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Kowalewska B, Milewska-Buzun M, Cybulski M, Szpakow A, Khvorik D, Sobolewski M, Aleksiejczuk P, Niczyporuk W. Reaction to Disease and Coping Strategies in Stressful Situations among Psoriasis Patients: Cross-Sectional Study. J Clin Med 2024; 13:4693. [PMID: 39200835 PMCID: PMC11355611 DOI: 10.3390/jcm13164693] [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: 07/04/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Background: In the contemporary world, a cult of perfection is being created, and deviations from such an ideal image are becoming socially unacceptable. A particular situation arises when a defect or symptoms of a disease appear on the skin, which, in the case of people suffering from psoriasis, are a source of stress, dissatisfaction with the disease, and a reduction in quality of life. The aim of this study was to assess whether the quality of life related to the occurrence of psoriasis and the level of acceptance of the disease affect coping strategies in stressful situations. Methods: The study involved 111 people with common psoriasis (46.8% women and 53.2% men). Inclusion criteria were as follows: a diagnosis of common psoriasis for at least 0.5 years, no other types of psoriasis, no mental illnesses, and an informed consent of the respondent to participate in the study. In order to compile the research input, a proprietary questionnaire was used along with the following standardised tools: the Dermatology Life Quality Index (DLQI), the Acceptance of Illness Scale (AIS), and the Coping Inventory for Stressful Situations (CISS). Results: The duration of the disease in the studied population varied and ranged from 0.5 years to over 50 years. Most respondents showed relatively low DLQI scores, with an average value of 10.8 points. In stressful situations (CISS), the respondents primarily used a strategy based on rational thinking (Task-oriented coping), with approximately 54 points on average; followed by an avoidant style (Avoidance-oriented coping), with approximately 50 points on average; and least often an emotional style (Emotion-oriented coping), with approximately 46 points on average. The average level of disease acceptance (AIS) in the studied group equalled approximately 26 points. Conclusions: Psoriatic lesions on the torso caused less rational behaviour in stressful situations (a decrease in the Task-oriented coping) in women but had the opposite result in men, whereas psoriatic lesions on the head stimulated the use of Task-oriented coping in women but had the opposite result in men. The higher the acceptance of the disease (AIS) presented by the respondents, the less often they used an emotional strategy (Emotion-oriented coping) in stressful situations. The higher the quality of life (DLQI) was, the lower the values of Emotion-oriented coping were noted.
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Affiliation(s)
- Beata Kowalewska
- Department of Integrated Medical Care, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.M.-B.); (M.C.)
| | - Marta Milewska-Buzun
- Department of Integrated Medical Care, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.M.-B.); (M.C.)
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.M.-B.); (M.C.)
| | - Andriej Szpakow
- International Academy of Applied Sciences in Lomza, 18-402 Lomza, Poland;
| | - Dzmitry Khvorik
- Department of Dermatovenerology, Medical University in Grodno, 230025 Grodno, Belarus;
| | - Marek Sobolewski
- Department of Quantitative Methods, Rzeszow University of Technology, 35-959 Rzeszow, Poland;
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Ghezzi G, Costanzo A, Borroni RG. Health-Related Quality of Life in Psoriasis: Literature Review. J Clin Med 2024; 13:4623. [PMID: 39200764 PMCID: PMC11354811 DOI: 10.3390/jcm13164623] [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: 07/19/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
The assessment of quality of life (QoL) in patients with psoriasis plays a crucial role in understanding the impact of the disease and evaluating treatment outcomes. We provide an overview of the key measures used to assess QoL in psoriasis patients, including both generic and psoriasis-specific instruments. The limitations and strengths of instruments such as the Dermatology Life Quality Index (DLQI), Skindex, and Psoriasis Disability Index (PDI) are discussed, highlighting their psychometric properties and areas for improvement. Furthermore, this review examines the potential of disease-specific QoL measures in providing greater sensitivity to disease-related burden and change compared to generic instruments. However, most of the available psoriasis-specific patient-reported outcome measures need further validation. We aim to provide valuable insights into the importance of using validated QoL measures in clinical practice and research, ultimately contributing to a more comprehensive assessment of the impact of psoriasis on patients' lives and enhancing the evaluation of treatment interventions.
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Affiliation(s)
- Gioele Ghezzi
- Humanitas University, 20072 Pieve Emanuele, MI, Italy;
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
| | - Antonio Costanzo
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
| | - Riccardo G. Borroni
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
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Wu CL, Chang YC, Yao WT, Chiang TI. Exploring the Effectiveness of Biological Therapy in Patients with Psoriasis: Body Image and Quality of Life. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:160. [PMID: 38256420 PMCID: PMC10819774 DOI: 10.3390/medicina60010160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Psoriasis is a chronic, long-term, incurable skin inflammatory disease characterized by the excessive proliferation of epidermal keratinocytes, dilation of blood vessels, thickening of the skin, and the formation of visible red patches of variable sizes. The impact on patients differs with the severity of the disease, leading to physiological discomfort and psychological distress, which significantly affect the quality of life. The etiology of psoriasis is not completely clear, but immune cells, including type 1 and type 17 cytokine-producing cells modulated by regulatory T cells (Tregs), play a critical role in driving the disease pathogenesis. With the ability to specifically target inflammatory markers, biologics can efficiently inhibit the spread of inflammation to achieve therapeutic effects. The goal was to explore the changes in body image and quality of life in psoriasis patients undertaking therapies with biologic agents. Materials and Methods: This study employed a quasi-experimental, single-sample, pretest-posttest design. Forty-four psoriasis patients were recruited from the dermatology outpatient clinics at two medical centers in northern Taiwan. A structured questionnaire, including demographic information, the Body Image Scale (BIS), and the Dermatology Life Quality Index (DLQI), was used as a research tool. Questionnaire assessments were conducted both before and three months after the biologic agent intervention. Statistical analyses were performed using SPSS version 22.0. Results: Our results indicated a significant difference in body image between psoriasis patients before and after intervention with biologic agents. In addition, overall quality of life (QoL) also showed significant improvements before and after biologic agent intervention. There was a positive correlation between body image and quality of life in psoriasis patients. Conclusions: The treatment for psoriasis has evolved rapidly in recent years, and biologic agents have proven to be effective therapies to improve the quality of life for psoriasis patients. Our study suggests that health-related education and psychological support can further benefit psoriasis patients to willingly and positively undertake treatment and therefore improve their positive body image and quality of life.
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Affiliation(s)
- Chia-Lien Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan; (C.-L.W.); (Y.-C.C.)
| | - Ya-Ching Chang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan; (C.-L.W.); (Y.-C.C.)
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 104, Taiwan;
- Department of Materials Science and Engineering, National Taiwan University, Taipei 106, Taiwan
| | - Tsay-I Chiang
- Department of Nursing, Hungkuang University, Taichung 403, Taiwan
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Adesanya EI, Matthewman J, Schonmann Y, Hayes JF, Henderson A, Mathur R, Mulick AR, Smith CH, Langan SM, Mansfield KE. Factors associated with depression, anxiety and severe mental illness among adults with atopic eczema or psoriasis: a systematic review and meta-analysis. Br J Dermatol 2022; 188:460-470. [PMID: 36745557 DOI: 10.1093/bjd/ljac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Evidence suggests an association between atopic eczema (AE) or psoriasis and mental illness; however, the factors associated with mental illness are unclear. OBJECTIVES To synthesize and evaluate all available evidence on factors associated with depression, anxiety and severe mental illness (SMI) among adults with AE or psoriasis. METHODS We searched electronic databases, grey literature databases and clinical trial registries from inception to February 2022 for studies of adults with AE or psoriasis. Eligible studies included randomized controlled trials (RCTs), cohort, cross-sectional or case-control studies where effect estimates of factors associated with depression, anxiety or SMI were reported. We did not apply language or geographical restrictions. We assessed risk of bias using the Quality in Prognosis Studies tool. We synthesized results narratively, and if at least two studies were sufficiently homogeneous, we pooled effect estimates in a random effects meta-analysis. RESULTS We included 21 studies (11 observational, 10 RCTs). No observational studies in AE fulfilled our eligibility criteria. Observational studies in people with psoriasis mostly investigated factors associated with depression or anxiety - one cross-sectional study investigated factors associated with schizophrenia. Pooled effect estimates suggest that female sex and psoriatic arthritis were associated with depression [female sex: odds ratio (OR) 1.62, 95% confidence interval (CI) 1.09-2.40, 95% prediction intervals (PIs) 0.62-4.23, I2 = 24.90%, τ2 = 0.05; psoriatic arthritis: OR 2.26, 95% CI 1.56-3.25, 95% PI 0.21-24.23, I2 = 0.00%, τ2 = 0.00] and anxiety (female sex: OR 2.59, 95% CI 1.32-5.07, 95% PI 0.00-3956.27, I2 = 61.90%, τ2 = 0.22; psoriatic arthritis: OR 1.98, 95% CI 1.33-2.94, I2 = 0.00%, τ2 = 0.00). Moderate/severe psoriasis was associated with anxiety (OR 1.14, 95% CI 1.05-1.25, I2 0.00%, τ2 = 0.00), but not depression. Evidence from RCTs suggested that adults with AE or psoriasis given placebo had higher depression and anxiety scores compared with comparators given targeted treatment (e.g. biologic agents). CONCLUSIONS Our review highlights limited existing research on factors associated with depression, anxiety and SMI in adults with AE or psoriasis. Observational evidence on factors associated with depression or anxiety in people with psoriasis was conflicting or from single studies, but some identified factors were consistent with those in the general population. Evidence on factors associated with SMIs in people with AE or psoriasis was particularly limited. Evidence from RCTs suggested that AE and psoriasis treated with placebo was associated with higher depression and anxiety scores compared with skin disease treated with targeted therapy; however, follow-up was limited. Therefore, long-term effects on mental health are unclear.
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Affiliation(s)
- Elizabeth I Adesanya
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julian Matthewman
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK
| | - Alasdair Henderson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amy R Mulick
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guys and St Thomas' Foundation Trust and King's College London, London, UK
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Health Data Research UK, London, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Gisondi P, Geat D, Armeni P, Bellinato F, Maurelli M, Girolomoni G. Cost per responder of Adalimumab biosimilars MSB11022 and ABP 501 versus the originator and methotrexate in chronic plaque psoriasis. Expert Opin Biol Ther 2022; 22:1579-1584. [PMID: 35466843 DOI: 10.1080/14712598.2022.2070428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pharmacoeconomic studies comparing the cost of adalimumab biosimilars versus the originator and conventional drugs in psoriasis are lacking. RESEARCH DESIGN AND METHODS To assess the cost per responder of adalimumab biosimilars versus the originator and methotrexate for psoriasis treatment. A cost per responder analysis comparing adalimumab biosimilars MSB11022 (Idacio®) and ABP 501 (Amgevita®), and methotrexate to the originator (Humira®) was performed. The incremental cost per responder was calculated by multiplying the cost of treatment based on the perspective of the National Healthcare System and number needed to treat for each therapy. RESULTS Considering the PASI75 response rate at 16 weeks, the cost per responder for MSB11022 and ABP 501 compared to the originator was € 500 versus 1,831 and € 968 versus 1,949, respectively. For the same endpoint, the cost per responder for subcutaneous or oral methotrexate was € 543 or 34 compared to 2,117 for adalimumab originator. At an indirect comparison among methotrexate, MSB11022 and ABP 501, the costs per PASI75 responder at week 16 were 2%, 26%, 27% and 50% of that of the originator, respectively. CONCLUSIONS The use of biosimilars was confirmed as a valuable pharmacoeconomic strategy to lower healthcare cost in patients with psoriasis.
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Affiliation(s)
- Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Davide Geat
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Patrizio Armeni
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Francesco Bellinato
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Martina Maurelli
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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Jalenques I, Bourlot F, Martinez E, Pereira B, D'Incan M, Lauron S, Rondepierre F. Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi. Acta Derm Venereol 2022; 102:adv00769. [DOI: 10.2340/actadv.v102.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The magnitude of the association between psoriasis and depression has been evaluated, but not that between psoriasis and anxiety. The aim of this systematic review and meta-analysis was to examine the prevalence and odds of anxiety disorders and symptoms in patients with psoriasis. Five medical databases (Cochrane Database, EMBASE, PubMed, PsychINFO, ScienceDirect) were searched for relevant literature. A total of 101 eligible articles were identified. Meta-analysis revealed different prevalence rates depending on the type of anxiety disorder: 15% [95% confidence interval [CI] 9–21] for social anxiety disorder, 11% [9–14] for generalized anxiety disorder, and 9% [95% CI 8–10] for unspecified anxiety disorder. There were insufficient studies assessing other anxiety disorders to be able to draw any conclusions on their true prevalence. Meta-analysis also showed a high prevalence of anxiety symptoms (34% [95% CI 32–37]). Case-control studies showed a positive association between psoriasis and unspecified anxiety disorder (odds ratio 1.48 [1.18; 1.85]) and between psoriasis and anxiety symptoms (odds ratio 2.51 [2.02; 3.12]). All meta-analyses revealed an important heterogeneity, which could be explained in each case by methodological factors. The results of this study raise the necessity of screening for the presence of anxiety disorders, as previously recommended for depressive disorders, in patients with psoriasis and, if necessary, to refer such patients for evaluation by a mental health professional and appropriate treatment.
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Kowalewska B, Krajewska-Kułak E, Sobolewski M. The Impact of Stress-Coping Strategies and the Severity of Psoriasis on Self-Esteem, Illness Acceptance and Life Satisfaction. Dermatol Ther (Heidelb) 2022; 12:529-543. [PMID: 35041156 PMCID: PMC8764316 DOI: 10.1007/s13555-021-00669-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Beata Kowalewska
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland.
| | - Elżbieta Krajewska-Kułak
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland
| | - Marek Sobolewski
- Faculty of Management, Rzeszow University of Technology, Rzeszow, Poland
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Kowalewska B, Jankowiak B, Krajewska-Kułak E, Milewski R, Sobolewski M. Skin-Disease Specific and Generic Psychometric Measures in Patients with Psoriasis. Dermatol Ther (Heidelb) 2021; 11:1999-2015. [PMID: 34585342 PMCID: PMC8478271 DOI: 10.1007/s13555-021-00609-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 01/19/2023] Open
Abstract
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).
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Affiliation(s)
- Beata Kowalewska
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland.
| | - Barbara Jankowiak
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland
| | - Elżbieta Krajewska-Kułak
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland
| | - Rafał Milewski
- Doctoral Studies at Faculty of Health Sciences, Department of Primary Healthcare, Medical University of Bialystok, Białystok, Poland
| | - Marek Sobolewski
- Faculty of Management, Rzeszow University of Technology, Rzeszów, Poland
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Demma A, Suitner C, Ferruzza E, Nicolini C, Donini M. The indirect effect of a focus group for psoriatic patients on their caregivers. ACTA ACUST UNITED AC 2021; 24:486. [PMID: 33937108 PMCID: PMC8082531 DOI: 10.4081/ripppo.2021.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022]
Abstract
Psoriasis is a chronic skin disease involving not only epidermic damages but also psychological distress for patients and their family caregivers. Little is known about the effects of a psychological support for psoriatic patients on their caregivers’ well-being. The goal of the present study was to investigate the indirect effects of the participation in a dynamic focus group reserved for psoriatic patients on their caregivers in terms of quality of life. The study involved 52 psoriatic patients and 41 family caregivers. Patients’ wellbeing was assessed using the dermatology quality of life index, hospital anxiety and depression scale. The impact of the disease on caregivers was assessed using the family dermatology life quality index (FDLQI). Data were analyzed with linear mixed models. The caregivers of psoriatic patients involved in the psychodynamic focus group reported levels of FDLQI that decreased over time, therefore showing an improvement in their quality of life in relation to the pathology of their relatives; the caregivers of patients who did not participate in the psychodynamic focus group, instead, had levels of FDLQI that were stable over time. The results provide preliminary evidence that the group setting of the Psychodynamic Focus Group may alleviate the negative impact of psychosomatic disease on the caregivers.
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Affiliation(s)
| | - Caterina Suitner
- Department of Psychology of Development and Socialization, University of Padova, Padova
| | - Emilia Ferruzza
- Department of Psychology of Development and Socialization, University of Padova, Padova
| | - Chiara Nicolini
- S.I.P.P., Società Italiana di Psicoterapia Psicoanalitica, Milano
| | - Massimo Donini
- Operative Unit of Dermatology, Ulss 3 Serenissima, Venezia, Italy
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Kowalewska B, Jankowiak B, Cybulski M, Krajewska-Kułak E, Khvorik DF. Effect of Disease Severity on the Quality of Life and Sense of Stigmatization in Psoriatics. Clin Cosmet Investig Dermatol 2021; 14:107-121. [PMID: 33564255 PMCID: PMC7866929 DOI: 10.2147/ccid.s286312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory disease of the skin having a profound effect on the quality of life and contributing to the sense of stigmatization in the affected patients. The aim of this study was to analyze the effect of psoriasis severity on the quality of life and sense of stigmatization in psoriatics and to investigate relationships between these measures and sociodemographic variables. PATIENTS AND METHODS The study included 111 patients with psoriasis. The inclusion criteria of the study were the diagnosis of psoriasis and written informed consent to participate. The study was based on a short survey prepared by the authors and four validated scales: Dermatology Life Quality Index (DLQI), 6-item Stigmatization Scale, 33-item Feelings of Stigmatization Questionnaire, and Psoriasis Area and Severity Index (PASI). RESULTS Mean PASI score for the study group was 14 pts. Most respondents presented with low DLQI scores, with the mean value of 10.8 pts suggesting that the disease-related ailments were not extremely burdensome for the majority of the patients. Mean stigmatization scores for the 6- and 33-item scale were 7-8 and 81-82 pts, respectively. CONCLUSION The severity of psoriasis was the strongest determinant of the quality of life measured with the DLQI. Also, the levels of stigmatization determined with the 6- and 33-item scale correlated significantly with PASI scores.
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Affiliation(s)
- Beata Kowalewska
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Jankowiak
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
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Kowalewska B, Jankowiak B, Niedżwiecka B, Krajewska-Kułak E, Niczyporuk W, Khvorik DF. Relationships between the acceptance of illness, quality of life and satisfaction with life in psoriasis. Postepy Dermatol Alergol 2020; 37:948-955. [PMID: 33603615 PMCID: PMC7874872 DOI: 10.5114/ada.2020.92906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/24/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Since the skin plays a pivotal role in interpersonal relationships, a chronic dermatological condition (psoriasis), may have a profound effect on the psychological status of patients. AIM To analyse the effects of skin lesions on satisfaction with life, acceptance of illness and quality of life in psoriasis. MATERIAL AND METHODS The study included psoriatics recruited at the Dermatology Outpatient Unit of the Regional Hospital in Lomza, Dermatology Outpatient Clinic in Siemiatycze and Dermatology and Medical Cosmetology Centre in Bialystok. The study patients were examined with a demographic survey prepared by the authors, as well as with three validated scales: AIS, SWLS and DLQI. A total of 263 questionnaire sets were handed out to the participants of the study; this pool included 200 questionnaires with complete data that were eventually included in the analysis. RESULTS Acceptance of Illness Scale scores of the study participants ranged between 8 and 40 pts. Mean AIS scores for female and male psoriatics were similar, 23 and 25 pts, respectively. Based on the distribution of Satisfaction with Life Scale scores, 42 of the study patients presented with high levels of satisfaction with life, whereas 37 and 21 showed moderate and low satisfaction levels, respectively. Quality of life turned out to be the best among 20- to 30-year-old respondents as up to 74.19 of them had Dermatology Life Quality Index scores no greater than 10 pts. CONCLUSIONS Psoriatics with higher levels of illness acceptance also presented with greater satisfaction with life.
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Affiliation(s)
- Beata Kowalewska
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Jankowiak
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | | | | | - Wiaczesław Niczyporuk
- Faculty of Health Sciences, Lomza State University of Applied Sciences, Lomza, Poland
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12
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Augustin M, Wirth D, Mahlich J, Pepper AN, Druchok C. Cost per responder analysis of guselkumab versus targeted therapies in the treatment of moderate to severe plaque psoriasis in Germany. J DERMATOL TREAT 2020; 33:976-982. [PMID: 32663067 DOI: 10.1080/09546634.2020.1793891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The fully human monoclonal antibody guselkumab is an effective treatment option for patients with moderate to severe psoriasis. OBJECTIVE The objective of this study was to examine the cost per responder of guselkumab compared with other targeted therapies for the treatment of moderate to severe plaque psoriasis in Germany. METHODS A one-year cost per responder model was developed based on efficacy and safety data from a published network meta-analysis. Drug, treatment administration, resource use, and adverse event costs were included in the analysis. The primary analysis assessed the cost per Psoriasis Area and Severity Index (PASI) 90 responder at week 16. Additional analyses were conducted at year 1. In the year 1 analyses, treatment response was assessed at the end of the induction period (week 16) to determine which patients continued onto maintenance therapy (responders) and which patients moved onto a subsequent adalimumab or secukinumab therapy (non-responders). RESULTS At week 16, the cost per PASI 90 responder was lower for guselkumab than all comparators except adalimumab and brodalumab. Similarly, in the year 1 analyses, guselkumab had a lower cost per PASI 90 responder than all comparators except brodalumab. CONCLUSIONS Guselkumab is a cost-effective therapy option in Germany.
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Jörg Mahlich
- Janssen-Cilag GmbH, Neuss, Germany.,Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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13
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Mavrogiorgou P, Mersmann C, Gerlach G, Herpertz S, Juckel G. Skin Diseases in Patients with Primary Psychiatric Disorders. Psychiatry Investig 2020; 17:157-162. [PMID: 32093459 PMCID: PMC7046994 DOI: 10.30773/pi.2019.0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The few psychodermatological studies of primary psychiatric populations so far suggest that parasitic-infectious skin diseases are the most common dermatological comorbidity in more than 70% of psychiatric patients, which should be studied here in a large data bank outside dermatological treatment facilities. METHODS In a descriptive-explorative and retrospective study, more than 17,000 patients with primary psychiatric disorders were examined to investigate dermatological comorbidities. RESULTS The proportion of patients with primary mental disorders and additional dermatological disease was 1.24% (n=212). Here, psoriasis (35.4%) and atopic dermatitis (22.6%) were the most frequent dermatological diseases among these 212 patients. Infectious-parasitic skin diseases were present in 13.2% of comorbid patients. The most common mental disorder was a depressive illness, seen in 42.5% (n=90) of patients. CONCLUSION Our results confirmed the frequent association of depression with psoriasis and atopic dermatitis, indicating the need for the early detection and treatment of such comorbid patients. In contrast, psychiatric inpatients do not appear to suffer from predominantly infectious-parasitic dermatoses.
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Affiliation(s)
- Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
| | - Corinna Mersmann
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
| | - Gabriele Gerlach
- Department of Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
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14
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Life satisfaction and health related quality of life – the same or a different construct? A survey in psoriasis patients. HEALTH PSYCHOLOGY REPORT 2020. [DOI: 10.5114/hpr.2020.95909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Tzur Bitan D, Krieger I, Comaneshter D, Cohen AD, Feingold D. The association between the socioeconomic status and anxiety-depression comorbidity in patients with psoriasis: a nationwide population-based study. J Eur Acad Dermatol Venereol 2019; 33:1555-1561. [PMID: 31054151 DOI: 10.1111/jdv.15651] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Numerous studies have indicated that comorbid anxiety and depression are associated with a more severe course of illness. Yet generally, the study of the effect of psoriasis on patients' mental health has considered anxiety and depression to be separate states. OBJECTIVE To measure the association between psoriasis and anxiety, depression and anxiety-depression co-occurrence among patients according to their socioeconomic statuses (SES). METHODS A nationwide population-based study of psoriasis patients and age and gender frequency-matched controls (n = 255 862) was designed. Diagnostic data were obtained from Clalit Health Services, the largest managed care organization in Israel. This database was established using continuous real-time input from healthcare providers, pharmacies, medical care facilities and administrative computerized operating systems. RESULTS After controlling for demographic and clinical variables, psoriasis was associated with anxiety (OR 1.11, 95% CI 1.01-1.23, P < 0.05), depression (OR 1.17, 95% CI 1.08-1.26, P < 0.001), and anxiety and depression co-occurrence (OR 1.32, 95% CI 1.21-1.45, P < 0.001) among patients with low SES, yet was associated only with anxiety (OR 1.15 95% CI 1.04-1.27, P < 0.001) but not depression or comorbid anxiety-depression among patients with high SES. Survival analyses indicated that between the ages of 40 and 60, the cumulative probability of psoriasis patients with low SES to suffer from anxiety, depression and their co-occurrence inclined more sharply with age as compared to psoriasis patients with high SES. CONCLUSIONS As psoriasis patients with low SES are prone to suffer from more severe courses of anxiety and depression, the choice of treatment of psoriasis should address the SES as well as the underlying psychiatric disease.
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Affiliation(s)
- D Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel.,Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Krieger
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Comaneshter
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - A D Cohen
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - D Feingold
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
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16
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Tian Z, Huang Y, Yue T, Zhou J, Tao L, Han L, Yan K, Huang Q, Zhang Z, Shao C. A Chinese cross-sectional study on depression and anxiety symptoms in patients with psoriasis vulgaris. PSYCHOL HEALTH MED 2018; 24:269-280. [PMID: 30293440 DOI: 10.1080/13548506.2018.1529323] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Previous studies have reported a higher incidence of depression and anxiety in psoriasis patients compared to the general population, which has important implications for assessment and treatment. In this study, we determined the frequency of depression and anxiety in Chinese patients with psoriasis and its relationship with disease severity and other demographic variables. The study included 208 Chinese patients with psoriasis vulgaris. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) were used to screen for depression and anxiety. The Psoriasis Area and Severity Index (PASI) was used to assess the severity of psoriasis. Of the 208 patients included in the study, 29 patients (13.9%) were positive for moderate-to-severe depression (PHQ-9 ≥ 10) and 22 patients (10.6%) were positive for anxiety (GAD-7 ≥ 10) symptoms. Both positive stress reactors who perceived stress as an exacerbating factor of psoriasis and moderate-to-severe psoriasis were found to be positive predictors for the presence of moderate-to-severe depression or anxiety symptoms while longer duration and late onset age played a protective role. In the sample of Chinese patients with psoriasis there was a clinically significant prevalence of depression and anxiety. Our study suggests that Chinese psoriasis patients should be screened for psychiatric comorbidities.
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Affiliation(s)
- Zhen Tian
- a Department of Dermatology,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
| | - Yike Huang
- a Department of Dermatology,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
| | - Tao Yue
- b Department of Rheumatology , Shanghai Guanghua Integrative Medicine Hospital , Shanghai , China
| | - Jiaqing Zhou
- a Department of Dermatology,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
| | - Lu Tao
- a Department of Dermatology,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
| | - Ling Han
- a Department of Dermatology,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
| | - Kexiang Yan
- a Department of Dermatology,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
| | - Qiong Huang
- a Department of Dermatology,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
| | - Zhenghua Zhang
- a Department of Dermatology,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
| | - Chunhong Shao
- c Department of Psychiatry,Huashan Hospital , Shanghai Medical College of Fudan University , Shanghai , China
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17
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Youn SW, Lee JH, Yu DY, Kim Y, Kim BS, Seo SJ, Choe YB, Yun SK, Park J, Kim NI, Choi CW, Youn JI, Lee SJ, Lee MG, Kim KJ, Park CJ, Ro YS, Song HJ, Shin BS, Ahn SK, Lee JY, Won YH, Jang MS, Kim KH, Kim MH, Kim TY, Choi JH. The relationship between clinical characteristics including presence of exposed lesions and health-related quality of life (HRQoL) in patients with psoriasis: analysis from the nationwide epidemiologic study for psoriasis in Korea (EPI-PSODE study). J Eur Acad Dermatol Venereol 2018; 32:1499-1506. [PMID: 29430733 DOI: 10.1111/jdv.14865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/25/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Psychological aspect and quality of life should be considered in treating patients with psoriasis. OBJECTIVE We sought to ascertain which clinical characteristics including presence of exposed lesions are associated with impairment of health-related quality of life (HRQoL) in patients with psoriasis. METHODS The EPI-PSODE study was a nationwide, multicenter, cross-sectional study conducted in Korea that included 1260 adult patients with psoriasis. In addition to clinical characteristics including presence of exposed lesions, data were collected using the Psoriatic Arthritis (PsA) Screening and Evaluation (PASE), Dermatology Life Quality Index (DLQI), MOS 36-Item Short-Form Health Survey (SF-36), Work Productivity and Activity Impairment Questionnaire Psoriasis (WPAI: PSO) and Medication Satisfaction Questionnaire (MSQ). RESULTS Patients with a DLQI score > 5 (n = 990) were younger, had an earlier onset of psoriasis, scored higher on the Psoriasis Area and Severity Index (PASI), had higher body surface area (BSA) and had higher PASE scores than patients with DLQI ≤ 5 (n = 266). The group of patients with exposed lesions (n = 871) were younger and male predominance, earlier onset of psoriasis, longer disease duration, higher PASI/BSA score and a higher proportion with drinking and smoking history each than the group of patients without exposed lesions (n = 389). Presence of exposed lesions negatively influenced DLQI, 36-Item Short-Form Health Survey (SF-36) (mental component), presenteeism, total work productivity impairment and total activity impairment in the WPAI: PSO. In multiple regression model, PASI score was the only variable which was significantly associated with all HRQoL measures. Presence of exposed lesions was a significant factor affecting DLQI and SF-36 (mental). CONCLUSION The presence of exposed lesions has a negative impact on quality of life, mental health and work productivity. Therefore, effective treatments are particularly needed for psoriasis patients with exposed lesions.
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Affiliation(s)
- S W Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - J-H Lee
- Department of Dermatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - D Y Yu
- Medical Affairs, Janssen Korea, Seoul, Korea
| | - Y Kim
- Medical Affairs, Janssen Korea, Seoul, Korea
| | - B S Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - Y B Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - S-K Yun
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
| | - J Park
- Department of Dermatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - N I Kim
- Department of Dermatology, KyungHee University Medical center, Seoul, Korea
| | - C W Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - J I Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - S-J Lee
- Department of Dermatology, Kyungpook National University Hospital, Daegu, Korea
| | - M-G Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - K J Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - C J Park
- Department of Dermatology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Y S Ro
- Department of Dermatology, Hanyang University Medical Center, Seoul, Korea
| | - H J Song
- Department of Dermatology, Korea University Guro Hospital, Seoul, Korea
| | - B S Shin
- Department of Dermatology, Chosun University Hospital, Gwangju, Korea
| | - S K Ahn
- Department of Dermatology, Wonju Severance Christian Hospital, Wonju, Korea
| | - J Y Lee
- Department of Dermatology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Y H Won
- Department of Dermatology, Chonnam National University Hospital, Gwangju, Korea
| | - M S Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - K H Kim
- Department of Dermatology, Dong-A University Hospital, Busan, Korea
| | - M H Kim
- Department of Dermatology, Dankook University Hospital, Cheonan, Korea
| | - T Y Kim
- Department of Dermatology, Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - J-H Choi
- Department of Dermatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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