Feeling of stigmatization and satisfaction with life among Arabic psoriatic patients

Measuring public attitudes towards people living with chronic diseases in Arabic-speaking populations: adaptation and development of the Social Stigma Scale of Chronic Diseases (SSS-CD)

BACKGROUND

A large proportion of the population in Arab countries suffer from chronic diseases. According to the statistics by the Global Health Estimates, chronic illnesses contribute by 71% to total deaths in the Arab region. While chronic illnesses have been demonstrated to carry high levels of social stigma, it is only recently that little research attention has been given to this topic in the Arab world. It is well-established that the social stigma construct is culturally-dependent. Therefore, the lack of an Arabic measure highlighted the urgent need for developing a culturally adapted and valid instrument to assess social stigma toward people living with chronic diseases. In this study, we aimed to examine the psychometric properties of the Arabic translation, adaptation and development of "the Social Stigma Scale of Chronic Diseases" (SSS-CD).

METHOD

Fifteen items derived from the literature and assessing social stigma towards chronic diseases have been administered to 570 Arabic-speaking adults from the Lebanese general population (aged 24.59 ± 6.75years; 68.6% women). Items were translated into Arabic using a forward-backward translation method. Exploratory factor analysis (EFA) using a principal-axis EFA on the first split-half subsample, followed by a confirmatory factor analysis (CFA) tested on the model extracted from the EFA on the second split-half subsample, were conducted to examine the construct validity of the SSS-CD. Fit indices were deemed adequate if the normed model chi-square (χ²/df) ≤ 3, the Steiger-Lind root mean square error of approximation (RMSEA) ≤ 0.08, the Tucker-Lewis Index (TLI) and the comparative fit index (CFI) ≥ 0.90.

RESULTS

Findings revealed that the 10-item SSS-CD has a unidimensional factor structure, with the following fit indices: χ²/df = 92.95/34 = 2.73, RMSEA = 0.077 (90% CI 0.059, 0.096), SRMR = 0.062, CFI = 0.939, TLI = 0.919. A good internal consistency was demonstrated by a McDonald's omega value of 0.73 for the total score. Findings also supported invariance across gender, with men exhibiting higher levels of social stigma attached to chronic diseases than women. All three dimensions of stigmatization (social, psychological and evolutionary stigmatization) were positively correlated with SSS-CD scores (Social self-interest [r = .40; p < .001], Evolutionary self-interest [r = .37; p < .001], Psychological self-interest [r = .42; p < .001]), demonstrating relatively strong convergent validity.

CONCLUSION

Our findings suggest that the SSS-CD has robust psychometric qualities. We thus preliminarily suggest that the scale is valid, reliable and suitable for use among Arabic-speaking people from the general population to measure public attitudes towards people living with chronic diseases. Providing this psychometrically sound measure will hopefully enable to foster research in this area in order to draw a clear overview of the prevalence and characteristics of social stigma attached to chronic diseases in Arabic-speaking communities. However, given that this was the first study to examine the psychometric properties of the SSS-CD, the present findings and conclusions should be considered tentative pending future cross-national validation studies.

Satisfaction with Life and Coping Strategies among Patients with Hidradenitis Suppurativa: A Cross-Sectional Study

INTRODUCTION

Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory dermatosis with vast psychosocial burden. The objective of this study is to thoroughly analyze satisfaction with life (SWL) and coping strategies of HS patients in relation to the clinical and psychosocial factors.

METHODS

114 HS patients (53.1% females; mean age 36.6 ± 13.1 years) were enrolled. Severity of the disease was measured using Hurley staging and International HS Score System (IHS4). Instruments utilized: Satisfaction with Life Scale (SWLS); Coping-Orientation to Problems-Experienced Inventory (Brief COPE); HS Quality of Life Scale (HiSQoL); Patient Health Questionnaire-9 (PHQ-9); Generalized Anxiety Disorder-7 (GAD-7); General Health Questionnaire (GHQ-28).

RESULTS

SWL was low in 31.6% of HS patients. No relation was found between SWL and Hurley staging and IHS4. SWL correlated with GHQ-28 (r = -0.579 p < 0.001), PHQ-9 (r = -0.603 p < 0.001), GAD-7 (r = -0.579 p < 0.001), and HiSQoL (r = -0.449 p < 0.001). Problem-focused coping strategies were most commonly used, followed by emotion-focused coping and avoiding coping strategies. Significant differences were found between the following coping strategies and SWL: self-distraction (p = 0.013), behavioral-disengagement (p = 0.001), denial (p = 0.003), venting (p = 0.019), and self-blame (p = 0.001).

CONCLUSIONS

HS patients present low SWL which correlates with psychosocial burden. Reducing anxiety-depression comorbidity and encouraging optimal coping strategies may be of great importance in holistic approach to HS patients.

Psoriasis in Northern Saudi Arabia: Clinical features and implications for quality of life

Introduction:

Psoriasis is a chronic non-contagious inflammatory skin disorder, which might impair patient’s social relationships, limit leisure activities, and lower self-esteem. Psoriasis patients might be stigmatized leading to psychological disorders such as anxiety and depression.

Objectives:

This study aimed to outline the clinical features of psoriasis and its effects on quality of life, and the feeling of stigmatization among psoriasis patients.

Methods:

This cross-sectional questionnaire-based study was conducted on 109 adult psoriasis patients in Arar City, Saudi Arabia. The study collected data on socio-demographic and clinical characteristics of psoriasis patients, self-reported psoriasis severity using the self-assessment Simplified Psoriasis Index (sa-SPI-s), patients’ quality of life using the dermatological life quality index (DLQI), and the feeling of stigmatization using the six-items stigmatization scale.

Results:

The mean age of psoriasis onset in studied patients was 20 (±7.65) years, females represented 58.72%, and 22% were unemployed. Joint and nail affection were reported in 46.79% and 51.38%, respectively. One third of patients had positive family history of psoriasis. Seasonal variation, life stressors, smoking and skin injuries were frequent provocative factors for psoriasis lesions. The average sa-SPI-s was 10.08 (±10.41), which was correlated with patients’ ages, disease duration, obesity, and pruritis. The average DLQI and six-items stigmatization scale for psoriasis patients were 8.95 (±5.77) and 7.61 (±4.5), respectively that were correlated with sa-SPI-s.

Conclusion:

The clinical manifestations and chronicity of psoriasis impaired patients’ quality of life and accompanied with social stigma due to skin disfigurement. These effects need to be addressed for better care of patients.

The Implication of Misinformation and Stigma in Age-Related Quality of Life, Depression, and Coping Mechanisms of Adult Patients with Psoriasis

Background and Objectives: Stigma and lack of acceptance in society might have detrimental effects on the quality of life of patients with psoriasis, sometimes being comparable with other chronic diseases and conditions that affect the appearance of a patient, such as burns. Therefore, we surveyed our patients diagnosed with psoriasis to determine the implications of misinformation and stigma for their quality of life, depression, and coping strategies stratified by different age categories. Materials and Methods: A cross-sectional study was designed for a sample size of a minimum of 45 patients considering a prevalence of psoriasis of 2–3% in the general population. The study participants (patients and controls) were given both a paper-based unstandardized questionnaire and an online version of three standardized surveys. The cohort of patients was further split into three age groups to determine their age-related quality of life and coping mechanisms. Results: The proportion of patients with a history of depression and depressive symptoms among patients with psoriasis was significantly higher. Multiple discrepancies were observed between patients and controls regarding questions that targeted stigma and misinformation. On the Coping Orientation to Problems Experienced Inventory (COPE-60) questionnaire, older patients were more likely to use positive coping mechanisms such as engagement and problem-focused coping, while the young patients were using more emotion-focused coping mechanisms. However, patients in the 30–50 age range group scored the highest on physical and mental health among all participants who filled the 12-Item Short Form Survey (SF-12) survey. The Dermatology Life Quality Index (DLQI) results showed significantly more patients answering “a lot and very much” concerning embarrassment and social activities, while sexual difficulties affected the older patients. The strongest correlations with depression were observed in the young patient group, who believed that psoriasis can cause skin cancer (rho = 0.418) and who had sexual difficulties (rho = 0.414) and embarrassment (rho = 0.359) as evaluated by the DLQI survey. In the 30- to 50-year-old group, the strongest correlations were with the feeling of being stigmatized (rho = 0.376), having sexual difficulties (rho = 0.367) and disengagement coping style (rho = 273). Conclusions: While the respondents are reasonably well-informed regarding psoriasis, a degree of stigma remains, likely due to involuntary emotional responses such as repulsion and embarrassment. It is essential to establish initiatives aimed at educating the general public, raising awareness, and establishing a more tolerant social environment for psoriasis patients.

The Impact of Stress-Coping Strategies and the Severity of Psoriasis on Self-Esteem, Illness Acceptance and Life Satisfaction

Introduction

The visibility of skin lesions is a significant burden for patients with psoriasis, who experience social hostility as well as many emotional and psychological problems. The recurrent nature of cutaneous manifestations and their location are also a source of emotional distress, which in turn is one of the main factors that intensifies skin lesions in these patients. The aim of the study was to assess the impact of the severity of psoriasis and stress-coping strategies on general psychometric measures in the affected patients.

Methods

The study used a short demographic questionnaire, Psoriasis Area and Severity Index (PASI), and four standardised general psychometric tools: Rosenberg Self-Esteem Scale (SES), Satisfaction With Life Scale (SWLS), Coping Inventory for Stressful Situations (CISS) and Acceptance of Illness Scale (AIS). A total of 111 patients participated in the study.

Results

The mean PASI score was 14.0 (12.1–15.9). The mean SWLS score was below average, i.e., 18.5 (17.3–19.7), and the SES score—26.8 points (26.1–27.5)—indicated self-esteem slightly above average among patients with psoriasis. The mean stress-coping level measured with CISS was 53.6 (51.9–55.2) for the task-oriented strategy (TOS), 46.2 (43.8–48.6) for the emotion-oriented strategy (EOS) and 50.1 (48.5–51.8) for the avoidance-oriented strategy (AOS). Higher PASI was associated with lower illness acceptance among men (r = 0.48) and lower self-esteem among women (r = 0.44). The level of life satisfaction was lower in respondents with higher PASI scores (mainly in the group of women, r = 0.44).

Conclusions

Higher severity of psoriasis (PASI) and greater frequency of emotion-oriented stress-coping mechanisms (CISS) are factors that negatively affect the overall psychophysical condition of respondents.

Stigmatization in Patients With Psoriasis: A Mini Review

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.

Skin-Disease Specific and Generic Psychometric Measures in Patients with Psoriasis

INTRODUCTION

Psychosocial problems of patients with chronic dermatoses, such as psoriasis, add to their somatic ailments, which results in the lack of illness acceptance, lowered self-esteem, deteriorated quality of life, and an array of somatic comorbidities. The aim of this study was to analyze the effect of psoriasis on the quality of life, sense of stigmatization, self-esteem, and satisfaction with life in patients with psoriasis.

METHODS

The study was based on a short survey prepared by the authors and five validated scales: Dermatology Life Quality Index (DLQI), 6-Item Stigmatization Scale, 33-Item Feelings of Stigmatization Questionnaire, Rosenberg Self-Esteem Scale (SES), and Satisfaction With Life Scale (SWLS). The study included 111 patients with psoriasis (46.8% women and 53.2% men). The inclusion criteria of the study were the diagnosis of plaque psoriasis and written informed consent to participate.

RESULTS

DLQI scores ranged between 0 and 28 points (pts) (mean 10.8 pts). Mean stigmatization scores determined with the 33- and 6-Item Stigmatization Scale were 81.6 pts and 7.5 pts, respectively. The mean SWLS score for the study group (18.5 pts) was slightly below the average. The mean score SES of 27 pts implies that the study respondents' self-esteem level was slightly above the average.

CONCLUSIONS

Satisfaction with life turned out to be significantly modulated by overall stigmatization level on the 33-Item Stigmatization Scale (the stronger the sense of stigmatization, the lower the satisfaction with life) and education (respondents with higher education presented with higher satisfaction with life than those with non-higher education).