Chronic skin disorders correlate with stigma, mental health impact in children

Key takeaways:

• Stigma regarding their chronic skin diseases was reported by 73% of pediatric patients in this cross-sectional study.
• Higher disease visibility was correlated with stigma, depression, QOL decline and anxiety.

Stigma has a major impact on mental health and quality of life for pediatric patients with chronic skin diseases, according to a study.

“It can be hard to ask patients to talk about their stigmatizing experiences or perceptions, including in front of a parent,” Amy S. Paller, MS, MD, Walter Hamlin Professor and Chair of Dermatology, professor of pediatrics and director of the Skin Biology and Diseases Resource-based Center at Northwestern University’s Feinberg School of Medicine, told Healio. “Among the various psychosocial domains, stigma was most highly correlated with impaired quality of life and had moderate to strong correlations with depression and anxiety.”

This cross-sectional study included 1,671 patients (mean age, 13.7 years; 57.9% girls) aged 8 to 17 years from 32 U.S. and Canada-based dermatology centers with moderate to severe chronic skin disease still visible when wearing clothes. The primary endpoint was to measure childhood stigma in relation to disease visibility.

Amy S. Paller

Using the Patient Reported Outcomes Instrumentation System (PROMIS) Pediatric Stigma (PPS), questionnaires were administered to patients that included 22 inquiries regarding disease severity and visibility, quality of life (QOL), anxiety, depression, peer relationships and parental responses.

High disease visibility was reported by 56.4% of participants, with 50.5% reporting moderate disease severity.

Stigma was reported by 73% of the participants. A PPS-Skin T-score below 40, meaning minimal or low stigma, was recorded in 27% of patients, whereas 43.8% had a T-score of 45 or higher, representing moderate stigma.

Based on density plots, patients with acne, atopic dermatitis, psoriasis and alopecia areata had PPS-Skin scores close to the mean of 43.8, whereas those with hyperhidrosis (47.9), ichthyosis (47.7), epidermolysis bullosa (47.3) and hidradenitis suppurativa (47.3) had higher mean stigma scores.

The researchers found that 29.4% of parents were aware of their child being bullied, and 94% of this bullying occurred at school.

Using Spearman’s rho correlations, researchers found reduced QOL (rho = 0.73), depression (rho = 0.61) and anxiety (rho = 0.54) were all significantly correlated with stigma scores.

“I hope that our findings reinforce the need to look beyond the observed skin manifestations to determine the impact on patient quality of life, including the role of stigma,” Paller said. “It should be noted that the development of social relationships and psychological well-being developed in school-aged children also sets the stage for adult health; the impaired development during school age similarly is lifelong.”

Shorter online forms evaluating stigma, QOL and mental health issues can be filled out at www.healthmeasures.net, Paller added. Using these forms in patients aged 8 years and older can help clinicians to evaluate if interventions, which are recommended for patients with at least moderate self-reported stigma, are needed.