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Spatial processing of facial emotion in patients with unipolar depression: a longitudinal study

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Abstract

Background: In this study, a face-in-the-crowd task was applied to examine the spatial detection of facial emotion as a function of depression and comorbid anxiety in the course of a psychotherapeutic inpatient treatment. Methods: Patients with unipolar depression (n=22) and normal controls (n=22) were tested twice, about 7 weeks apart, on a face-in-the-crowd task using displays of schematic faces. Half the patients were suffering from a comorbid anxiety disorder. Results: From test 1 to test 2, depressivity, frequency of negative thoughts, and worrying of patients improved significantly. At both sessions, depressed patients, irrespective of the presence of comorbid anxiety disorders, showed no performance differences in the detection of negative faces compared to controls. However, depressed patients with but not those without comorbid anxiety disorders were slower in responding to positive faces than controls. Both patient groups were slower in responding to the neutral faces' condition than controls. Conclusions: Our data indicate a spatial processing deficit for positive facial expression in depressives with a comorbid anxiety disorder. This impairment, which appears to persist during remission, might be due to deficits in effortful visual search processes.

Introduction

Visuospatial processing has been found to be impaired in depressives during periods of acute illness as well as during recovery (Asthana et al., 1998). There is evidence that depressed patients have lasting deficits in effortful, but not in automatic, visual search processes (Hammar et al., 2003). Abnormal processing of emotional facial expressions is thought to be relevant to the persistence and relapse of depression (Bouhuys et al., 1999).

The detection of facial expressions is assumed to be highly efficient (Purcell and Stewart, 1986). However, there are substantial differences in the spatial processing of negative and positive facial expressions. Search functions for the detection of a negative face are flatter than for the detection of a positive face White, 1995, Öhman et al., 2001. Suslow et al. (2001) first applied a face-in-the-crowd task to examine the relationship between depression and spatial detection of facial expression of emotions. Depressive mood was found to be selectively associated with reduced spatial attention to positive faces.

The purpose of the present study was to examine the time course of spatial processing of facial emotion in depressed patients in the course of an inpatient treatment programme. A face-in-the-crowd task using schematic stimuli was administered to depressed patients and healthy controls. It was hypothesised that, when in an acute state, depressed patients should exhibit a slower spatial processing of positive but not of negative faces compared to normal subjects. It was expected that this processing deficit of depressed patients should diminish during remission. In the present study, the impact of comorbid anxiety on the processing of facial affect in depression was also examined. Since spatial vigilance for negative faces was found to be primarily a function of anxiety (Bradley et al., 1998), it was predicted that depressed patients suffering from an anxiety disorder might show decreased response latencies for negative faces as compared to noncomorbid patients and normal subjects.

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Subjects

Twenty-two patients fulfilling the criteria for a DSM-IV diagnosis of major depression as assessed by the Structured Clinical Interview for DSM-IV (SCID-I, Wittchen et al., 1997) participated in the study (see Table 1). Eleven of the depressed patients were suffering from an anxiety disorder (panic disorder, agoraphobia, social phobia, generalised anxiety disorder, or an anxiety disorder not otherwise specified). Subjects with a neurological disease, substance dependence, organic impairments,

Results

Study groups differed with respect to intelligence (F(2,41)=3.7, P<0.05) (see Table 1). However, intelligence was not significantly related to (overall) speed and accuracy of detection responses, either at time 1 or at time 2. To examine the time course of affective characteristics in depressed patients compared to healthy subjects, 3×2 ANOVAs were calculated (see Table 2). For the BDI, the ATQ, and the PSWQ, significant main effects of group (F's(2,41)>21.0, P's<0.001) and time (F

Discussion

The present data corroborate previous findings that spatial detection of negative faces is unimpaired in depression (Suslow et al., 2001). Depressed patients with but not depressed patients without comorbid anxiety disorders were slower in responding to positive faces than controls. According to this finding, the presence of an anxiety disorder lowers the efficiency of visual search processes with respect to positive faces in depressives. However, contrary to our hypothesis, it does not have

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