1
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Prignano F, Argenziano G, Bardazzi F, Borroni RG, Brunasso AMG, Burlando M, Cagni AE, Campione E, Cinotti E, Colonna F, Cuccia A, Dastoli S, De Pasquale R, De Simone C, Di Lernia V, Dini V, Fabbrocini G, Galluzzi C, Giacchetti A, Giofrè C, Lasagni C, Lembo S, Loconsole F, Montesu MA, Pella P, Piaserico S, Pigatto P, Richetta AG, Scuotto A, Stroppiana E, Venturini M, Vinci AS, Zichichi L, Fargnoli MC. Understanding Barriers Impacting upon Patient Wellbeing: A Nationwide Italian Survey and Expert Opinion of Dermatologists Treating Patients with Moderate-to-Severe Psoriasis. J Clin Med 2023; 13:101. [PMID: 38202108 PMCID: PMC10779771 DOI: 10.3390/jcm13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
A nationwide cross-sectional online survey was administered to dermatologists managing patients with moderate-to-severe plaque psoriasis across Italy to obtain real-world dermatologists' perspectives on the impact of psoriasis and its treatment on patients' daily lives and quality of life (QoL). A total of 91 dermatologists (aged 39.1 ± 11.2 years) completed a 31-question survey and workshop sessions were undertaken in order to identify the best management approach to achieve patient wellbeing. Social (4.2 ± 0.1), physical (4.26 ± 0.2) and mental components (4.1 ± 0.3) were rated by dermatologists as contributing to patient wellbeing to similar extents. While a high proportion (85.4%; rating of 4.3 out of 5) of dermatologists felt that they considered the QoL of patients, a lower proportion (69.6%; rating of 3.7 out of 5) felt that patients were satisfied in this regard. The psoriasis area and severity index and body surface area were the instruments most frequently used to assess the physical domain, while interviews/questions and the dermatology life quality index were used to assess social and mental domains, with only 60% of dermatologists following up on these aspects. The importance of investigating the presence of comorbidities was recognized but not always carried out by many dermatologists, (>70%), particularly for obesity and anxiety/depression. This survey identified key components contributing to barriers impacting on the QoL of patients with moderate-to-severe psoriasis from the perspective of the dermatologist.
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Affiliation(s)
- Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
| | | | - Federico Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Riccardo G. Borroni
- Department of Biomedical Sciences, Humanitas University, 20089 Milan, Italy;
- Dermatology Unit, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy
| | | | - Martina Burlando
- Dermatologic Clinic, DISSAL, San Martino Policlinico San Martino Hospital, 16132 Genova, Italy;
| | - Anna Elisabetta Cagni
- Unità Operativa Dipartimentale di Dermatologia e Venereologia, IRCCS San Gerardo, 20900 Milan, Italy;
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (E.C.); (C.G.)
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy;
| | - Fabrizio Colonna
- Dipartimento di Psicologia, Università di Torino, 10124 Turin, Italy;
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, 52100 Arezzo, Italy;
| | - Stefano Dastoli
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | | | - Clara De Simone
- Institute of Dermatology, Catholic University, 00185 Rome, Italy;
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Valentina Dini
- Unit of Dermatology, University of Pisa, 56126 Pisa, Italy;
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical, Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Claudia Galluzzi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (E.C.); (C.G.)
| | | | - Claudia Giofrè
- Dermatology Complex Operative Unit, Papardo Hospital, 98158 Messina, Italy;
| | - Claudia Lasagni
- AOU Policlinico di Modena, Department of Specialized Medicine, University of Modena, 41121 Modena, Italy;
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy;
| | - Francesco Loconsole
- Clinica Dermatologica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy;
| | - Maria Antonia Montesu
- Department of Surgical, Microsurgical and Medical Sciences, Dermatology, University of Sassari, 07100 Sassari, Italy;
| | - Paolo Pella
- Dermatologia, Ospedale degli Infermi, 13875 Biella, Italy;
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, 35122 Padova, Italy;
| | - Paolo Pigatto
- Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, Istituto Ortopedico Galezzi, University of Milan, 20122 Milan, Italy;
| | - Antonio Giovanni Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, 00185 Rome, Italy;
| | - Adriana Scuotto
- Department of Advanced Biomedical Science, Legal Medicine Section, University of Naples Federico II, 80131 Naples, Italy;
| | - Elena Stroppiana
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Marina Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili, 25121 Brescia, Italy;
| | | | - Leonardo Zichichi
- Unit of Dermatology, San Antonio Abate Hospital, 80057 Trapani, Italy;
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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2
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Munz J, Kupfer J, Schepko M, Weisshaar E, Schut C. [Stigmatization and social anxiety in patients with skin diseases]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:799-808. [PMID: 37721562 DOI: 10.1007/s00105-023-05219-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/19/2023]
Abstract
Stigmatization of patients with skin diseases has only recently attracted more attention in research. However, both external stigmatization by society and self-stigmatization by the affected patients are widespread in patients with skin diseases. Many studies show that in this group of patients, the experience of both kinds of stigmatization is associated with psychosocial burden, such as social anxiety. This is often independent of the visibility of skin lesions. The psychosocial burden of affected individuals may lead to psychological comorbidities, such as depression or anxiety disorders, making it important to screen patients in dermatologic settings for the presence of these conditions. Interventions to reduce external and self-stigmatization have been developed, but more randomized controlled trials are needed to test the effects of such interventions.
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Affiliation(s)
- J Munz
- Institut für Medizinische Psychologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland.
| | - J Kupfer
- Institut für Medizinische Psychologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - M Schepko
- Institut für Medizinische Psychologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - E Weisshaar
- Sektion Berufsdermatologie, Zentrum Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Schut
- Institut für Medizinische Psychologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
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3
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Augustin M, John SM. Learning lessons for the battle against disease burden and stigmatization in chronic skin diseases: Call for action needed? J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:15-16. [PMID: 37805998 DOI: 10.1111/jdv.18985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/15/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Swen M John
- Department of Dermatology, Environmental Medicine, Health Theory, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Osnabrueck, Germany
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4
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Langenbruch A, Mohr N, Andrees V, Kessens I, Reich A, Czarnecka-Operacz M, Puig L, Dauden E, Iversen L, Augustin M. PsoBarrier EU study: a Multicentre, Cross-sectional Survey Investigating the Quality of Psoriasis Care in Four European Countries. Acta Derm Venereol 2023; 103:adv6532. [PMID: 37649411 PMCID: PMC10496845 DOI: 10.2340/actadv.v103.6532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/11/2023] [Indexed: 09/01/2023] Open
Abstract
Enhanced treatment options for psoriasis and growing use of guidelines increased the potential to better quality of psoriasis care in Europe. The aim of the PsoBarrier EU study is to compare the quality and processes of psoriasis care in four European countries with different healthcare systems, based on validated quality indicators. This cross-sectional survey was conducted in dermatology centres in Denmark, Germany, Poland and Spain on 1,304 patients, using standardized patient and physician questionnaires. Measured by quality of psoriasis care indicators, patients in Poland had the most critical outcomes, such as the highest disease severity (Psoriasis Area and Severity Index; PASI) and lowest health-related quality of life (Dermatology Life Quality Index; DLQI). This indicates differences in psoriasis care, with Polish participants experiencing more severe psoriasis and its consequences. Differences in the healthcare systems, which create barriers to accessing treatments, could explain variations in quality of care.
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Affiliation(s)
- Anna Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Germany.
| | - Nicole Mohr
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Valerie Andrees
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Ihno Kessens
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | | | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Esteban Dauden
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Germany
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Maspero S, Ebert C, Moser S, Zink A, Sichert P, Schielein M, Weis J, Ziehfreund S. The Potential of Instagram to Reduce Stigmatization of People with Psoriasis: A Randomized Controlled Pilot Study. Acta Derm Venereol 2023; 103:adv3513. [PMID: 36967544 PMCID: PMC10074282 DOI: 10.2340/actadv.v103.3513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/21/2022] [Indexed: 03/29/2023] Open
Abstract
Psoriasis is a stigmatized skin disease. This randomized controlled trial aimed to evaluate an Instagram based stigma-reduction intervention targeting daily Instagram users aged 18 to 49 years without psoriasis. After stratification for baseline characteristics (t0), stigmatization of psoriasis was assessed using a questionnaire and a photo-rating task immediately before (t1) and after (t2) the intervention and two weeks post-intervention (t3). Data from 54 participants, recruited in a university setting and via Instagram, were analysed. For 10 min between t1 and t2, the intervention group (n = 26) and the control group (n = 28) scrolled through two different Instagram accounts. Psoriasis-sensitizing content was displayed to the intervention group while beauty-glorifying posts were shown to the control group. Results indicated significantly less Disease-related Misconceptions in the intervention group in comparison to the control group at t2 (U = 145.50, Z = -3.79, p < 0.001) and at t3 (U = 177.00, Z = -3.25, p = 0.003). Moreover, the intervention group showed a significant reduction over time in Stereotype Endorsement (F(2, 50) = 13.40, p < 0.001, partial η² = 0.35) and Disease-related Misconceptions (χ2(2) = 12.64, p = 0.002). These findings suggest that addressing psoriasis on Instagram has the potential to effectively reduce the related stigmatization. Further studies are necessary to assess the impact of social media on stigmatization concerning psoriasis in more depth.
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Affiliation(s)
- Simona Maspero
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Christopher Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Selina Moser
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Pablo Sichert
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Maximilian Schielein
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Johanna Weis
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany; Technical University of Munich, Institute of General Practice and Health Services Research, School of Medi-cine, Munich, Germany.
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6
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Juntongjin P, Abouelsaad S, Sugkraroek S, Taechakraichana N, Lungchukiet P, Nuallaong W. Awareness of vitiligo among multi-ethnic populations. J Cosmet Dermatol 2022; 21:5922-5930. [PMID: 35785468 DOI: 10.1111/jocd.15211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vitiligo is a common acquired pigmentary disorder reported worldwide. Although asymptomatic, vitiligo negatively affects the patients' quality of life because it provokes psychological stigmatization and social discrimination. There are several misconceptions regarding vitiligo. OBJECTIVE This study aimed to evaluate the knowledge of and attitudes toward vitiligo in the general population and in different ethnic groups. METHODS A cross-sectional survey was conducted during which the participants were required to watch a brief video portraying a waitress affected by vitiligo and to fill a questionnaire related to the video content. Participants were recruited from among people who visited a private international hospital in Bangkok, Thailand, and who freely accepted to participate in the study. RESULTS Out of 405 participants who voluntarily participated in the study, approximately 30% were able to identify the condition as vitiligo. Approximately 66% and 88% of the participants had sufficient knowledge about and positive attitudes toward vitiligo, respectively. Those with sufficient knowledge scores significantly had more positive attitudes (p = 0.001). However, there were some differences among ethnic groups (p < 0.0001). Arabians had the highest knowledge and attitude scores. Regarding close-relationship attitudes, Asians tended to have perceptions that were different from that of others. CONCLUSION Knowledge of and attitudes toward vitiligo varied among ethnicities. Only 30% of the study population could identify this condition. Arabians had the highest knowledge score, whereas Caucasians had the highest prevalence of positive attitudes. Therefore, global awareness of vitiligo should be emphasized.
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Affiliation(s)
- Premjit Juntongjin
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Sara Abouelsaad
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | | | - Nimit Taechakraichana
- Department of Medical Education and Clinical Research Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Palita Lungchukiet
- Department of Medical Education and Clinical Research Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Winitra Nuallaong
- Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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7
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Aulbach MB, Harjunen VJ, Spapé M. Visible skin disease symptoms of another person reduce automatic imitation of their hand movements. PSYCHOLOGICAL RESEARCH 2022; 87:1466-1474. [PMID: 36149502 DOI: 10.1007/s00426-022-01731-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/26/2022] [Indexed: 02/03/2023]
Abstract
Imitation is an important mechanism for social interaction and learning, and humans tend to imitate others automatically. While imitating others is often useful, it can backfire when imitation is incongruent with one's goals. For example, in forced-choice reaction time tasks, this tendency results in a reliable slowing of reactions if the observed and self-initiated actions are incompatible (compatibility effect). While imitation is commonly explained as a social phenomenon, previous results on the compatibility effect's dependence on social cues are inconsistent. However, in many previous studies, the associated social cues were easy to ignore by the participants. To make the social modifier more salient, the current study manipulated emotionally relevant aspects of the model hand itself in an imitation inhibition task by using models displaying skin disease symptoms which we expected to elicit (1) perceptions of dissimilarity and (2) disgust in participants. As predicted, participants' (n = 63) reaction times were influenced more by the incompatible actions of the symptom-free than the symptomatic model hand. However, both levels of self-reported disgust toward and self-other overlap with symptomatic hands were low and did not account for the observed effect on automatic imitation. Our findings show that automatic imitation depends on social factors if these are an integral part of the model and processed quickly, presumably due to their affective salience or the salience of the self-other distinction. Whether this effect is driven by emotional reactions to the model remains an open question.
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Affiliation(s)
- Matthias Burkard Aulbach
- Dept. Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland.
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
- Department of Psychology, Centre for Cognitive Neuroscience, Paris-Lodron University Salzburg, Salzburg, Austria.
| | | | - Michiel Spapé
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Sommer R, Weinberger NA, Von Spreckelsen R, Mrowietz U, Schielein MC, Luck-Sikorski C, Augustin M. A Structured Intervention for Medical Students Significantly Improves Awareness for Stigmatisation in Visible Chronic Skin Diseases: A Randomised Controlled Trial. Acta Derm Venereol 2021; 102:adv00641. [PMID: 34904689 PMCID: PMC9631292 DOI: 10.2340/actadv.v101.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
People with visible skin diseases often experience stigmatisation. The aim of this study was to develop and evaluate a new intervention for medical students to counter the stigmatisation of people with skin diseases. The intervention was evaluated using a randomised controlled design. Effectiveness was assessed at 3 time points. Data from 127 participants were analysed. Regarding the outcome “social distance”, a significant difference between the measurement points was observed for the intervention group (χ2(2) = 54.32, p < 0.001), which also showed a significant effect on agreement with negative stereotypes (F(1.67, 118.67) = 23.83, p < 0.001, partial η2 = 0.25). Regarding the outcome “agreement with disease-related misconceptions”, a significant difference between the measurement time points was observed for the intervention group (χ2(2) = 46.33, p < 0.001); similar results were found for the outcome “stigmatising behaviour” (F(1.86, 131.89) = 6.16, p = 0.003, partial η2 = 0.08). The results should encourage medical faculties to invest in such courses in order to prevent stigmatisation of people with skin diseases.
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Affiliation(s)
- Rachel Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, DE-20246 Hamburg, Germany.
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9
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Zhang H, Yang Z, Tang K, Sun Q, Jin H. Stigmatization in Patients With Psoriasis: A Mini Review. Front Immunol 2021; 12:715839. [PMID: 34867945 PMCID: PMC8634029 DOI: 10.3389/fimmu.2021.715839] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Psoriasis is a chronic and recurrent immune-related skin disease that often causes disfigurement and disability. Due to the visibility of lesions in patients and inadequate understanding of dermatology knowledge in the general public, patients with psoriasis often suffer from stigma in their daily lives, which has adverse effects on their mental health, quality of life, and therapeutic responses. This review summarized the frequently used questionnaires and scales to evaluate stigmatization in patients with psoriasis, and recent advances on this topic. Feelings of Stigmatization Questionnaire, Questionnaire on Experience with Skin Complaints, and 6-item Stigmatization Scale have been commonly used. The relationship between sociodemographic characteristics, disease-related variables, psychiatric disorders, quality of life, and stigmatization in patients with psoriasis has been thoroughly investigated with these questionnaires. Managing the stigmatization in patients with psoriasis needs cooperation among policymakers, dermatologists, psychologists, psychiatrists, researchers, and patients. Further studies can concentrate more on these existing topics, as well as other topics, including predictors of perceived stigmatization, stigmatization from non-patient groups, influence of biologics on stigmatization, and methods of coping with stigmatization.
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Affiliation(s)
- Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zihan Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keyun Tang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiuning Sun
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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10
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Luck-Sikorski C, Roßmann P, Topp J, Augustin M, Sommer R, Weinberger NA. Assessment of stigma related to visible skin diseases: a systematic review and evaluation of patient-reported outcome measures. J Eur Acad Dermatol Venereol 2021; 36:499-525. [PMID: 34817889 DOI: 10.1111/jdv.17833] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
Misconceptions about visible skin diseases are widespread, and patients often face discrimination and stigmatization due to their condition. The associated negative health and psychosocial consequences of stigmatization in skin diseases have prompted an increase in research activity in recent times, resulting in a wide variety of assessment measures. This study aimed at aggregating and evaluating evidence of psychometric properties and methodological quality of published measures to assess stigma in visible skin diseases. Studies assessing stigmatization in visible skin diseases were searched in four databases (Medline, PsycINFO, Web of Science and Embase) until February 2021. The review followed PRISMA guidelines. Papers regarding development and/or validation of measures were identified by two independent researchers. Inclusion criteria were defined as follows: (i) quantitative studies in (ii) populations with skin diseases using (iii) questionnaires explicitly assessing (iv) perceived or public stigmatization or discrimination available in (iv) English or German language. The COnsensus-based Standards of health Measurement INstruments (COSMIN) checklist was used to evaluate their psychometric properties and risk of bias. 35 studies using 21 instruments were identified. Twenty instruments focused on assessing the perceived reality of those affected by visible skin diseases, while public stigma was only assessed by two instruments. Twelve scales could be recommended for use, while nine instruments had the potential to be recommended after further studies have assessed their quality. Some limitations are to be noted. Only studies in English and German were included. Research on self-constructed instruments can lead to new validated instruments, but they were not included in the review at this point. Several validated instruments could be recommended for use. Future research is needed regarding the assessment of stigma across different visible skin diseases, in children and adolescents, and in the general public.
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Affiliation(s)
- C Luck-Sikorski
- Research Group: Chronic Diseases and Psychological health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
| | - P Roßmann
- Research Group: Chronic Diseases and Psychological health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
| | - J Topp
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Centre for Health Services Research in Dermatology (CVderm), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Centre for Health Services Research in Dermatology (CVderm), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - R Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Centre for Health Services Research in Dermatology (CVderm), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - N A Weinberger
- Research Group: Chronic Diseases and Psychological health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
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11
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Hölsken S, Krefting F, Schneider L, Benson S, Schedlowski M, Sondermann W. A brief screening tool for depression in psoriasis patients: The Two Questions Test in clinical practice. J Dermatol 2021; 49:341-348. [PMID: 34806209 DOI: 10.1111/1346-8138.16241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
Patients suffering from chronic inflammatory diseases such as psoriasis are prone to develop depressive symptoms. However, within the time constraints of dermatological clinics, depressive symptoms in psoriasis patients are often overlooked and thus underdiagnosed. The Two Questions Test may serve as a quick screening tool for an initial assessment of depressive burden in these patients. We evaluated its usefulness in the clinical context analyzing the records of patients starting systemic treatment for psoriasis with a selective interleukin (IL)23- or IL17A-inhibitor. In a total sample of N = 139 patients, baseline Two Questions Test scores were analyzed together with measures of psoriatic and psychiatric symptoms. In addition, the development of the Two Questions Test scores over the course of the first 28 weeks of treatment was assessed. No association was found between the Two Questions Test scores and skin symptoms measured by the Psoriasis Area and Severity Index and the visibility of skin lesions. However, skin related quality of life analyzed with the Dermatology Life Quality Index was associated with the Two Questions Test scores. In addition, the longitudinal analysis revealed improvement in Two Questions Test outcomes over the course of patients' treatment. These results indicate the Two Questions Test's usefulness both as an initial screening tool of depressive symptoms, as well as in its use as a sensitive tool for the repeated assessment of depressive symptoms in psoriasis patients.
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Affiliation(s)
- Stefanie Hölsken
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frederik Krefting
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lea Schneider
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Sommer R, Augustin M, Hilbring C, Ständer S, Hubo M, Hutt H, Stülpnagel C, Silva N. Significance of chronic pruritus for intrapersonal burden and interpersonal experiences of stigmatization and sexuality in patients with psoriasis. J Eur Acad Dermatol Venereol 2021; 35:1553-1561. [DOI: 10.1111/jdv.17188] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/14/2021] [Indexed: 01/07/2023]
Affiliation(s)
- R. Sommer
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - M. Augustin
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - C. Hilbring
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - S. Ständer
- Kompetenzzentrum Chronischer PruritusUniversitätsklinikum Münster (UKM) Münster Germany
| | - M. Hubo
- LEO Pharma GmbH Neu‐Isenburg Germany
| | - H.J. Hutt
- LEO Pharma GmbH Neu‐Isenburg Germany
| | - C.C. Stülpnagel
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - N. Silva
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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Germain N, Augustin M, François C, Legau K, Bogoeva N, Desroches M, Toumi M, Sommer R. Stigma in visible skin diseases - a literature review and development of a conceptual model. J Eur Acad Dermatol Venereol 2021; 35:1493-1504. [PMID: 33428316 DOI: 10.1111/jdv.17110] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
The burden of visible skin diseases (VSDs) includes not only physical symptoms but also psychosocial consequences such as depression, anxiety, impaired quality of life and low self-esteem. Stigmatization was shown to play a major role in people with skin diseases. The aim of the study was to review the evidence for the components, drivers and impacts of (self-)stigma, and to organize the data into a series of conceptual models. A targeted literature search was conducted to identify studies on (self-)stigma in relation to VSD. Conceptual models of stigma in VSDs were developed from existing generic conceptual models for VSD and of generic conceptual models of stigma and were refined after discussion with a board of experts, patient advocacy groups, clinicians and researchers. A total of 580 references were identified, of which 56 references were analysed and summarized. Two conceptual models of stigma were identified: one with external stigma and self-stigma dimensions, the other for self-stigma in mental health. These models were adapted to allow a complete description of stigma in VSDs. For this, a distinction was made between 'discrimination' and 'impact'. Finally, five models were developed: macro-overview; stigma, impact and socio-demographics; stigma, impact and disease characteristics; stigma, impact and quality of life; and stigma, impact and coping. Gaps were identified in available quantitative evidence. To our knowledge, this is the first conceptual model of stigma in VSDs. The model will help to standardize evaluation of stigma and to enhance empirical evaluation of anti-stigma interventions in VSDs. Further research should be conducted to develop a more complete model in stigma due to significant gaps in existing evidence, particularly including the stigma in others (external stigma) and also to cover a broader range of VSDs as their impact on particular dimensions of stigma differs.
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Affiliation(s)
- N Germain
- HEOR, Creativ-Ceutical, Paris, France
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - K Legau
- LEO Pharma, Kopenhagen, Denmark
| | - N Bogoeva
- HEOR, Creativ-Ceutical, Sofia, Bulgaria
| | | | - M Toumi
- Public Health Department, Aix-Marseille University, Marseilles, France
| | - R Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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