What is the nonverbal communication of depression? Assessing expressive differences between depressive patients and healthy volunteers during clinical interviews.

BACKGROUND: It is unclear if individuals with Major Depressive Disorder (MDD) present different nonverbal behavior (NVB) compared with healthy individuals, and also if depression treatments affect NVB. In this study, we compared the NVB of MDD subjects and healthy controls. We also verified how MDD subjects' NVB is affected by depression severity and acute treatments. METHODS: We evaluated 100 MDD outpatients and 83 controls. We used a 21-category ethogram to assess the frequency of positive and negative NVB at baseline. MDD subjects were also assessed after eight weeks of treatment (pharmacotherapy or neuromodulation). We used the Wilcoxon signed-rank test to compare the NVB of MDD subjects and controls; beta regression models to verify associations between MDD severity and NVB; the Shapiro-Wilk test to verify changes in NVB after treatment; and logistic regression models to verify NVB associated with treatment response according to the Hamilton depression rating scale. RESULTS: Compared with controls, MDD subjects presented higher levels of six negative NVB (shrug, head and lips down, adaptive hand gestures, frown and cry) and lower levels of two positive NVB (eye contact and smile). MDD subjects' NVB was not associated with depression severity, and did not significantly change after depression treatment. Treatment responders showed more interpersonal proximity at baseline than non-responders. LIMITATIONS: Our ethogram had no measure of behavior duration, and we had a short follow-up period. CONCLUSIONS: MDD subjects have more negative and less positive social NVB than controls. Their nonverbal behavior remained stable after clinical response to acute depression treatments.

Is nonverbal behavior in patients and interviewers relevant to the assessment of depression and its recovery? A study with Dutch and Brazilian patients.

Nonverbal behaviors exhibited by patients with depression in their interactions with others may reflect social maladjustment and depression maintenance. Investigations of associations between unipolar depression and both patients' and interviewers' behaviors have been scarce and restricted to European samples. This study examined whether nonverbal behavior in patients and their interviewers is associated with depression severity and recovery. Cultural differences were explored. Seventy-eight depressed outpatients (28 Brazilians, 50 Dutch) were evaluated before and after 8-week pharmacological treatment. Patients were videotaped during the Hamilton Depression Scale interview before treatment, and the Brazilians were also videotaped after treatment. Nonverbal behaviors (patients' speaking effort and interviewers' encouragement) were analyzed using a two-factor ethogram. Results revealed that speaking effort was associated with encouragement and both are not influenced by baseline depression severity. However, from before to after treatment, whereas encouragement remained unchanged, speaking effort increased among unrecovered patients. Speaking effort was associated with patients' culture: Brazilians exhibited higher speaking effort than Dutch. These findings highlight that whereas the supportive nonverbal behavior of the interviewer may be stable, the set of nonverbal behaviors composed by head movements, eye contact and gestures displayed by the patients during their speaking in clinical interviews reflects depression persistence after treatment.

Talking bodies: nonverbal behavior in the assessment of depression severity.

BACKGROUND: Evaluations of clinical depression are traditionally based on verbal information. Nonverbal expressive behavior, however, being associated with a person's reflexive responses, may reveal negative emotional or social processes that are not under complete control of the patients. However, investigations of nonverbal behavior in the evaluation of depressed patients are still scarce. This study examines the nonverbal behaviors of a group of Brazilian patients, associating their nonverbal behavior with severity of depression. METHODS: Forty depressed patients were evaluated at baseline (T0) and after a two-week transcranial direct current stimulation treatment (T1), according to rating scales and through a 21-category Ethogram for assessment of the frequency of nonverbal behaviors displayed during an interview. RESULTS: Behaviors that were related to negative feelings and social disinterest decreased with corresponding clinical improvement and were associated with increased severity of symptoms at T0 and greater negative affect and dissatisfaction at T1. Pro-social behaviors were associated with milder symptoms at T0 and increased after treatment. Facial, head and hand expressive movements stood out as important indicators because of their associations with severity of depression. LIMITATIONS: Duration of behaviors was not assessed and there was not a healthy control group with which to compare the findings. CONCLUSIONS: These results support the usefulness of nonverbal behavior as an evaluation technique in the assessment of clinical depression.

Comunicação não-verbal e depressão: uso de indicadores não-verbais para avaliação de gravidade, melhora clínica e prognóstico / Nonverbal communication and depression: the use of non-verbal indicators for assessment of severity, clinical improvement and prognosis

Depressão é um transtorno de humor de alta prevalência e repercussões negativas para o indivíduo do ponto de vista físico, psicológico e social. Entre os múltiplos aspectos da doença ainda pouco investigados está o comportamento expressivo não-verbal que pode indicar emoções, pensamentos e intenções automáticos que ocasionam problemas interpessoais e piora da depressão. O objetivo desta tese foi investigar o papel da comunicação não-verbal como parâmetro para avaliar características diagnósticas, prognósticas e de melhora clínica da depressão. Para tanto, foram usadas técnicas etológicas para observação de: 1) indicadores não-verbais de pacientes deprimidos (em associação com medidas clínicas e neuropsicológicas); e 2) fatores comportamentais de envolvimento não-verbal de pacientes e do entrevistador. A tese foi dividida em duas partes. Na Parte I apresentam-se estudos que enfocam o comportamento de pacientes deprimidos (n=40) submetidos a três diferentes condições de tratamento com Estimulação Elétrica Transcraniana de Corrente Contínua (ETCC). Pacientes foram avaliados no pré (T0) e pós-tratamento (T1) por meio de escalas para mensuração de sintomas depressivos (medidas clínicas); bateria de testes neuropsicológicos; e entrevistas filmadas. A análise das filmagens foi feita com catálogo de registro de frequência de comportamentos nãoverbais de pacientes (etograma), desenvolvido por nosso grupo de pesquisa. Encontramos que silêncio dos pacientes e menos movimentos expressivos faciais e de cabeça relacionam-se a maior intensidade da depressão, sendo que silêncio em T0 prediz pior prognóstico em T1. Mediante melhora clínica, indicadores de emoções negativas decrescem (ex. choro, testa franzida) enquanto de interesse interpessoal aumentam (ex. contato ocular, yes-nooding). Pacientes também apresentam alterações em funções mnêmicas de longo prazo, atencionais e executivas. Mediante melhora clínica, o (...)

... desempenho aumenta nas tarefas executivas e atencionais. Melhor performance em tarefa de atenção focada em T0, entretanto, associou-se a menos afetos positivos em T1. Os resultados indicam que a depressão compromete o funcionamento afetivo, cognitivo e expressivo dos pacientes e que indicadores não-verbais apresentam padrão mais consistente de associação com medidas clínicas do que variáveis neuropsicológicas. Na Parte II, apresentam-se estudos que enfocam a interação de pacientes deprimidos (n=38) com seu entrevistador (n=1). Pacientes foram submetidos a tratamento medicamentoso e avaliados no pré (T0) e pós-tratamento (T1) por meio de medidas clínicas e entrevistas filmadas. A análise das filmagens foi feita com um etograma de registro de frequência e duração de comportamentos de pacientes e do entrevistador. Encontramos que comportamentos nãoverbais de envolvimento de pacientes (fator Esforço Comunicativo, EC) e do entrevistador (fator Encorajamento, EN) estão associados e aumentam ao longo da interação. O ajuste (convergência) entre EC e EN ao longo da entrevista associa-se com satisfação dos pacientes. EC em T0 prediz redução de afetos negativos em T1 e, após melhora clínica, EC e EN aumentam. Portanto, o comportamento de busca por suporte social associa-se a maior apoio do entrevistador e este aumento de envolvimento pode indicar melhora clínica. O conjunto de achados sugere que a comunicação não-verbal, avaliada com técnicas etológicas, transmite informações relevantes associadas à gravidade, melhora clínica e prognóstico da depressão

Depression is a highly prevalent mood disorder bearing negative consequences for individuals in physical, psychological and social domains. Among the many aspects of the disease which remain poorly understood, the expressive nonverbal behavior of sufferers is an important example: it has been highlighted as an indicator of emotions, automatic thoughts and intentions which can lead to interpersonal problems and worsening of depression. The aim of this thesis is to investigate the role of such nonverbal communication in the evaluation of depression diagnosis, prognosis and clinical response. To this end, we conducted an ethological observation where we analyzed: 1) non-verbal indicators of depressed patients (in combination with clinical and neuropsychological measures), and 2) behavioral factors of nonverbal involvement of patients and their interviewers. This thesis is divided in two parts. Part I presents studies focused on the behavior of patients (n=40) treated with different types of Transcranial Direct Current Stimulation (tDCS). Patients are evaluated before (T0) and after treatment (T1) through clinical scales for the assessment of depressive symptoms, neuropsychological tests, and the analysis of videotaped interviews. The analysis of interviews is based on an ethogram developed by our research group, wherein the frequencies of nonverbal behaviors of patients are registered. We found that silence, as well as low levels of expressive facial and head movements were related to higher depression severity. Silence at T0 also predicted poor prognosis at T1. There was a decrease in the frequency of indicators of negative emotions (e.g. crying, frowning) and increase in pro-social indicators (e.g. eyes contact, yes-nooding) upon clinical improvement. Patients also showed alterations in long-term memory, attention and executive (...)

... functions. Their performance increased in executive and attentional tasks, upon clinical improvement. However, a better performance in the focused attention task at T0 was associated with less positive affect at T1. The results indicate that depression affects the patients emotional, cognitive and expressive functioning. In addition, non-verbal indicators showed a more consistent pattern of being associated with clinical measures than with neuropsychological measures. In Part II, we show studies focused on the interaction of depressed patients (n=38) with their interviewer (n=1). Patients treated with psychopharmacotherapy were evaluated before (T0) and after treatment (T1) through clinical scales, and videotaped interviews. Interviews were analyzed through the use of an ethogram which considers frequency and duration of both patients and interviewer behaviors. We found that nonverbal behaviors of involvement of patients (Speaking Effort factor, SE) and their interviewer (Encouragement factor, EN) were correlated and both of them increased during the interaction. The adjustment (convergence) between SE and EN during the interview was associated with patient satisfaction. SE at T0 predicted a reduction of negative affect at T1. Additionally, both factors increased after clinical improvement. Therefore, the support seeking behavior is associated with support giving behavior of the interviewer. The increase of both involvement behaviors may therefore indicate clinical improvement. Taken together, these findings suggest that nonverbal communication, when evaluated by ethological techniques, can convey important information on the severity, prognosis and amenability to clinical improvement of depression

Posture and body image in individuals with major depressive disorder: a controlled study / Postura e imagem corporal em indivíduos com depressão: um estudo controle

OBJECTIVE: In this study, we aimed to quantify posture and body image in patients with major depressive disorder during episodes and after drug treatment, comparing the results with those obtained for healthy volunteers. METHOD: Over a 10-week period, we evaluated 34 individuals with depression and 37 healthy volunteers. Posture was assessed based on digital photos of the subjects; CorelDRAW software guidelines and body landmarks were employed. Body image was evaluated using the Body Shape Questionnaire. RESULTS: During depressive episodes (in comparison with the post-treatment period), patients showed increased head flexion (p < 0.001), increased thoracic kyphosis (p < 0.001), a trend toward left pelvic retroversion (p = 0.012) and abduction of the left scapula (p = 0.046). During remission, patient posture was similar to that of the controls. At week 1 (during the episode), there were significant differences between the patients and the controls in terms of head flexion (p < 0.001) and thoracic kyphosis (p < 0.001); at weeks 8-10 (after treatment), such differences were seen only for shoulder position. The mean score on the Body Shape Questionnaire was 90.03 during the depressive episode, compared with 75.82 during remission (p = 0.012) and 62.57 for the controls. CONCLUSION: During episodes of depression, individuals with major depressive disorder experience changes in posture and mild dissatisfaction with body image. The findings demonstrate that the negative impact of depression includes emotional and physical factors.

OBJETIVO: O objetivo deste estudo foi avaliar quantitativamente a postura e a imagem corporal em pacientes com transtorno depressivo maior, durante o episódio depressivo e após tratamento medicamentoso, e comparar com voluntários sadios. MÉTODO: Durante o período de dez semanas, foram avaliados 34 indivíduos com depressão e 37 voluntários sadios. A postura foi avaliada através de fotos digitais e do software CorelDRAW. A imagem corporal foi avaliada através do Body Shape Questionnaire. RESULTADOS: No episódio depressivo (em comparação ao período pós tratamento), os pacientes apresentaram aumento da flexão da cabeça (p < 0,001), aumento da cifose (p < 0,001), retroversão pélvica esquerda (p = 0,012) e abdução da escápula esquerda (p = 0,046). Na remissão, a postura foi similar ao grupo controle. Na comparação entre controles e transtorno depressivo maior, houve diferença para postura da cabeça (p < 0,001) e cifose torácica (p < 0,001). Na remissão houve diferença para a postura do ombro. A média dos escores do Body Shape Questionnaire foram 90,03 no episódio e 75,82 na remissão (p = 0,012). O grupo controle apresentou escore 62,57. CONCLUSÃO: Houve diferença da postura e insatisfação da imagem corporal durante o episódio em indivíduos com transtorno depressivo maior. Os achados destacam que o impacto negativo da depressão abrange tanto fatores emocionais quanto físicos.

Posture and body image in individuals with major depressive disorder: a controlled study.

OBJECTIVE: In this study, we aimed to quantify posture and body image in patients with major depressive disorder during episodes and after drug treatment, comparing the results with those obtained for healthy volunteers. METHOD: Over a 10-week period, we evaluated 34 individuals with depression and 37 healthy volunteers. Posture was assessed based on digital photos of the subjects; CorelDRAW software guidelines and body landmarks were employed. Body image was evaluated using the Body Shape Questionnaire. RESULTS: During depressive episodes (in comparison with the post-treatment period), patients showed increased head flexion (p<0.001), increased thoracic kyphosis (p<0.001), a trend toward left pelvic retroversion (p=0.012) and abduction of the left scapula (p=0.046). During remission, patient posture was similar to that of the controls. At week 1 (during the episode), there were significant differences between the patients and the controls in terms of head flexion (p<0.001) and thoracic kyphosis (p<0.001); at weeks 8-10 (after treatment), such differences were seen only for shoulder position. The mean score on the Body Shape Questionnaire was 90.03 during the depressive episode, compared with 75.82 during remission (p=0.012) and 62.57 for the controls. CONCLUSION: During episodes of depression, individuals with major depressive disorder experience changes in posture and mild dissatisfaction with body image. The findings demonstrate that the negative impact of depression includes emotional and physical factors.

Alterações afetivas em pacientes deprimidos submetidos à estimulação transcraniana por corrente contínua / Affective changes in depressed patients treated with transcranial direct current stimulation

O presente estudo avaliou o efeito da Estimulação Transcraniana por Corrente Contínua (ETCC), de córtex pré-frontal dorsolateral esquerdo, no tratamento de pacientes deprimidos, por meio de auto-relatos de afetos positivos, de afetos negativos e de satisfação com a vida. Participaram do estudo 31 pacientes com depressão maior, distribuídos em dois grupos: Grupo Ativo (n=21), submetido a dez sessões de ETCC anódica de 2mA no córtex pré-frontal, e Grupo Controle (n=10), submetido a dez sessões de ETCC placebo. Ambos os grupos responderam uma Escala Breve de Afetividade e avaliaram a satisfação com a vida em uma Escala de Faces Esquemáticas antes e após o tratamento. Pacientes do Grupo Ativo apresentaram aumento de afetos positivos, diminuição de afetos negativos e aumento na satisfação com a vida. Os resultados apontam para a presença de alterações afetivas bidimensionais na depressão e para o potencial terapêutico da ETCC no reajustamento de afetos positivos e negativos.(AU)

The present study evaluated, through self-reports of positive affects, of negative affects and of life satisfaction, the therapeutic effects of anodal Transcranial Direct Current Stimulation (TDCS) on depressed patients. Thirty one patients with major depression participated on this study. They were distributed in two groups: Active Group (n=21) treated with ten sessions of anodal 2mA TDCS applied in the left dorsolateral prefrontal cortex and the Control Group (n=10) treated with ten sessions of TDCS placebo. Both groups answered a Brief Affect Scale and evaluated their life satisfaction through a Scale of Schematic Faces before and after the treatment. Patients of the Active Group presented an increase of positive affects, a reduction of negative affects and an increase of their life satisfaction. These findings point to the presence of bidimensional affective alterations in depression and to the therapeutic potential of the TDCS in the readjustment of positive and negative affects.(AU)

Bem-estar subjetivo: influência de variáveis pessoais e situacionais em auto-relato de afetos positivos e negativos / Subjective well-being: the influence of personal and environmental factors in reports of positive and negative affects

O objetivo do Estudo 1 foi comparar auto-relatos de afetos positivos e negativos de homens e mulheres de diferentes grupos etários (jovens, adultos, meia-idade e idosos), habitantes de quatro cidades brasileiras. Aplicou-se a Escala de Afetos Positivos e Negativos (PANAS) a uma amostra composta por habitantes de São Paulo/capital (N = 84), de Socorro-SP (N = 85), de João Pessoa-PB (N = 80) e de Salvador-BA (N = 82). Os resultados foram analisados através de ANOVA. Encontrou-se efeito principal significativo de cidade e idade para afetos positivos e negativos. Habitantes de São Paulo apresentaram escores mais baixos de afetos positivos em comparação com habitantes das demais cidades e escores mais elevados de afetos negativos em comparação com habitantes de Socorro. Os idosos apresentaram escores mais elevados de afetos positivos e mais baixos de afetos negativos que os adultos e os jovens. Finalmente, foi encontrado efeito de interação sexo x idade. Mulheres adultas relataram mais afetos negativos que homens adultos, enquanto na velhice as mulheres ultrapassaram os homens quanto aos escores de afetos positivos. Os resultados obtidos estão de acordo com as previsões feitas pela teoria da seletividade socioemocional, segundo a qual o bem-estar aumenta com a idade em função de uma melhor regulação de emoções. A presente pesquisa mostra que relatos de afetos positivos e negativos podem ser modulados por gênero em faixas etárias específicas. O conflito maternidade x emprego é um grande fator de estresse e pode contribuir para os resultados obtidos. O objetivo do Estudo 2 foi verificar até que ponto o padrão de resultados de Desejabilidade Social (DS) replicaria o padrão de resultados obtido para a PANAS através da aplicação da Escala de Desejabilidade Social de Crowne e Marlowe (1960) a uma amostra de participantes (N = 115) com distribuição por sexo e idade semelhante a do primeiro estudo. Foi encontrado efeito principal significativo de idade, com os idosos apresentando escores mais elevados de DS que pessoas mais jovens, mas não foi encontrada diferença significativa de gênero para os escores de DS. Estes dados indicam que os resultados do Estudo 1 não podem ser inteiramente atribuídos à influência de DS. O objetivo do Estudo 3 foi comparar auto-relatos de Afetos Positivos e Negativos de pacientes deprimidos e de pessoas sem depressão...(AU)

Bem-estar subjetivo e regulação de emoções / Subjective well-being and emotional regulation

O presente estudo investigou o sentimento de bem-estar em função de idade (jovens, adultos, meia-idade e idoso) e gênero (81 homens e 84 mulheres). Idosos de forma geral consideram-se mais satisfeitos com a vida do que pessoas mais jovens. Homens jovens avaliaram-se como mais calmos do que mulheres de mesma idade. Os resultados são compatíveis com as previsões da teoria da seletividade socioemocional (AU)

Bem-estar subjetivo e regulação de emoções / Subjective well-being and emotional regulation

O presente estudo investigou o sentimento de bem-estar em função de idade (jovens, adultos, meia-idade e idoso) e gênero (81 homens e 84 mulheres). Idosos de forma geral consideram-se mais satisfeitos com a vida do que pessoas mais jovens. Homens jovens avaliaram-se como mais calmos do que mulheres de mesma idade. Os resultados são compatíveis com as previsões da teoria da seletividade socioemocional

The effect of age (young, adult, middle-aged and old people) and gender (81 males e 84 females) on the feeling of well-being was examined in this study. In general, old people were found to be more satisfied with their lives than young people. Self-reports of calmness were higher among young males than among young females. Our results are in accordance with the Theory of Socioemotional Selectivity.