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Murshidi R, Hammouri M, Al-Ani A, Kitaneh R, Al-Soleiti M, Al Ta'ani Z, Sweis S, Halasa Z, Fashho E, Arafah M, Almaani N, Abdallat M, Al-Dar'awi F, Kittaneh E, Jaber B, Almudallal F, Smadi Z. Investigating the prevalence of body dysmorphic disorder among Jordanian adults with dermatologic and cosmetic concerns: a case-control study. Sci Rep 2024; 14:5993. [PMID: 38472284 PMCID: PMC10933333 DOI: 10.1038/s41598-024-56315-8] [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: 10/16/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
Body Dysmorphic Disorder (BDD) is an underexplored psychiatric condition in Middle Eastern countries, particularly in patients with dermatologic concerns, where alterations in appearance may elevate the risk of BDD. We studied patients at Jordan University Hospital's general dermatology and cosmetic clinics from July to September 2022, comparing them to healthy controls. Patients with dermatologic conditions were evaluated per the International Classification of Diseases (ICD-10) criteria by trained dermatologists. All participants completed the Dysmorphic Concerns Questionnaire (DCQ), Perceived Stress Scale, Patient Health Questionnaire-2, General Anxiety Disorder Assessment tool-2. We assessed BDD prevalence using four DCQ cutoffs: 9, 11, 14, and 17, reporting effect sizes as odds ratios (OR). Our study involved 1500 participants, with an average age of 29.3 (± 14.8) years and a female-to-male ratio of 3.15-to-1. At the 9, 11, 14, and 17 DCQ cutoffs, BDD prevalence was 78.2%, 54.2%, 26.5%, and 11.7%, respectively. Patients with dermatologic concerns were more likely to exhibit clinical BDD symptoms than controls at the 11-cutoff (OR: 1.26; 95% CI 1.01-1.58; p < 0.05). Conversely, those with cosmetic concerns were more prone to clinical BDD than controls at cutoffs 9 (OR: 2.26; 95% CI 1.28-3.97; p < 0.05) and 11 (OR: 1.50; 95% CI 1.03-2.20; p < 0.05). Our logistic regression revealed consistent associations between higher DCQ scores and elevated anxiety, depression, perceived skin disease-related stigma, and reduced quality of life (p < 0.05). In conclusion, patients with dermatologic issues and those seeking cosmetic procedures are at significant risk of developing BDD, necessitating proactive screening and referrals for specialized care by dermatologists due to the associated psychological distress and unproductive consultations. Providing specialized training for healthcare professionals to establish an integrated care approach to address the needs of patients with BDD should be the focus of future research projects.
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Affiliation(s)
- Rand Murshidi
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Razi Kitaneh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, 06519, USA
| | | | - Zain Al Ta'ani
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Sami Sweis
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Zeina Halasa
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Eva Fashho
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Malak Arafah
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Noor Almaani
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Abdallat
- Department of Neurosurgery, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Eman Kittaneh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Besan Jaber
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Zina Smadi
- School of Medicine, The University of Jordan, Amman, Jordan
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2
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Muntyanu A, Gabrielli S, Donovan J, Gooderham M, Guenther L, Hanna S, Lynde C, Prajapati VH, Wiseman M, Netchiporouk E. The burden of alopecia areata: A scoping review focusing on quality of life, mental health and work productivity. J Eur Acad Dermatol Venereol 2023; 37:1490-1520. [PMID: 36708097 DOI: 10.1111/jdv.18926] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
Alopecia areata (AA) is a common inflammatory autoimmune disease of the hair which can have a significant negative impact on quality of life (QoL), mental health and productivity. The aim of this scoping review is to elucidate the burden of AA focusing on these three realms. Inclusion criteria included all original manuscripts with no restriction on study type or statistical method written in English (or having an English abstract). For QoL 40 articles were included, 85 for psychiatric comorbidities, and 9 for work/school absenteeism/presenteeism mostly consisting of cross-sectional and observational cohort studies. QoL impairment was detected in over 75% of patients and up to one-third reported extremely severe QoL impairments. Specific QoL dimensions with the greatest impact were embarrassment, social functioning, as well as shopping and/or housework. Cross-sectional studies assessing the psychological burden of adult patients with AA found that the presence of signs of anxiety and/or depression ranged from 30% to 68% and affected all age groups. Rates of work absenteeism and unemployment were significantly higher in AA patients compared to healthy controls. Up to 62% reported making major life decisions including relationships, education and career based on their AA. Additionally, the extensive camouflage techniques and time lost from work led to a strong financial burden for patients and the numerous physician visits added to the healthcare costs. The overall impact of AA stretches much further than simply being an aesthetic concern and can negatively impact every part of an individual's life. An individualized approach and effective treatments will help reduce the psychosocial consequences and distress and return patients to their normal state of health.
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Affiliation(s)
| | | | - Jeffrey Donovan
- Donovan Hair Clinic, Whistler, British Columbia, Canada
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Peterborough, Ontario, Canada
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Queen's University, Kingston, Ontario, Canada
- Division of Dermatology, Western University, London, Ontario, Canada
| | - Lyn Guenther
- Division of Dermatology, Western University, London, Ontario, Canada
- Guenther Research Inc., London, Ontario, Canada
| | - Sameh Hanna
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Dermatology on Bloor, Toronto, Ontario, Canada
| | - Charles Lynde
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Division of Dermatology, Western University, London, Ontario, Canada
- Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - Vimal H Prajapati
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Sections of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Dermatology Research Institute, Calgary, Alberta, Canada
- Skin Health & Wellness Centre, Calgary, Alberta, Canada
| | - Marni Wiseman
- Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- SKiNWISE Dermatology, Winnipeg, Manitoba, Canada
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3
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Heim‐Ohmayer P, Freiberger A, Gedik M, Beckmann J, Ziehfreund S, Zink A, Hähl W, Schielein MC. The impact of stigmatization of psoriasis, atopic dermatitis and mastocytosis in different areas of life-A qualitative interview study. SKIN HEALTH AND DISEASE 2022; 2:e62. [PMID: 36479263 PMCID: PMC9720196 DOI: 10.1002/ski2.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 06/07/2023]
Abstract
Background Stereotypes and false assumptions about chronic and visible skin diseases can determine the behaviour towards affected individuals and result in stigmatization or discrimination. Objective The aim of this study was to analyze the perceived disease-related stigmatization of individuals with psoriasis, atopic dermatitis (AD) or mastocytosis. The study also aims to broaden people-centred knowledge of the effects of stigmatization in different areas of life, namely in everyday life, at work, in sports and in relationships. Methods Qualitative in-depth semi-structured interviews were conducted among individuals with either psoriasis, AD or mastocytosis. Participants were recruited via self-help networks and were asked to express their experience of stigmatization in different areas of life. All interviews were audio recorded, transcribed verbatim and evaluated based on Mayring's content analysis. Results In total, 24 individuals aged 19-79 years and living in Germany were included in the study-eight for each disease. Stigmatization was experienced in all three diseases in all mentioned areas of life as well as in interaction with medical professionals. Self-exclusion, negative self-perception and negative behaviour of others were the most frequent experiences with stigmatization. Conclusion Stigmatization, both internal and external, is an important factor contributing to the mental burden of people with chronic skin diseases. More research is needed to gain deeper insight into stigmatization and its psychological burden in various contexts to enhance people-centred care in chronic skin diseases.
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Affiliation(s)
- P. Heim‐Ohmayer
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - A. Freiberger
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - M. Gedik
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - J. Beckmann
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
- School of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | - S. Ziehfreund
- Department of Dermatology and AllergySchool of MedicineTechnical University of MunichMunichGermany
| | - A. Zink
- Department of Dermatology and AllergySchool of MedicineTechnical University of MunichMunichGermany
- Unit of Dermatology and VenereologyDepartment of MedicineKarolinska University HospitalKarolinska InstitutetSolnaSweden
| | - W. Hähl
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - M. C. Schielein
- Department of Dermatology and AllergySchool of MedicineTechnical University of MunichMunichGermany
- Unit of Dermatology and VenereologyDepartment of MedicineKarolinska University HospitalKarolinska InstitutetSolnaSweden
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4
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Huck GE, Umucu E, Shelton S, Brickham D, Smedema S. An Evaluation of the PERMA Model as a Framework for Reducing Psychiatric Comorbidity in Individuals With Alopecia Areata. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2022. [DOI: 10.1027/2512-8442/a000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Abstract. Background: Alopecia areata (AA) is among the most common immunological conditions. Although AA is considered to be a medically benign condition, those living with AA often report comorbid psychiatric conditions, high levels of functional impairment, and diminished quality of life. These consequences are largely due to the unique psychological turmoil associated with the condition. Unfortunately, little research has considered how to improve quality of life outcomes for this group. Aims: The purpose of this study was to evaluate how the PERMA framework of well-being is associated with the individual subjective experience of AA. A greater understanding of how PERMA applies to this group holds promise for assisting clinicians with devising psychosocial coping strategies for this population. Method: 274 individuals were recruited for participation. Hierarchical regression analyses were used to evaluate associations between the PERMA variables and AA-related (a) subjective symptoms (e.g., self-consciousness, sadness) and (b) relationship impact (e.g., perceived attractiveness). Each analysis controlled for demographic and condition-specific variables. Results: Demographic and PERMA variables were found to be significantly associated with positive experiences of each quality of life outcome. Limitations: The male to female ratio of participants was biased toward females. Furthermore, the nature of cross-sectional survey research has inherent limitations. Conclusion: The findings provide support for a relationship between PERMA variables and quality of life outcomes among people with AA. Clinical implications and future research directions are discussed.
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Affiliation(s)
- Garrett E. Huck
- Department of Rehabilitation and Human Services, The Pennsylvania State University, Hazleton, PA, USA
- Department of Rehabilitation and Human Services, The Pennsylvania State University, Wilkes-Barre, PA, USA
| | - Emre Umucu
- Department of Rehabilitation Sciences, The University of Texas, El-Paso, TX, USA
| | - Shaina Shelton
- Department of Rehabilitation and Human Services, The Pennsylvania State University, Wilkes-Barre, PA, USA
| | - Dana Brickham
- Department of Rehabilitation Counseling, Western Washington University, Everett, WA, USA
| | - Susan Smedema
- Department of Rehabilitation Psychology and Special Education, The University of Wisconsin, Madison, WI, USA
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5
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Association between Androgenetic Alopecia and Psychosocial Disease Burden: A Cross-Sectional Survey among Polish Men. Dermatol Res Pract 2022; 2022:1845044. [PMID: 35340914 PMCID: PMC8947924 DOI: 10.1155/2022/1845044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
A decline in quality of life in men with androgenetic alopecia (AGA) is frequently reported, so we aimed to evaluate the psychosocial burden related to AGA in Polish male patients with AGA. We enrolled 75 adult patients with AGA. The study was conducted in an outpatient dermatology clinic in Poland. Each participant answered 23 dedicated questions about demographic data, history of the disease, and a psychosocial condition. Overall, 38.7% of patients did not notice any impact of AGA on their contact with other people or activity in their free time; 50.7% of patients observed little or no effect on their relationship with their partner; 60% of patients often or sometimes felt embarrassed by their baldness (mainly those aged 18–25 years; p=0.002); 66.7% of patients reported a rather large negative impact on their self-esteem; and 81.3% of patients sometimes experienced stress in everyday life. We conclude that AGA impairs the emotional condition and social functioning of men of all ages, but particularly of younger men. Broader interventions should be planned to allow access to a psychological and psychosocial support, starting treatment at an early stage of the disease, and involving family physicians in the treatment of AGA.
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6
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Schut C, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Ständer S, Tomas-Aragones L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva-Panovska V, Spillekom-van Koulil S, Balieva F, Szepietowski JC, Reich A, Roque Ferreira B, Lvov A, Romanov D, Marron SE, Gracia-Cazaña T, Svensson Å, Altunay IK, Thompson A, Zeidler C, Kupfer J. Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries. Br J Dermatol 2022; 187:115-125. [PMID: 35041211 DOI: 10.1111/bjd.21021] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 01/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. OBJECTIVES To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. METHODS This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. RESULTS The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation. CONCLUSIONS This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.
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Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - Florence J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University of London, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Department, Leiden University, The Netherlands
| | | | - Lars Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Lucia Tomas-Aragones
- Department of Psychology, University of Zaragoza, Spain.,Aragon Psychodermatology Research Group Zaragoza, Spain
| | - Nienke Vulink
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Csanád Szabó
- Department of Dermatology and Allergology, University of Szeged, Hungary
| | - Vesna Grivcheva-Panovska
- University St. Cyril and Methodius, School of Medicine, PHI University Clinic of Dermatology Skopje, N. Macedonia
| | - Saskia Spillekom-van Koulil
- Radbout Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Poland
| | - Bárbara Roque Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Portugal.,Department of Dermatology, Centre Hospitalier de Mouscron, Belgium.,University of Brest, Lien, France
| | - Andrey Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia.,Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia.,Moscow Scientific and Practical Centre of Dermatology, Venereology and Cosmetology of Moscow City Health Department, Moscow, Russia
| | - S E Marron
- Aragon Psychodermatology Research Group Zaragoza, Spain.,Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Å Svensson
- Department of Dermatology, Skane University Hospital, Malmö, Sweden
| | - Ilknur K Altunay
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, Istanbul, Turkey
| | - Andrew Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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7
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Creadore A, Manjaly P, Li SJ, Tkachenko E, Zhou G, Joyce C, Huang KP, Mostaghimi A. Evaluation of Stigma Toward Individuals With Alopecia. JAMA Dermatol 2021; 157:392-398. [PMID: 33688916 DOI: 10.1001/jamadermatol.2020.5732] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Perceived stigma among patients with alopecia is associated with impaired quality of life; however, the magnitude of laypersons' stigma toward individuals with alopecia is unknown. Objective To determine the prevalence and magnitude of laypersons' stigma toward individuals with varying degrees of alopecia and whether stigma increases with increased severity of alopecia. Design, Setting, and Participants This was a cross-sectional study using an internet survey administered to a convenience sample of adult respondents in the US participating on the Amazon Mechanical Turk platform. Portrait images of 6 individuals without hair loss were created using artificial intelligence and stock images. Each portrait was edited to create 2 additional versions, 1 with scalp hair loss and 1 with complete hair loss, for a total of 18 images. On January 9 to 10, 2020, the survey presented each internet respondent with 1 randomly selected portrait to be used in answering a series of stigma-related questions from 3 domains: stereotypes, social distance, and disease-related myths; the third domain was presented only to respondents who believed that the individual pictured had a medical condition. Main Outcomes and Measures The main outcome was the prevalence and magnitude of stigma of laypersons toward individuals with alopecia and the percentage of laypersons who believed the individual pictured had a medical condition as recorded in survey responses. Results The survey was completed by 2015 respondents (99.9% completion rate) with a mean age of 37 (range, 18-78) years; 1014 (50.3%) were men; 1596 (79.2%) were White; and 1397 (69.3%) had a college or postcollege education. Endorsement of every stigma item increased as alopecia severity increased (2.4%-27.6%). Absolute change on the stereotype (0.5-0.6) and social distance scales (0.2-0.5) also increased, indicating more stigma. The percentage of respondents believing the individual pictured had a medical condition increased as alopecia severity increased (33.6%-75.7%; P < .001). Among the subgroup of respondents who were asked to rate their agreement with disease-related myths, the absolute change on the myth scale decreased as alopecia severity increased, indicating decreased stigma (-0.7 to -1.2). Conclusions and Relevance This cross-sectional survey study found that stigmatizing attitudes of laypersons toward patients with alopecia exist across a multitude of social and professional scenarios. Stigma prevalence and magnitude vary by alopecia severity and possibly by whether alopecia is believed to be a medical condition.
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Affiliation(s)
- Andrew Creadore
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Elizabeth Tkachenko
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University, Chicago, Illinois
| | - Kathie P Huang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Associate Editor, JAMA Dermatology
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8
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Schielein MC, Tizek L, Ziehfreund S, Sommer R, Biedermann T, Zink A. Stigmatisierung durch Haarausfall – eine systematische Literaturübersicht. J Dtsch Dermatol Ges 2020; 18:1357-1369. [PMID: 33373136 DOI: 10.1111/ddg.14234_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/07/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Maximilian Christian Schielein
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Linda Tizek
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Stefanie Ziehfreund
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Rachel Sommer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Alexander Zink
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
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9
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Burns LJ, Mesinkovska N, Kranz D, Ellison A, Senna MM. Cumulative Life Course Impairment of Alopecia Areata. Int J Trichology 2020; 12:197-204. [PMID: 33531741 PMCID: PMC7832162 DOI: 10.4103/ijt.ijt_99_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/29/2020] [Indexed: 02/01/2023] Open
Abstract
Alopecia areata (AA), an unpredictable, nonscarring hair loss, is commonly perceived as a cosmetic, rather than medical, concern. However, substantial evidence exists describing the negative impact on quality of life, as the disease affects patients personally, socially, financially, and physically. Over time, the cumulative disability may perpetuate poor confidence, social disconnection, negative coping strategies, and failure to achieve a full life potential. Here, we describe the cumulative life course impairment (CLCI) of AA by examining the complex interaction of (1) stigmatization, (2) physical and psychiatric comorbidities, and (3) coping strategies. The model aggregates existing cross-sectional data, which have previously captured disease burden only as snapshots in time. Thus, by examining cumulative effects, the CLCI model serves as a proxy for longitudinal data to better describe life course epidemiology of the disease.
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Affiliation(s)
- Laura J Burns
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Natasha Mesinkovska
- National Alopecia Areata Foundation, San Rafael, USA.,Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - Dory Kranz
- National Alopecia Areata Foundation, San Rafael, USA
| | - Abby Ellison
- National Alopecia Areata Foundation, San Rafael, USA
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Schielein MC, Tizek L, Ziehfreund S, Sommer R, Biedermann T, Zink A. Stigmatization caused by hair loss - a systematic literature review. J Dtsch Dermatol Ges 2020; 18:1357-1368. [PMID: 33015951 DOI: 10.1111/ddg.14234] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Abstract
Hair loss is a symptom that can cause stigmatization and severe impairment of quality of life. The aim of this systematic review was to evaluate the literature on stigmatization of hair loss. Using predefined MeSH terms and keywords, a systematic search was performed in the databases MEDLINE (PubMed), EMBASE, PsycINFO and PsycNET. No time restriction was chosen (last update: May 07, 2019; PROSPERO registration number: CRD42019122966). A total of 98 studies were identified, of which eleven were selected for inclusion in this work. The Hairdex, a questionnaire on disease-specific quality of life, was the most frequently used instrument for the quantitative assessment of stigma. The studies were highly heterogeneous and values for stigmatization of androgenetic alopecia varied widely. However, regardless of the pathogenesis, patients with hair loss often suffer from stigmatization which limits their quality of life. Stigmatization of people with visible skin lesions has often been neglected in clinical practice and in daily contact with affected individuals. Studies that specifically address the stigma of hair loss are rare. Further studies are needed to achieve comparability within pathogeneses as well as with other visible dermatoses in order to better understand the enormous psychosocial burden of hair loss.
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Affiliation(s)
| | - Linda Tizek
- Department of Dermatology and Allergology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergology, Faculty of Medicine, Technical University of Munich, Munich, Germany
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Kyriakou G, Drivelou V, Glentis A. Villainous hair: ba(l)d to the bone - would they be so evil if they had hair? Br J Dermatol 2020; 184:156-157. [PMID: 32876336 DOI: 10.1111/bjd.19508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- G Kyriakou
- Department of Dermatology, University General Hospital of Patras, Patras, Greece
| | - V Drivelou
- Department of Management Tourism Enterprises, TEI of Western Greece, Patras, Greece
| | - A Glentis
- Department of General Medicine, University General Hospital of Patras, Patras, Greece
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Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH. Bidirectional association between alopecia areata and major depressive disorder among probands and unaffected siblings: A nationwide population-based study. J Am Acad Dermatol 2020; 82:1131-1137. [PMID: 32007291 DOI: 10.1016/j.jaad.2019.11.064] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/23/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alopecia areata (AA) has long been associated with major depressive disorder (MDD). However, most evidence to date has derived from cross-sectional or case-control studies. OBJECTIVE To investigate the bidirectional association between AA and MDD among probands and unaffected siblings. METHODS Study participants were recruited from the National Health Insurance Research Database in Taiwan. We included 2123 probands with AA, 2298 unaffected siblings, and 9192 matched controls to assess the risk of MDD. We included 16,543 probands with MDD, 17,352 unaffected siblings, and 69,408 matched controls to assess the risk of AA. The Breslow-Cox model was used to calculate the adjusted relative risk. RESULTS Compared with controls, AA probands and unaffected siblings had adjusted relative risks of 8.22 (95% confidence interval [CI], 6.41-10.54) and 2.55 (95% CI, 1.91-3.40), respectively, for MDD. MDD probands and unaffected siblings had adjusted relative risks for AA of 1.66 (95% CI, 1.24-2.22) and 1.64 (95% CI, 1.27-2.12), respectively. LIMITATION The National Health Insurance Research Database lacked information on disease severity, body mass index, smoking habit, alcohol consumption, and stressful life events. CONCLUSION Our study demonstrated a bidirectional association between AA and MDD among probands and unaffected siblings, thus suggesting shared familial mechanisms underlying AA and MDD.
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Affiliation(s)
- Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chiang Chen
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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Yeshua-Katz D, Shvarts S, Segal-Engelchin D. Hierarchy of hair loss stigma: media portrayals of cancer, alopecia areata, and cancer in Israeli newspapers. Isr J Health Policy Res 2019; 8:68. [PMID: 31481109 PMCID: PMC6720986 DOI: 10.1186/s13584-019-0338-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over 300,000 people in Israel cope with temporary or permanent hair loss (alopecia) that results from diseases and medical treatments. For women, hair loss can be a highly traumatic event that may lead to adverse psychosocial consequences and health outcomes. Nevertheless, this phenomenon has been mostly ignored by health professionals as it is primarily considered an aesthetic-rather than as a health-related issue. Only recently the Healthcare Basket Committee approved financial assistance for the purchase of wigs by patients coping with hair loss. Given the important role that the media plays in shaping health policies related to diagnoses, treatment and support services, the current study sought to enrich our understanding of how the media portrays disease-related hair-loss. METHODS Using framing and agenda-setting theories, this study examined the media portrayals of hair loss associated with three diseases-cancer, alopecia areata, and ringworm, depicted in Israeli newspapers in 1994-2016. The sample consisted of 470 articles about the three diseases: 306 on cancer, 36 on AA, and 128 on ringworm. RESULTS Textual and visual analysis revealed the ways media marginalize this physical flaw. Cancer was framed in medical terms, and patients were portrayed as older Israeli-born people whose hair loss was absent from their experience. Ringworm was framed as a fear-inducing disease; patients were portrayed as faceless, unidentified immigrants that coped with visible hair loss. Articles on AA provided the greatest focus on the patient's experience of hair loss, but patients were portrayed as young foreign people. CONCLUSIONS Our results revealed a hierarchy of stigmas against hair loss, in which the media coverage marginalized this experience. The omission of hair loss by the media may explain, at least in part, why health professionals often ignore the psychosocial needs of these patients. Health insurance funding of wigs is a helpful but nevertheless insufficient solution to coping with feminine hair loss. Our findings may encourage media leaders to conduct planned media interventions to increase awareness of clinicians and health policymakers about the unique challenges faced by women coping with hair loss and promote health policy-making aimed at the well-being of these women.
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Affiliation(s)
- Daphna Yeshua-Katz
- Department of Communication Studies, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, Israel
| | - Shifra Shvarts
- Moshe Prywes Center for Medical Education, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dorit Segal-Engelchin
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Davern J, O’Donnell AT. Stigma predicts health-related quality of life impairment, psychological distress, and somatic symptoms in acne sufferers. PLoS One 2018; 13:e0205009. [PMID: 30265724 PMCID: PMC6161901 DOI: 10.1371/journal.pone.0205009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/18/2018] [Indexed: 11/18/2022] Open
Abstract
Acne vulgaris has been associated with deficits in psychological well-being and health-related quality of life. Few studies have investigated how stigma contributes to our understanding of the well-being of acne sufferers, although it is clear that acne is stigmatized and stigmatization is associated with impaired well-being. The current study aimed to investigate the ability of perceived stigma to predict health-related quality of life, psychological distress, and somatic symptoms over and above established predictors. University students and staff suffering from acne completed self-report measures online. Hierarchical multiple regression analyses showed that perceived stigma significantly contributed to the prediction of all three well-being measures, over and above the effects of gender, acne severity, acne location, and use of medication. Indeed, perceived stigma made the largest unique contribution to predicting well-being. Our findings suggest that interventions that attempt to counter stigma could also improve the overall well-being of people affected by acne.
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Affiliation(s)
- Jamie Davern
- Department of Psychology and Centre for Social Issues Research, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| | - Aisling T. O’Donnell
- Department of Psychology and Centre for Social Issues Research, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
- * E-mail:
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Abstract
OBJECTIVES This study aimed to examine levels of social anxiety, anxiety and depression reported by people with alopecia as a result of a dermatological condition and associations with wig use. The study also sought to report on experiences of wearing wigs in social situations and the relationship with social confidence. DESIGN A cross-sectional survey was sent by email to the Alopecia UK charity mailing list and advertised on social media. PARTICIPANTS Inclusion criteria were a diagnosis of alopecia, aged 13 or above and sufficient English to complete the survey. Exclusion criteria included experiencing hair loss as a result of chemotherapy treatment or psychological disorder. Participants (n=338) were predominantly female (97.3%), Caucasian (93.5%) and aged between 35 and 54 years (49.4%) with a diagnosis of alopecia areata (82.6%). MAIN OUTCOME MEASURES The Social Phobia Inventory measured symptoms of social anxiety, and the Hospital Anxiety and Depression Scale was used to measure symptoms of anxiety and depression. Survey questions were designed to measure the use of wigs. Open-ended questions enabled participants to comment on their experiences of wearing wigs. RESULTS Clinically significant levels of social anxiety (47.5%), anxiety (35.5%) and depression (29%) were reported. Participants who reported worries about not wearing a wig reported significantly higher levels of depression: t(103)=3.40, p≤0.001; anxiety: t(109)=4.80, p≤0.001; and social anxiety: t(294)=3.89, p≤0.001. Wearing wigs was reported as increasing social confidence; however, the concealment it afforded was also reported as both reducing fear of negative evaluation and maintaining anxiety. DISCUSSION Overall, 46% of participants reported that wearing a wig had a positive impact on their everyday life with negative experiences related to fears of the wig being noticed. Psychological interventions alongside wig provision would be beneficial for people living with alopecia.
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Affiliation(s)
- Kerry Montgomery
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Caroline White
- Dermatopharmacology Unit, University of Manchester, Manchester, Greater Manchester, UK
| | - Andrew Thompson
- Department of Psychology, University of Sheffield, Sheffield, UK
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