for communication, and the results of these studies have inconsistent information regarding age and gender.

AIMS

The primary aim of this study is to assess the perception of emotional prosody in healthy ageing. The other aim is to examine the effects of variables such as age, gender, language and neurocognitive capacity on the prediction of emotional prosody recognition skills.

METHODS AND PROCEDURES

Sixty-nine participants between the ages of 18-75 were included in the study. Participants were grouped as the young group aged 18-35 (n = 26), the middle-aged group aged 36-55 (n = 24) and the elderly group aged 56-75 (n = 19). Perceptual emotional prosody test, motor response time test, and neuropsychological test batteries were administered to the participants. Participants were asked to recognise the emotion in the sentences played on the computer. Natural (neutral, containing neither positive nor negative emotion), happy, angry, surprised and panic emotions were evaluated with sentences composed of pseudoword stimuli.

RESULTS AND OUTCOMES

It was observed that the elderly group performed worse in recognising angry, panic, natural and happy emotions and in total recognition, which gives the correct recognition performance in recognition of all emotions. There was no age-related difference in recognition of the emotion of surprise. The women were more successful in recognising angry, panic, happy and total emotions compared to men. Age and Motor Reaction Time Test scores were found to be significant predictors in the emotional response time regression model. Age, language, attention and gender variables were found to have a significant effect on the regression model created for the success of total recognition of emotions (p < 0.05).

CONCLUSIONS AND IMPLICATIONS

This was a novel study in which emotional prosody was assessed in the elderly by eliminating lexical-semantic cues related to emotional prosody and associating emotional prosody results with neuropsychiatric tests. All our findings revealed the importance of age for the perception of emotional prosody. In addition, the effects of cognitive functions such as attention, which decline with age, were found to be important. Therefore, it should not be forgotten that many factors contribute to the success of recognising emotional prosody correctly. In this context, clinicians should consider variables such as cognitive health and education when assessing the perception of emotional prosody in elderly individuals.

WHAT THIS PAPER ADDS

What is already known on the subject Most of the studies compare young and old groups, and these studies evaluate the perception of emotional prosody by using sentences formed by observing the speech sounds, syllables, words and grammar rules in the vocabulary of the language. It has been reported that the perception of emotional prosody is lower, mostly in the elderly group, but there is inconsistent information in terms of age and gender. What this paper adds to existing knowledge Perceptual Prosody Recognition was evaluated with an experimental design in which sentence structures consisting of lexemes were used as stimuli and neurocognitive tests were included, taking into account the phonological and syntactic rules of language. This study was a novel study in diagnosing emotional prosody in terms of comparing different age groups and determining the factors affecting multidimensional emotional prosody, including neuropsychiatric features. What are the clinical implications of this work? All our findings revealed the importance of age for the perception of emotional prosody. In addition, it was determined that the effects of cognitive functions such as attention were important with age.

An Examination of Social Inferencing Skills in Males and Females Following Traumatic Brain Injury

OBJECTIVE

This study examines sex differences in social inferencing deficits after traumatic brain injury (TBI), and examines the odds of males and females being impaired while controlling for potential confounders.

DESIGN

Cross-sectional survey.

SETTING

Outpatient.USA and a University in Canada.

PARTICIPANTS

One hundred five participants with TBI (60 males, 45 females) and 105 healthy controls (HC; 57 males, 48 females).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Awareness of Social Inference Test (TASIT), which includes 1) Emotional Evaluation Test (EET), 2) Social Inference-Minimal (SI-M) test, and 3) Social Inference-Enriched (SI-E) test.

RESULTS

Within the HC sample, males and females performed similarly on all three TASIT subtests. Within the TBI group, males had significantly lower scores than females on EET (P = 0.03), SI-M (P=0.01) and SI-E (P=0.04). Using impairment cutoffs derived from the HC sample, significantly more males with TBI (30%) were impaired on the EET than females(16.7%); impairment was similar between males and females on SI-M and SI-E. When adjusting for executive functioning and education, the odds of being impaired on the EET did not significantly differ for males and females (OR = 0.47; 95% CI: 0.16 - 1.40; P = 0.18).

CONCLUSIONS

While more males with TBI have emotion perception deficits than females, the difference appears to be driven by education and executive functioning. Research is needed in larger samples with more definitive norms to better understand social inferencing impairments in males and females with TBI, and translation to interpersonal behaviors.

Unisensory and Multisensory Stroop Effects Modulate Gender Differences in Verbal and Nonverbal Emotion Perception

Purpose This study aimed to examine the Stroop effects of verbal and nonverbal cues and their relative impacts on gender differences in unisensory and multisensory emotion perception. Method Experiment 1 investigated how well 88 normal Chinese adults (43 women and 45 men) could identify emotions conveyed through face, prosody and semantics as three independent channels. Experiments 2 and 3 further explored gender differences during multisensory integration of emotion through a cross-channel (prosody-semantics) and a cross-modal (face-prosody-semantics) Stroop task, respectively, in which 78 participants (41 women and 37 men) were asked to selectively attend to one of the two or three communication channels. Results The integration of accuracy and reaction time data indicated that paralinguistic cues (i.e., face and prosody) of emotions were consistently more salient than linguistic ones (i.e., semantics) throughout the study. Additionally, women demonstrated advantages in processing all three types of emotional signals in the unisensory task, but only preserved their strengths in paralinguistic processing and showed greater Stroop effects of nonverbal cues on verbal ones during multisensory perception. Conclusions These findings demonstrate clear gender differences in verbal and nonverbal emotion perception that are modulated by sensory channels, which have important theoretical and practical implications. Supplemental Material https://doi.org/10.23641/asha.16435599.

Gender Differences in Identifying Facial, Prosodic, and Semantic Emotions Show Category- and Channel-Specific Effects Mediated by Encoder's Gender

Purpose The nature of gender differences in emotion processing has remained unclear due to the discrepancies in existing literature. This study examined the modulatory effects of emotion categories and communication channels on gender differences in verbal and nonverbal emotion perception. Method Eighty-eight participants (43 females and 45 males) were asked to identify three basic emotions (i.e., happiness, sadness, and anger) and neutrality encoded by female or male actors from verbal (i.e., semantic) or nonverbal (i.e., facial and prosodic) channels. Results While women showed an overall advantage in performance, their superiority was dependent on specific types of emotion and channel. Specifically, women outperformed men in regard to two basic emotions (happiness and sadness) in the nonverbal channels and only the anger category with verbal content. Conversely, men did better for the anger category in the nonverbal channels and for the other two emotions (happiness and sadness) in verbal content. There was an emotion- and channel-specific interaction effect between the two types of gender differences, with male subjects showing higher sensitivity to sad faces and prosody portrayed by the female encoders. Conclusion These findings reveal explicit emotion processing as a highly dynamic complex process with significant gender differences tied to specific emotion categories and communication channels. Supplemental Material https://doi.org/10.23641/asha.15032583.

Sex Differences in Emotional Insight After Traumatic Brain Injury

OBJECTIVE

To compare sex differences in alexithymia (poor emotional processing) in males and females with traumatic brain injury (TBI) and uninjured controls.

DESIGN

Cross-sectional study.

SETTING

TBI rehabilitation facility in the United States and a university in Canada.

PARTICIPANTS

Sixty adults with moderate to severe TBI (62% men) and 60 uninjured controls (63% men) (N=120).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Toronto Alexithymia Scale-20 (TAS-20).

RESULTS

Uninjured men had significantly higher (worse) alexithymia scores than uninjured female participants on the TAS-20 (P=.007), whereas, no sex differences were found in the TBI group (P=.698). Men and women with TBI had significantly higher alexithymia compared with uninjured same-sex controls (both P<.001). The prevalence of participants with scores exceeding alexithymia sex-based norms for men and women with TBI was 37.8% and 47.8%, respectively, compared with 7.9% and 0% for men and women without TBI.

CONCLUSIONS

Contrary to most findings in the general population, men with TBI were not more alexithymic than their female counterparts with TBI. Both men and women with TBI have more severe alexithymia than their uninjured same-sex peers. Moreover, both are equally at risk for elevated alexithymia compared with the norms. Alexithymia should be evaluated and treated after TBI regardless of patient sex.

A sensorimotor control framework for understanding emotional communication and regulation

Our research team was asked to consider the relationship of the neuroscience of sensorimotor control to the language of emotions and feelings. Actions are the principal means for the communication of emotions and feelings in both humans and other animals, and the allostatic mechanisms controlling action also apply to the regulation of emotional states by the self and others. We consider how motor control of hierarchically organised, feedback-based, goal-directed action has evolved in humans, within a context of consciousness, appraisal and cultural learning, to serve emotions and feelings. In our linguistic analysis, we found that many emotion and feelings words could be assigned to stages in the sensorimotor learning process, but the assignment was often arbitrary. The embodied nature of emotional communication means that action words are frequently used, but that the meanings or senses of the word depend on its contextual use, just as the relationship of an action to an emotion is also contextually dependent.

A novel combined visual scanning and verbal cuing intervention improves facial affect recognition after chronic severe traumatic brain injury: A single case design

A single case design (AB with follow up) was used to determine the effect of a combined visual scanning and verbal cuing intervention technique in improving facial affect recognition after traumatic brain injury (TBI). A 35-year-old male (BR) with impaired ability to recognize facial emotions as a result of severe TBI participated in the study over a 3-month duration. BR's mean accuracy across six universal static facial expressions of emotion improved significantly during intervention and was maintained at follow up. BR was most impaired in labelling negative (sad, angry, disgusted, anxious) versus positive facial expressions (surprised, happy). BR's accuracy to negative facial affect significantly improved during intervention. No further improvement was possible for positive expressions because a ceiling effect was observed at baseline. Overall BR's mean response times across emotions was reduced at baseline but increased significantly during intervention. This was also recorded for both positive and negative expressions, respectively. This novel combined intervention has potential to improve facial affect recognition after TBI. Further evaluation using a multiple-baseline design is recommended. Additional research is needed to determine whether improved facial affect recognition following training translates to improvements in social function and communication in people with TBI.

Sex and Gender Differences in Emotion Recognition and Theory of Mind After TBI: A Narrative Review and Directions for Future Research

A growing body of literature has examined sex differences in a variety of outcomes from moderate-severe traumatic brain injury (TBI), including outcomes for social functioning. Social functioning is an area in which adults with TBI have significant long-term challenges (1-4), and a better understanding of sex and gender differences in this domain may have a significant clinical impact. This paper presents a brief narrative review of current evidence regarding sex differences in one aspect of social functioning in adults with TBI: social cognition, specifically affect recognition and Theory of Mind (ToM). Data from typical adults and adults with TBI are considered in the broader context of common stereotypes about social skills and behaviors in men vs. women. We then discuss considerations for future research on sex- and gender-based differences in social cognition in TBI, and in adults more generally.

Sex differences in response to emotion recognition training after traumatic brain injury

OBJECTIVE

To examine sex differences in the effectiveness of a Stories intervention for teaching affect recognition in people with a traumatic brain injury (TBI).

SETTING

Post-acute rehabilitation facilities.

PARTICIPANTS

203 participants (53 women and 150 men) with moderate to severe TBI were screened. 71 were eligible and randomized to one of three treatment conditions: two affect recognition conditions and an active control (cognition). This paper examines sex differences between the Stories intervention (n = 23, 5 women and 18 men) and the cognitive treatment control (n = 24, 8 women and 16 men).

DESIGN

Randomized controlled trial with immediate, 3- and 6-month follow-up post-tests. Interventions were 9 hours of computer-based training with a therapist.

MEASURES

Facial Affect Recognition (DANVA2-AF); Emotional Inference from Stories Test (EIST).

RESULTS

A significant treatment effect was observed for the Stories intervention for women, who demonstrated and maintained improved facial affect recognition. In contrast, males in our sample did not benefit from the Stories intervention.

CONCLUSION

This positive finding for the Stories intervention for females contrasts with our conclusions in a previous paper, where an analysis collapsed across sex did not reveal an overall effectiveness of the Stories intervention. This intervention warrants further research and development.

Gender Differences in the Recognition of Vocal Emotions

The conflicting findings from the few studies conducted with regard to gender differences in the recognition of vocal expressions of emotion have left the exact nature of these differences unclear. Several investigators have argued that a comprehensive understanding of gender differences in vocal emotion recognition can only be achieved by replicating these studies while accounting for influential factors such as stimulus type, gender-balanced samples, number of encoders, decoders, and emotional categories. This study aimed to account for these factors by investigating whether emotion recognition from vocal expressions differs as a function of both listeners' and speakers' gender. A total of N = 290 participants were randomly and equally allocated to two groups. One group listened to words and pseudo-words, while the other group listened to sentences and affect bursts. Participants were asked to categorize the stimuli with respect to the expressed emotions in a fixed-choice response format. Overall, females were more accurate than males when decoding vocal emotions, however, when testing for specific emotions these differences were small in magnitude. Speakers' gender had a significant impact on how listeners' judged emotions from the voice. The group listening to words and pseudo-words had higher identification rates for emotions spoken by male than by female actors, whereas in the group listening to sentences and affect bursts the identification rates were higher when emotions were uttered by female than male actors. The mixed pattern for emotion-specific effects, however, indicates that, in the vocal channel, the reliability of emotion judgments is not systematically influenced by speakers' gender and the related stereotypes of emotional expressivity. Together, these results extend previous findings by showing effects of listeners' and speakers' gender on the recognition of vocal emotions. They stress the importance of distinguishing these factors to explain recognition ability in the processing of emotional prosody.

White matter microstructure predicts longitudinal social cognitive outcomes after paediatric traumatic brain injury: a diffusion tensor imaging study

BACKGROUND

Deficits in social cognition may be among the most profound and disabling sequelae of paediatric traumatic brain injury (TBI); however, the neuroanatomical correlates of longitudinal outcomes in this domain remain unexplored. This study aimed to characterize social cognitive outcomes longitudinally after paediatric TBI, and to evaluate the use of sub-acute diffusion tensor imaging (DTI) to predict these outcomes.

METHODS

The sample included 52 children with mild complex-severe TBI who were assessed on cognitive theory of mind (ToM), pragmatic language and affective ToM at 6- and 24-months post-injury. For comparison, 43 typically developing controls (TDCs) of similar age and sex were recruited. DTI data were acquired sub-acutely (mean = 5.5 weeks post-injury) in a subset of 65 children (TBI = 35; TDC = 30) to evaluate longitudinal prospective relationships between white matter microstructure assessed using Tract-Based Spatial Statistics and social cognitive outcomes.

RESULTS

Whole brain voxel-wise analysis revealed significantly higher mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) in the sub-acute TBI group compared with TDC, with differences observed predominantly in the splenium of the corpus callosum (sCC), sagittal stratum (SS), dorsal cingulum (DC), uncinate fasciculus (UF) and middle and superior cerebellar peduncles (MCP & SCP, respectively). Relative to TDCs, children with TBI showed poorer cognitive ToM, affective ToM and pragmatic language at 6-months post-insult, and those deficits were related to abnormal diffusivity of the sCC, SS, DC, UF, MCP and SCP. Moreover, children with TBI showed poorer affective ToM and pragmatic language at 24-months post-injury, and those outcomes were predicted by sub-acute alterations in diffusivity of the DC and MCP.

CONCLUSIONS

Abnormal microstructure within frontal-temporal, limbic and cerebro-cerebellar white matter may be a risk factor for long-term social difficulties observed in children with TBI. DTI may have potential to unlock early prognostic markers of long-term social outcomes.

What's New in the Clinical Management of Disorders of Social Cognition?

Social cognition refers to the ability to use social cues to infer the meaning and intentions behind the behaviour of others in order to respond in a socially adaptive manner. It is increasingly recognised that disorders of social cognition, including problems with emotion perception, theory of mind, conversational inference, morality judgements, decision making and social inhibition, characterise many developmental and psychiatric disorders and are highly relevant to many with acquired brain injuries or diseases, especially the frontotemporal dementias. This review provides an introduction and overview of the papers in this special edition on social cognition and places these in the context of other recent research. In doing so, several current issues in the clinical management of social cognition are delineated. Given that social cognition seems to be a sensitive predictor of psychosocial function, the assessment of social cognition is seen by many clinicians to be important although which profession is responsible is yet to be resolved. Issues in how social cognition are assessed are discussed, including the importance of context to social cognition, its interactive nature and the need to recognise influences such as family upbringing, gender and emotional state on social cognitive performance. There also needs to be development of tests that address all aspects of social cognition, including decision making and inhibition. Finally, this review discusses intervention research. Interventions are especially well developed in relation to schizophrenia, and less well developed in brain injury. These appear to be generally effective although treatments for emotional self-awareness are yet to be developed.