Erwin Geerts

Nonverbal interpersonal sensitivity and persistence of depression : Perception of emotions in schematic faces

Deficits in the decoding of facial emotional expressions may play a role in the persistence of depression. In a prospective longitudinal study, 33 depressed outpatients (30 major depression, 2 dysthymia, and 1 cyclothymic disorder) judged schematic faces with respect to the emotions they expressed (fear, happiness, anger, sadness, disgust, surprise, rejection, and invitation) at admission (T0) and again 6 and 30 weeks later. Severity of depression (BDI) was assessed at these three times. Those patients who perceived less sadness, rejection, or anger in faces at T0 were less likely to show a favorable course of depression after 6 weeks (sadness, anger) or after 30 weeks (sadness, rejection, anger). These relationships could not be ascribed to initial levels of depression, age, or gender. The perception of sadness and rejection did not change over time, and therefore may have trait-like qualities. Depression appears to be more persistent in the subgroup that is hyposensitive to (negative) facial signals.

Relationship between perception of facial emotions and anxiety in clinical depression: Does anxiety-related perception predict persistence of depression?

Within the framework of interpersonal theories on depression, it was postulated 1) that an anxiety-related mood-congruent bias with respect to the perception of facial expressions could be demonstrated in clinically depressed patients: 2) that the perception of negative facial emotions would be associated with co-occurring anxiety levels rather than with depression, and 3) that the putative anxiety-related bias would predict the subsequent course of depression. Such relationships would support the possible causal role of negative biases for the persistence of depression. Thirty-nine depressed patients (thirty-six patients met the criteria for major depression, two had a dysthymic disorder and one patient suffered from a cyclothymic disorder) were studied. The patients judged schematic faces with respect to the emotions they express (fear, happiness, anger, sadness, disgust, surprise, rejection and invitation) at admission (T0), and after 6 (T1) and 30 (T2) weeks. Severity of depression (BDI) and anxiety (SCL-90) were assessed at these three points. We found considerable support for the first 2 hypotheses: a) The perception of negative emotions was related to anxiety but not to depression (at T0 this association was significant and at T1 and T2 tendencies were found); b) When the level of depression was controlled for, significant relationships remained (emerged) between anxiety and the perception of negative emotions at each of the three different time points; c) Anxiety and perception of negative emotions covaried within subjects when large changes in depression/anxiety were involved, i.e. after 30 weeks. This relationship disappeared when depression change was partialled out. The third hypothesis was not confirmed: The perception of negative emotions did not predict the course of depression. Although a direct relationship with depression persistence and a negative bias in the perception of interaction-relevant stimuli (i.e. facial emotions) in anxious depressed patients could not be found, the existence of such anxiety-related negative bias forms indirect evidence for the notion that this negative bias may mediate rejective attitudes of others towards depressives and consequently may contribute to an unfavorable course of depression.

Gender-specific mechanisms associated with outcome of depression : perception of emotions, coping and interpersonal functioning

We proposed that a negative bias in the perception of facial expressions would affect the way in which deficient coping and interpersonal functioning influenced the risk of persistent depression. Furthermore, we hypothesised that cognitions, coping strategies, and interpersonal functioning would be more likely to contribute to the prediction of outcome of depression among women than among men. At admission, 60 in-patients with major depression judged 12 schematic faces with respect to the emotions that they expressed (fear, happiness, anger, sadness, disgust, surprise, rejection and invitation). In addition, difficulty in assertiveness and social distress, and coping strategies for dealing with stressful events were measured with self-report questionnaires. At admission and 6 weeks later, the severity of depression was evaluated with the Beck Depression Inventory. Women who were inclined to perceive high levels of negative emotions from facial expressions and who reported high levels of social distress at admission were less likely to be improved after 6 weeks. Among women, these high levels of perception of negative emotions and high levels of social distress tended to predict the persistence of depression independently. A propensity to perceive negative facial expressions may underlie the unfavourable course of depression, especially among women.

Ethological approaches to psychiatric disorders : focus on depression and schizophrenia

Behavioural observation of psychiatric patient groups using ethological methodology has never been a mainstream approach in psychiatry. In the present review article it is argued that the assessment of non-verbal behaviour in psychiatric disorders has much to offer to clinicians. Based on a Medline survey, the literature on ethological observation of patients with depression and schizophrenia was reviewed. Ethological observation of psychiatric patient groups has the potential to improve prediction of course and outcome of severe psychiatric disorders at a very early stage. Disadvantages of the ethological approach lie within its technical requirements and its inherent time-consuming evaluation of data. A full appreciation of psychiatric disorders may require answers to questions to the proximate causes and evolutionary (Darwinian) trajectories of behaviour, an approach that may well be expanded to maladaptive cognition and emotion.

Children's opinions about organ donation: a first step to assent?

BACKGROUND Parents have to decide about organ donation after the death of their child. Although most parents probably would like to respect their childs intentions, parents often are not aware of their childs wishes. This requires insight into childrens opinions about donation. METHODS An internet survey that investigated whether Dutch children in the age range of 12 through 15 years had heard about organ donation, what their opinions were on donation and whether the topic had been discussed at home. Questionnaire response rate 38%. RESULTS Around 99% of 2016 responders had heard about organ donation and about the possibility of becoming a donor, 75% preferred to decide for themselves about donation, 43% had discussed organ donation more than once at home, 66% were willing to donate. The willingness to donate was positively associated with age and socio-economic status. CONCLUSION This survey indicates that these children at 12 through 15 years of age are capable and willing to think about organ donation. Thought should be given about how to raise awareness and how to enable parents and children to develop some sort of health literacy concerning the concept of organ donation. Children and their parents should be given adequate opportunities to receive appropriate information, suited to their psychological and moral developmental status.

Non-verbal interaction involvement as an indicator of prognosis in remitted depressed subjects

Fifty-one remitted depressed inpatients and their interviewers were observed during a conversation. We investigated whether non-verbal behavioral elements indicative of involvement displayed by the remitted patients and/or their interviewers were predictive of depressive symptoms 6 months later. Involvement behavior of the patients appeared to be related to future complaints; the lower the level of involvement displayed, the more unfavorable the outcome. We interpret these results with reference to concepts of social support.

Lack of association between conversation partners' nonverbal behavior predicts recurrence of depression, independently of personality

High neuroticism and low extraversion are related to depression and its recurrence. We investigated whether nonverbal involvement behavior during social interaction is one of the factors via which these relations are effectuated. We measured nonverbal expressions of involvement from videotaped behavior of remitted depressed outpatients (n=101) and their conversation partners, and assessed self-reported neuroticism and extraversion scores. During a 2-year follow-up, we assessed the recurrence of depression. Twenty-eight participants (27.7%) experienced a recurrent episode. Time to recurrence was predicted by neuroticism and extraversion, and also by the degree of association between levels of nonverbal involvement behavior of conversation partners. The behavioral effect did not explain the personality effect. Neuroticism moderated the behavioral effect. The results point to the independent relevance of personality and nonverbal behavior in the long-term course of depressive disorder.

Nonverbal communication sets the conditions for the relationship between parental bonding and the short-term treatment response in depression

The role of parental bonding and nonverbal communication in the short-term treatment response was investigated in 104 depressed outpatients. At baseline patients completed the Parental Bonding Instrument. We registered the nonverbal involvement behaviour of patients and interviewers from video recordings of baseline clinical interviews and calculated the convergence between patient-interviewer behaviour over the interview. The course of depression was assessed with the Beck Depression Inventory. As hypothesized, low maternal care and high paternal overprotection predicted a poor response to an 8-week treatment. Maternal care was positively correlated with nonverbal convergence. Moreover, convergence moderated the relationship between maternal care and the response to treatment: Lack of convergence between patients and interviewers turned out to annul the positive effects of maternal care on the treatment response. The findings link theories on early parenting to interpersonal theories of depression.

Mindfulness-based cognitive therapy for seasonal affective disorder: A pilot study

BACKGROUND The best available treatment for seasonal affective disorder (SAD) is light therapy. Yet, this treatment does not prevent recurrence of depression in subsequent seasons. The aim of the study is to gain preliminary insight in the efficacy of Mindfulness Based Cognitive Therapy (MBCT) in the prevention of SAD recurrence. METHODS This is a randomized controlled pilot study, in which SAD patients in remission were randomly allocated to an individual format of MBCT or a control condition (i.e. treatment as usual). MBCT was given between May and June 2011, when there was no presence of depressive symptoms. The Inventory for Depressive Symptomatology Self-Report (IDS-SR), which patients received on a weekly basis from September 2011 to April 2012, was used to assess moment of recurrence (≥20) and severity at moment of recurrence. RESULTS 23 SAD patients were randomized to MBCT and 23 to the control condition. Kaplan-Meier survival curve showed that the groups did not differ in moment of recurrence (χ²(1).41, p=.52). T-tests showed no group difference in mean IDS-SR scores at moment of recurrence (t(31)=-.52, p=.61). LIMITATIONS The results are limited by small sample size (n=46) and missing data of weekly IDS-SR assessments. CONCLUSION The findings of this pilot RCT suggest that individual MBCT is not effective in preventing a SAD recurrence when offered in a symptom free period (i.e. spring).

ATTUNEMENT OF NONVERBAL BEHAVIOR BETWEEN DEPRESSED-PATIENTS AND A PSYCHIATRIST AT ADMISSION IS RELATED TO PERSISTENCE OF DEPRESSION

According to interpersonal theories on depression, the type of interaction between depression-prone subjects and their social environment plays a causal role in the development and course of depression (e.g. Coyne et al.). So far, interpersonal theories have been tackled mostly by psychometrical methods. However, non-verbal behaviour plays an important role in human social interactions. It is assumed that 60-65% of human communication is non-verbal. Ethological observations have shown that non-verbal interpersonal behaviour of depressed subjects, as assessed prior to treatment, is related to treatment-response or subsequent course of depression. These results are in line with an interpersonal approach of depression.