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Original Investigation
December 08, 2016

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

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
JAMA Facial Plast Surg. Published online December 8, 2016. doi:10.1001/jamafacial.2016.1462
Key Points

Question  What is the association between facial paralysis, depression, and quality of life in patients seeking treatment by a facial plastic reconstructive surgeon?

Findings  In study of 263 patients, patients seeking treatment for facial paralysis were significantly associated with higher depression scores and lower quality-of-life scores compared with patients without facial paralysis. Moreover, patients with greater severity of facial paralysis were significantly more likely to screen positive for depression.

Meaning  Clinicians initially evaluating patients should consider the psychological impact of facial paralysis to better direct patients to appropriate services if needed.

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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