Concealment, depression and poor quality of life in patients with congenital facial anomalies

Objectives: Studies have shown that patients with congenital facial anomalies are vulnerable to depression. In addition, concealment of facial anomalies in an effort to mask handicaps is common, and these patients also often have difficulties with interpersonal relationships and in social situations. Despite this, no previous study has investigated the association between concealment of facial anomalies and depression, and a patient's quality of life. Methods: A group of 65 patients, who had been scheduled for plastic surgery, completed this study. A total of 50 patients who had congenital facial anomalies, some of whom concealed their facial anomalies (N = 22), and some whom didn't (N = 28), as well as 15 patient controls were interviewed and subsequently administered the Beck Depression Inventory-II (BDI-II), the Structured Clinical Interview for DSM-IV (SCID), the Millon Behavioral Medicine Diagnostic (MBMD) and the WHO Quality of Life (WHOQOL). Results: Among patients with congenital facial anomalies, those who concealed their anomalies exhibited a significantly higher level of depression and anxiety; higher rates of self-accusation, dissatisfaction, hypochondria, weight loss and antisocial personality traits; and a lower quality of life than those who did not conceal their anomalies. To the contrary, no significant differences were found with respect to depression, anxiety and quality of life between the congenital facial anomaly group and controls. Further, the concealment of facial anomalies was a significant predictor for lifetime major depressive disorder (odds ratio (OR) = 7.1, 95% confidence interval (CI) 1.4-37.3), after adjusting for age, gender and microtia. Conclusion: Facial concealment is a significant predictor of depression and poor quality of life in patients with congenital facial anomalies.