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. 2017 May 1;19(3):190-196.
doi: 10.1001/jamafacial.2016.1462.

Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

Jason C Nellis  1 , Masaru Ishii  1 , Patrick J Byrne  1 , Kofi D O Boahene  1 , Jacob K Dey  1 , Lisa E Ishii  1
Affiliations

Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

Jason C Nellis et al. JAMA Facial Plast Surg. .

Abstract

Importance: Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL).

Objective: To measure the association between depression, QOL, and facial paralysis in patients seeking treatment at a facial plastic surgery clinic.

Design, setting, participants: Data were prospectively collected for patients with all-cause facial paralysis and control patients initially presenting to a facial plastic surgery clinic from 2013 to 2015. The control group included a heterogeneous patient population presenting to facial plastic surgery clinic for evaluation. Patients who had prior facial reanimation surgery or missing demographic and psychometric data were excluded from analysis.

Main outcomes and measures: Demographics, facial paralysis etiology, facial paralysis severity (graded on the House-Brackmann scale), Beck depression inventory, and QOL scores in both groups were examined. Potential confounders, including self-reported attractiveness and mood, were collected and analyzed. Self-reported scores were measured using a 0 to 100 visual analog scale.

Results: There was a total of 263 patients (mean age, 48.8 years; 66.9% were female) were analyzed. There were 175 control patients and 88 patients with facial paralysis. Sex distributions were not significantly different between the facial paralysis and control groups. Patients with facial paralysis had significantly higher depression, lower self-reported attractiveness, lower mood, and lower QOL scores. Overall, 37 patients with facial paralysis (42.1%) screened positive for depression, with the greatest likelihood in patients with House-Brackmann grade 3 or greater (odds ratio, 10.8; 95% CI, 5.13-22.75) compared with 13 control patients (8.1%) (P < .001). In multivariate regression, facial paralysis and female sex were significantly associated with higher depression scores (constant, 2.08 [95% CI, 0.77-3.39]; facial paralysis effect, 5.98 [95% CI, 4.38-7.58]; female effect, 1.95 [95% CI, 0.65-3.25]). Facial paralysis was associated with lower QOL scores (constant, 81.62 [95% CI, 78.98-84.25]; facial paralysis effect, -16.06 [95% CI, -20.50 to -11.62]).

Conclusions and relevance: For treatment-seeking patients, facial paralysis was significantly associated with increased depression and worse QOL scores. In addition, female sex was significantly associated with increased depression scores. Moreover, patients with a greater severity of facial paralysis were more likely to screen positive for depression. Clinicians initially evaluating patients should consider the psychological impact of facial paralysis to optimize care.

Level of evidence: 2.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure
Figure. Conceptual Path Diagram Demonstrating the Associations Among the Variables in the Structural Equation Model
QOL indicates quality of life, ε1 indicates the error term for quality of life, and ε2 indicates the error term for depression.
See this image and copyright information in PMC

Comment in

References

    1. Frith C. Role of facial expressions in social interactions. Philos Trans R Soc Lond B Biol Sci. 2009;364(1535):3453–3458. doi: 10.1098/rstb.2009.0142. - DOI - PMC - PubMed
    1. Shaw WC. Folklore surrounding facial deformity and the origins of facial prejudice. Br J Plast Surg. 1981;34(3):237–246. - PubMed
    1. Macgregor FC. Facial disfigurement: problems and management of social interaction and implications for mental health. Aesthetic Plast Surg. 1990;14(4):249–257. - PubMed
    1. Valente SM. Visual disfigurement and depression. Plast Surg Nurs. 2004;24(4):140–146. - PubMed
    1. Ishii L, Godoy A, Encarnacion CO, Byrne PJ, Boahene KD, Ishii M. Not just another face in the crowd: society’s perceptions of facial paralysis. Laryngoscope. 2012;122(3):533–538. - PubMed