{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T18:16:43Z","timestamp":1770747403778,"version":"3.49.0"},"reference-count":49,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education","award":["NRF-2017R1D1A1A02018479"],"award-info":[{"award-number":["NRF-2017R1D1A1A02018479"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Facial expressions play a crucial role in the diagnosis of mental illnesses characterized by mood changes. The Facial Action Coding System (FACS) is a comprehensive framework that systematically categorizes and captures even subtle changes in facial appearance, enabling the examination of emotional expressions. In this study, we investigated the association between facial expressions and depressive symptoms in a sample of 59 older adults without cognitive impairment. Utilizing the FACS and the Korean version of the Beck Depression Inventory-II, we analyzed both \u201cposed\u201d and \u201cspontaneous\u201d facial expressions across six basic emotions: happiness, sadness, fear, anger, surprise, and disgust. Through principal component analysis, we summarized 17 action units across these emotion conditions. Subsequently, multiple regression analyses were performed to identify specific facial expression features that explain depressive symptoms. Our findings revealed several distinct features of posed and spontaneous facial expressions. Specifically, among older adults with higher depressive symptoms, a posed face exhibited a downward and inward pull at the corner of the mouth, indicative of sadness. In contrast, a spontaneous face displayed raised and narrowed inner brows, which was associated with more severe depressive symptoms in older adults. These findings suggest that facial expressions can provide valuable insights into assessing depressive symptoms in older adults.<\/jats:p>","DOI":"10.3390\/s23167080","type":"journal-article","created":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T10:52:40Z","timestamp":1691664760000},"page":"7080","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Facial Expressions Track Depressive Symptoms in Old Age"],"prefix":"10.3390","volume":"23","author":[{"given":"Hairin","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6985-2680","authenticated-orcid":false,"given":"Seyul","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Psychology, Pusan National University, Busan 46241, Republic of Korea"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-126X","authenticated-orcid":false,"given":"So Young","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6504-3333","authenticated-orcid":false,"given":"Eui Chul","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Human-Centered Artificial Intelligence, Sangmyung University, Hongjimun 2-Gil 20, Jongno-Gu, Seoul 03016, Republic of Korea"}]},{"given":"Soowon","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Teacher Education, College of General Education for Truth, Sincerity and Love, Kyonggi University, Suwon 16227, Republic of Korea"}]},{"given":"Hyunwoong","family":"Ko","sequence":"additional","affiliation":[{"name":"Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul 06355, Republic of Korea"},{"name":"Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul 08826, Republic of Korea"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4877-975X","authenticated-orcid":false,"given":"Minju","family":"Bae","sequence":"additional","affiliation":[{"name":"Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul 08826, Republic of Korea"}]},{"given":"Myogyeong","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea"}]},{"given":"Gieun","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5893-3124","authenticated-orcid":false,"given":"Jun-Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1192\/bjp.2019.74","article-title":"The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: Systematic review and meta-analysis","volume":"215","author":"Wei","year":"2019","journal-title":"Br. J. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1097\/JGP.0b013e3180cc2bf1","article-title":"The relationship between suicide ideation and late-life depression","volume":"15","author":"Vannoy","year":"2007","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1093\/gerona\/58.3.M249","article-title":"Depression in late life: Review and commentary","volume":"58","author":"Blazer","year":"2003","journal-title":"J. Gerontol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.arr.2012.09.004","article-title":"The prevalence of mental disorders in older people in Western countries\u2014A meta-analysis","volume":"12","author":"Volkert","year":"2013","journal-title":"Ageing Res. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jad.2010.09.015","article-title":"A tune in \u201ca minor\u201d can \u201cb major\u201d: A review of epidemiology, illness course, and public health implications of subthreshold depression in older adults","volume":"129","author":"Meeks","year":"2011","journal-title":"J. Affect. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1037\/0022-006X.51.6.945","article-title":"The Beck Depression Inventory and Research Diagnostic Criteria: Congruence in an Older Population","volume":"51","author":"Gallagher","year":"1983","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1212\/01.wnl.0000242734.16663.09","article-title":"Memory complaints are related to Alzheimer disease pathology in older persons","volume":"67","author":"Barnes","year":"2006","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1111\/j.1532-5415.1992.tb01988.x","article-title":"Factors Attenuating the Validity of the Geriatric Depression Scale in a Dementia Population","volume":"40","author":"Feher","year":"1992","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/NMD.0b013e31823e653b","article-title":"Nonverbal behavior during clinical interviews: Similarities and dissimilarities among Schizophrenia, mania, and depression","volume":"200","author":"Annen","year":"2012","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1016\/j.jad.2013.05.002","article-title":"Talking bodies: Nonverbal behavior in the assessment of depression severity","volume":"150","author":"Fiquer","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.imavis.2013.12.007","article-title":"Nonverbal social withdrawal in depression: Evidence from manual and automatic analyses","volume":"32","author":"Girard","year":"2014","journal-title":"Image Vis. Comput."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1109\/TIFS.2015.2414392","article-title":"Automated depression diagnosis based on facial dynamic analysis and sparse coding","volume":"10","author":"Wen","year":"2015","journal-title":"IEEE Trans. Inf. Forensics Secur."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Cohn, J.F., Kruez, T.S., Matthews, I., Yang, Y., Nguyen, M.H., Padilla, M.T., Zhou, F., and De La Torre, F. (2009, January 10\u201312). Detecting depression from facial actions and vocal prosody. Proceedings of the 2009 3rd International Conference on Affective Computing and Intelligent Interaction and Workshops, ACII 2009, Amsterdam, The Netherlands.","DOI":"10.1109\/ACII.2009.5349358"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s12193-013-0123-2","article-title":"Multimodal assistive technologies for depression diagnosis and monitoring","volume":"7","author":"Joshi","year":"2013","journal-title":"J. Multimodal User Interfaces"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0165-1781(00)00168-2","article-title":"Reduced facial expression and social context in major depression: Discrepancies between facial muscle activity and self-reported emotion","volume":"95","author":"Gehricke","year":"2000","journal-title":"Psychiatry Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1037\/a0017562","article-title":"Further Evidence for the Cultural Norm Hypothesis: Positive Emotion in Depressed and Control European American and Asian American Women","volume":"16","author":"Tsai","year":"2010","journal-title":"Cult. Divers. Ethn. Minor. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s00406-004-0510-5","article-title":"Facial expressivity in the course of schizophrenia and depression","volume":"254","author":"Gaebel","year":"2004","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3449","DOI":"10.1098\/rstb.2009.0189","article-title":"Darwin\u2019s contributions to our understanding of emotional expressions","volume":"364","author":"Ekman","year":"2009","journal-title":"Philos. Trans. R. Soc. B Biol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Park, S., Lee, K., Lim, J.A., Ko, H., Kim, T., Lee, J.I., Kim, H., Han, S.J., Kim, J.S., and Park, S. (2020). Differences in facial expressions between spontaneous and posed smiles: Automated method by action units and three-dimensional facial landmarks. Sensors, 364.","DOI":"10.3390\/s20041199"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Gavrilescu, M., and Vizireanu, N. (2019). Predicting depression, anxiety, and stress levels from videos using the facial action coding system. Sensors, 19.","DOI":"10.3390\/s19173693"},{"key":"ref_21","first-page":"2513","article-title":"An Automated and Real-time Approach of Depression Detection from Facial Micro-expressions","volume":"73","author":"Gilanie","year":"2022","journal-title":"Comput. Mater. Contin."},{"key":"ref_22","first-page":"455","article-title":"Extraction of Facial Features for Depression Detection among Students","volume":"118","author":"Venkataraman","year":"2018","journal-title":"Int. J. Pure Appl. Math."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"P251","DOI":"10.1093\/geronj\/49.6.P251","article-title":"Age differences in the symptoms of depression: A latent trait analysis","volume":"49","author":"Gallo","year":"1994","journal-title":"J. Gerontol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1001\/archpsyc.61.6.587","article-title":"The nature and determinants of neuropsychological functioning in late-life depression","volume":"61","author":"Butters","year":"2004","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1017\/S1355617700001454","article-title":"Spontaneous and posed facial expression in Parkinson\u2019s Disease","volume":"2","author":"Smith","year":"1996","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s12144-016-9448-9","article-title":"Spontaneous Facial Expressions Are Different from Posed Facial Expressions: Morphological Properties and Dynamic Sequences","volume":"36","author":"Namba","year":"2017","journal-title":"Curr. Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.1212\/WNL.43.11.2412-a","article-title":"The clinical dementia rating (cdr): Current version and scoring rules","volume":"43","author":"Morris","year":"1993","journal-title":"Neurology"},{"key":"ref_28","first-page":"27","article-title":"A normative study of the Mini-Mental State Examination for Dementia Screening (MMSE-DS) and its short form (SMMSE-DS) in the Korean elderly","volume":"14","author":"Han","year":"2010","journal-title":"J. Korean Geriatr. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"69","DOI":"10.4103\/0972-2327.74248","article-title":"The complex relationship between depression and dementia","volume":"13","author":"Muliyala","year":"2010","journal-title":"Ann. Indian Acad. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1177\/1073191120971357","article-title":"The Impact of Education on Depression Assessment: Differential Item Functioning Analysis","volume":"29","author":"Taple","year":"2022","journal-title":"Assessment"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1111\/j.1365-2702.2008.02739.x","article-title":"Health literacy and functional health status in Korean older adults","volume":"18","author":"Kim","year":"2009","journal-title":"J. Clin. Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1001\/archpsyc.1961.01710120031004","article-title":"An Inventory for Measuring Depression","volume":"4","author":"Beck","year":"1961","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2934","DOI":"10.3389\/fpsyg.2019.02934","article-title":"Diagnostic Utility and Psychometric Properties of the Beck Depression Inventory-II Among Korean Adults","volume":"10","author":"Park","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ekman, P., and Friesen, W.V. (1978). Manual for the Facial Action Coding System, Consulting Psychologists Press.","DOI":"10.1037\/t27734-000"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Baltru\u0161aitis, T., Mahmoud, M., and Robinson, P. (2015, January 4\u20138). Cross-dataset learning and person-specific normalisation for automatic Action Unit detection. Proceedings of the 2015 11th IEEE International Conference and Workshops on Automatic Face and Gesture Recognition, FG 2015, Ljubljana, Slovenia.","DOI":"10.1109\/FG.2015.7284869"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1023\/A:1010671109788","article-title":"A psychometric evaluation of the facial action coding system for assessing spontaneous expression","volume":"25","author":"Sayette","year":"2001","journal-title":"J. Nonverbal Behav."},{"key":"ref_37","unstructured":"Scherer, K.R., and Ekman, P. (1982). Handbook of Methods in Nonverbal Behavior Research, Cambridge University Press."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"992","DOI":"10.3758\/s13428-013-0421-3","article-title":"Psychometric challenges and proposed solutions when scoring facial emotion expression codes","volume":"46","author":"Olderbak","year":"2014","journal-title":"Behav. Res. Methods"},{"key":"ref_39","first-page":"201","article-title":"A study on the reliability and the validity of Korean version of the Beck Depression Inventory-II (BDI-II)","volume":"14","author":"Sung","year":"2008","journal-title":"J. Korean Soc. Biol. Ther. Psychiatry"},{"key":"ref_40","unstructured":"Revelle, M.W. (2017). psych: Procedures for Personality and Psychological Research (R Package), Northwestern University Press."},{"key":"ref_41","unstructured":"Cheong, J., Xie, T., Byrne, S., and Chang, L. (2021). Py-Feat: Python Facial Expression Analysis Toolbox. arXiv."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1038\/nn.2138","article-title":"Expressing fear enhances sensory acquisition","volume":"11","author":"Susskind","year":"2008","journal-title":"Nat. Neurosci."},{"key":"ref_43","unstructured":"Kanade, T., Cohn, J.F., and Tian, Y. (2000, January 28\u201330). Comprehensive database for facial expression analysis. Proceedings of the 4th IEEE International Conference on Automatic Face and Gesture Recognition, FG 2000, Grenoble, France."},{"key":"ref_44","unstructured":"Ekman, P., and Rosenberg, E.L. (2012). What the Face Reveals: Basic and Applied Studies of Spontaneous Expression Using the Facial Action Coding System (FACS), Oxford University Press."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1037\/0033-2909.95.1.52","article-title":"The neuropsychology of facial expression: A review of the neurological and psychological mechanisms for producing facial expressions","volume":"95","author":"Rinn","year":"1984","journal-title":"Psychol. Bull."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Pfister, T., Li, X., Zhao, G., and Pietikainen, M. (2011, January 6\u201313). Differentiating spontaneous from posed facial expressions within a generic facial expression recognition framework. Proceedings of the IEEE International Conference on Computer Vision, Barcelona, Spain.","DOI":"10.1109\/ICCVW.2011.6130343"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"648346","DOI":"10.3389\/fpsyg.2021.648346","article-title":"The Relationship Between Facial Expression and Cognitive Function in Patients with Depression","volume":"12","author":"Ruihua","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1080\/07317115.2021.1937426","article-title":"Recognition of Facial Expressions of Emotion and Depressive Symptoms among Caregivers with Different Levels of Empathy","volume":"45","author":"Bomfim","year":"2022","journal-title":"Clin. Gerontol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.jad.2022.12.029","article-title":"A method for diagnosing depression: Facial expression mimicry is evaluated by facial expression recognition","volume":"323","author":"Fu","year":"2023","journal-title":"J. Affect. Disord."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/16\/7080\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:30:26Z","timestamp":1760128226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/16\/7080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,10]]},"references-count":49,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["s23167080"],"URL":"https:\/\/doi.org\/10.3390\/s23167080","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,10]]}}}