An analysis of qualitative responses from a UK survey of the psychosocial wellbeing of people with skin conditions and their experiences of accessing psychological support

Healthcare professionals' views on psychological support for children and families affected by skin conditions in the UK: A qualitative study

Background

Skin conditions can have a psychological impact on a child and their caregivers, however, support is not equally distributed between geographical regions in the United Kingdom (UK).

Objectives

This study aimed to investigate the experience of National Health Service (NHS) healthcare professionals (HCPs) of addressing the psychological needs of children with skin conditions and their families, and gain expert opinion as to how services need to further develop.

Design

HCPs were recruited to a qualitative study with an advert posted on social media.

Methods

Fifteen HCPs took part in interviews, including dermatologists (n = 4), dermatology nurse consultants/specialists (n = 4), clinical psychologists (n = 4), liaison psychiatrists (n = 2), and a children's psychological well-being practitioner (n = 1).

Results

Thematic analysis revealed children often presented with anxiety, depression, self-harm and suicidal ideation. The impact on caregivers was equally profound. There were differences in service provision across the UK and all HCPs recognised the urgent need for psychological support to be integrated into standard care. Participants described how a range of interventions are typically required including cognitive behavioural therapy (CBT), and systemic approaches, as well as mindfulness/third-wave approaches. Barriers to the delivery of psychological services were associated with a lack of funding and training opportunities for core and specialist staff alike. However, in some instances, participants had overcome these challenges to be able to deliver unique services.

Conclusions

There exist several barriers to providing paediatric psychological interventions, and many locations across the UK remain vulnerable as a result of continuing lack of national guidelines for the provision of psychological services.

Defining well-being in psoriasis: A Delphi consensus among healthcare professionals and patients

Psoriasis is a chronic skin disease that negatively impacts on patient's life. A holistic approach integrating well-being assessment could improve disease management. Since a consensus definition of well-being in psoriasis is not available, we aim to achieve a multidisciplinary consensus on well-being definition and its components. A literature review and consultation with psoriasis patients facilitated the design of a two-round Delphi questionnaire targeting healthcare professionals and psoriasis patients. A total of 261 panellists (65.1% patients with psoriasis, 34.9% healthcare professionals) agreed on the dimensions and components that should integrate the concept of well-being: emotional dimension (78.9%) [stress (83.9%), mood disturbance (85.1%), body image (83.9%), stigma/shame (75.1%), self-esteem (77.4%) and coping/resilience (81.2%)], physical dimension (82.0%) [sleep quality (81.6%), pain/discomfort (80.8%), itching (83.5%), extracutaneous manifestations (82.8%), lesions in visible areas (84.3%), lesions in functional areas (85.8%), and sex life (78.2%)], social dimension (79.5%) [social relationships (80.8%), leisure/recreational activities (80.3%), support from family/friends (76.6%) and work/academic life (76.5%)], and satisfaction with disease management (78.5%) [treatment (78.2%), information received (75.6%) and medical care provided by the dermatologist (80.1%)]. This well-being definition reflects patients' needs and concerns. Therefore, addressing them in psoriasis will optimise management, contributing to better outcomes and restoring normalcy to the patient's life.

Is it really ever 'just acne'? Considering the psychodermatology of acne

Acne can create a significant burden for people of all ages. However, the psychological consequences might often be overlooked. This review comments on recent evidence in the field of psychodermatology, to highlight the importance of considering a person's mental health in the treatment of acne. A range of presenting issues are discussed, and cases of underserved patients needing additional considerations are highlighted. This article considers how the psychological sequelae can contribute to the pathogenesis of acne, and discusses how psychotherapeutic approaches can be of benefit to people experiencing appearance-related distress. Importantly, attention is paid to the need for clinicians to assess a patient's wellbeing alongside their physical symptoms. In doing this, early intervention can be facilitated if psychological comorbidities are present, with referral to appropriate specialist services, where available. To improve treatment outcomes, the skin and the mind must be addressed together in a multidisciplinary approach to dermatology care.

[Stigmatization and social anxiety in patients with skin diseases]

Stigmatization of patients with skin diseases has only recently attracted more attention in research. However, both external stigmatization by society and self-stigmatization by the affected patients are widespread in patients with skin diseases. Many studies show that in this group of patients, the experience of both kinds of stigmatization is associated with psychosocial burden, such as social anxiety. This is often independent of the visibility of skin lesions. The psychosocial burden of affected individuals may lead to psychological comorbidities, such as depression or anxiety disorders, making it important to screen patients in dermatologic settings for the presence of these conditions. Interventions to reduce external and self-stigmatization have been developed, but more randomized controlled trials are needed to test the effects of such interventions.

A mixed methods systematic review of digital interventions to support the psychological health and well-being of people living with dermatological conditions

Background

Dermatological conditions can have a substantial impact on psychological as well as physical health yet dedicated face-to-face psychological support for patients is lacking. Thus, individuals may require additional support to self-manage dermatological conditions effectively. Digital technology can contribute to long-term condition management, but knowledge of the effectiveness of digital interventions addressing psychological (cognitive, emotional, and behavioural) aspects of dermatological conditions is limited.

Objectives

To identify, determine the effectiveness, and explore people’s views and experiences of digital interventions supporting the psychological health of people with dermatological conditions.

Methods

A mixed methods systematic review informed by JBI methodology. The protocol was registered on PROSPERO. Eight electronic databases were searched for papers written between January 2002 and October 2021. Data screening and extraction were conducted in Covidence. The methodological quality of studies were scrutinised against JBI critical appraisal tools. Intervention characteristics were captured using the Template for Intervention Description and Replication checklist and guide. Data were synthesised using a convergent segregated approach. The results were reported in a narrative summary.

Results

Twenty-three papers were identified from 4,883 references, including 15 randomised controlled trials. Nineteen interventions were condition-specific, 13 were delivered online, 16 involved an educational component, and 7 endorsed established, evidence-based therapeutic approaches. Improvements in knowledge, mood, quality of life, the therapeutic relationship, and reduced disease severity in the short to medium term, were reported, although there was substantial heterogeneity within the literature. Thirteen studies captured feedback from users, who considered various digital interventions as convenient and helpful for improving knowledge, emotion regulation, and personal control, but technical and individual barriers to use were reported. Use of established qualitative methodologies was limited and, in some cases, poorly reported.

Conclusion

Some web-based digital psychological interventions seem to be acceptable to people living with mainly psoriasis and eczema. Whilst some digital interventions benefitted cognitive and emotional factors, heterogeneity and inconsistencies in the literature meant definitive statements about their effectiveness could not be drawn. Interdisciplinary and patient-centred approaches to research are needed to develop and test quality digital interventions supporting the psychological health of adults living with common and rare dermatological conditions.

Systematic review registration

[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=285435], identifier [CRD42021285435].

Analysis of Herdsmen's Credit Behavior under the Identification Scheme of Emotional and Psychological State

Herdsmen's access to credit funds plays an important supporting role in promoting the modern economic development of pastoral areas and broadening the channels for herders to increase their income. This paper studies the credit behavior of herdsmen from the perspective of emotional and psychological state identification to analyze the current credit behavior of herdsmen. Firstly, the internal mechanism of herdsmen's credit and emotional and psychological identification research content are analyzed. Secondly, a scheme of emotional and psychological state identification is proposed, and a corresponding survey of herdsmen is carried out according to the scheme. Finally, the Probit and Heckman models are introduced to analyze the credit behavior of herdsmen. The results show that herdsmen with high emotional and psychological scores strongly demand credit. They are likely to have access to credit and have a high level of credit. Herdsmen with low scores of emotional and psychological characteristics have low or no apparent demand for credit, and their credit availability is also low. The herdsmen with high emotional and psychological characteristics have a 71% higher probability of generating credit demand than herdsmen with low openness. Their likelihood of obtaining credit is also 33.47% higher than herdsmen with low emotional and psychological characteristics. They also have easy access to higher loan amounts. The results provide a reference for related research and analysis of herdsman's credit behavior and economic development.

A digital therapeutic for management of psychosocial aspects of psoriasis: A pre‐post proof of concept study

Background

Despite the psychosocial challenges of living with psoriasis many patients may not be able to access appropriate services to manage these challenges. Mobile health interventions may be helpful as a means to support patients in managing the impact of their condition.

Objective

To conduct a preliminary examination of the feasibility and acceptability of a bespoke psoriasis‐specific digital therapeutic solution (hereafter termed Allay), and to provide initial data on psychological changes pre‐post.

Methods

Phase one proof of concept pre‐post study. Eligible patients were provided with Allay on their smartphone and assessed at baseline and at 12 weeks on a range of indices of well‐being. Participants experiences on usability were collected by telephone interview at 4 weeks, 8 and 12 weeks.

Results

Out of 66 participants recruited, 59 persisted in using Allay after the familiarisation phase, and 34 participants completed the 12 weeks programme. Participants showed a statistically significant improvement between induction and the end of the 12 weeks programme on Quality of life, Resilience, Perceptions of ‘Overall impact’ of psoriasis, and ‘Emotional impact’. There was a significant change over the course of using Allay for symptoms of depression but not anxiety. While there was an interaction effect of changes in severity of psoriasis symptoms over the course of the study for dermatology‐specific measures, there was no interaction between such changes in psoriasis symptoms and changes in depression, resilience or beliefs in emotional impact.

Conclusions

Study results suggest that the use of Allay as an adjunct to medical management of psoriasis may help patients improve resilience, mood, beliefs about their condition and enhance their quality of life. Given that this is a phase one proof of concept study, and our rates of attrition further research is necessary to examine comparative effectiveness and stability of these findings.