Specific impairment of smiling increases the severity of depressive symptoms in patients with facial neuromuscular disorders

Depressive symptoms and related emotional distress are prevalent among pati ents with facial neuromuscular disorders, and the psychological distress im pacts the functional disabilities associated with the facial impairment. A specific impairment in the ability to smile may elevate the risk for depres sion, with patients experiencing a reduced physiological feedback associate d with smiling as well as the social consequences of the inability to commu nicate positive emotion. We tested the hypothesis that specific impairments in the ability to smile increase the severity of depressive symptoms in pa tients with facial neuromuscular disorders. Twenty-nine consecutive patient s (mean age, 50.2 years; SD, 17.0 years; range, 18-81 years) with a facial neuromuscular disorder, who volunteered and completed all of the assessment measures participated. Facial neuromuscular impairments were assessed usin g multiple measures of facial motility and dysfunction, and emotional funct ioning was assessed using self-report measures of depression, anxiety, and positive and negative affect. Severity of global facial impairment was stat istically controlled in evaluating the association between specific impairm ent in smiling and the degree of depressive symptoms. Separate hierarchical linear regression analyses indicated the specific impairment of smiling co ntributed to the prediction of depression (R-2 = .41, df = 3,25, p = .00) a nd anxiety (R-2 = .35, df = 3,25, p = .00), controlling first for the contr ibution of global impairment and facial physical disability. The specific i mpairment of smiling did not contribute to the prediction of positive emoti onal experience. Specific impairment of smiling and physical disability, bu t not global impairment of facial motion, were key predictors of depression in patients with facial neuromuscular disorders. The results emphasize the need to assess and treat depression and anxiety in patients with a facial neuromuscular disorder.