1. Nonverbal behavior of depressed patients: comparisons with healthy volunteers and association with severity of depression
Juliana T. Fiquer1, Andre R. Brunoni,1,2, Ricardo A. Moreno1, Fernando Fernandes1, Victoria M. Portela1,3 & Clarice Gorenstein1
Institute of Psychiatry, University of Sao Paulo; 2. University Hospital, University of Sao Paulo ; 3. United Metropolitan Faculties, Sao Paulo, Brazil
Background
The assessment of clinical depression is traditionally based on patient´s verbal information, which may be biased by over/under report of symptoms. Nonverbal expressive behavior, on the other hand, associates with reflex responses and facilitates access to individual´s emotional states.
Ethological approaches used to analyze nonverbal behavior in depression suggested that depressed patients display few pro-social behaviors during interactions.
Despite the promising findings of nonverbal behavior in the evaluation of patients, research in this field is still scarce.
Results
Nonverbal Behavior in Depressed Patients and Healthy Volunteers
Patients with depression displayed more behaviors of negative feelings and social disinterest, as well as less pro-social behaviors during the interview than volunteers (Fig. 1).
Conclusions
Behavioral repertoire of depressed individuals was marked by facial, head and hand movements associated to negative feelings, such as sadness and anxiety, in comparison with healthy volunteers.
Positive affect behaviors that contribute with social interactions, such as smile and eye contact, were reduced in depressed patients.
Facial behavioral elements related to negative feelings (head down; tight lips) and silence show some association with depression symptoms as assessed by verbal measures.
These results highlight the nonverbal behavior, assessed with ethological techniques, as a useful tool to differentiate depressed from non-depressed individuals.
Objectives
1) To compare expressive nonverbal behavior of depressed patients and individuals without any psychiatric disorder.
2) To evaluate associations between patient´s nonverbal behavior and severity of depression.
Methods
Participants
Depressed Patients: 54 female outpatients from specialized clinics of two public hospitals, meeting criteria for major depression (DSM-IV-TR), aged 45 years (SD 12), free of antidepressant medications.
Healthy volunteers: 64 female healthy volunteers, aged 34 years (SD 12), without psychiatric disorders (SCID interview).
Instruments & Procedure
Severity of depressive symptoms: 17-item Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI-II).
Behavioral assessment: Participant´s behavior was recorded during a 15-min interview and registered by a blinded judge through a 21-category ethogram.
References
Fiquer J, Boggio P, Gorenstein C (2013). Talking bodies: nonverbal behavior in the assessment of depression severity. JAD, 150: 1114 –9.
Joiner J, Timmons K (2008). Depression in its interpersonal context. In: Gotlib and Hammen (Eds.), Handbook of Depression. Guilford Press: 322–39.
Perez J, Riggio R. (2003). Nonverbal social skills and psychopathology. In: Philippot, Feldman, Coats (Eds.), Nonverbal Behavior in Clinical Settings. Oxf. Univ. Press, 17–44.
The study was supported by FAPESP-Brazil; grants 11/ , 12/
Figure 1. Mean scores of the behavioral categories of the Depressed Patients (n=54) and Healthy Volunteers (n=64) (*MANOVA, p<0.05)
Association between Nonverbal Behavior and Severity of Depression
The severity of depression was associated with more patient´s silence, head down and tight lips, as well as with less speaking during the interview (Table 1).
Table 1. Correlations between nonverbal behavior categories and depression measures (HDRS, BDI-II) among depressed patients (n=54) (Pearson correlation, p<0.05)