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Variation in recognition of happy and sad facial expressions and self-reported depressive symptom severity: A prospective cohort study

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)461-469
Number of pages9
JournalJournal of Affective Disorders
Early online date22 Jun 2019
DateAccepted/In press - 21 Jun 2019
DateE-pub ahead of print - 22 Jun 2019
DatePublished (current) - 1 Oct 2019


OBJECTIVE: Cognitive theories suggest people with depression interpret self-referential social information negatively. However, it is unclear whether these biases precede or follow depression. We investigated whether facial expression recognition was associated with depressive symptoms cross-sectionally and longitudinally.

METHODS: Prospective cohort study of people who had visited UK primary care in the past year reporting depressive symptoms (n = 509). Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9) at four time-points, 2 weeks apart. A computerised task assessed happy and sad facial expression recognition at three time-points (n = 505 at time 1). The unbiased hit rate measured ability to recognise emotions accounting for any general tendency to identify the emotion when it was not present.

RESULTS: The sample included the full range of depressive symptom severity, with 45% meeting diagnostic criteria for depression. There was no evidence that happy or sad unbiased hit rates were associated with concurrent or subsequent depressive symptoms. There was weak evidence that, for every additional face incorrectly classified as happy, concurrent PHQ-9 scores reduced by 0.05 of a point (95% CI = -0.10 to 0.002, p = 0.06 after adjustment for confounders). This association was strongest for more ambiguous facial expressions (interaction term p<0.001).

LIMITATIONS: This was an observational study with relatively short follow-up (6 weeks) and small changes in depressive symptoms and emotion recognition. Only 7% of invited patients consented to participate.

CONCLUSIONS: Reduced misclassifications of ambiguous faces as happy could be a state marker of depression, but was not associated with subsequent depressive symptoms. Future research should focus on the interpretation of ambiguous social information.

Additional information

Copyright © 2019. Published by Elsevier B.V.

    Structured keywords

  • Brain and Behaviour
  • Cognitive Science
  • Social Cognition
  • Tobacco and Alcohol

    Research areas

  • Cognition, Cohort study, Depression, Emotion recognition, Facial expressions

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    Licence: CC BY-NC-ND


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