JEADV
DOI: 10.1111/jdv.12355
ORIGINAL ARTICLE
Social problem-solving, perceived stress, negative life events, depression and life satisfaction in psoriasis an3 €cß u €kaydog M. Eskin,1 E. S ß avk,2,* M. Uslu,2 N. Ku 1
Adnan Menderes University, Faculty of Medicine, Department of Psychiatry, Aydin, Turkey Adnan Menderes University, Faculty of Medicine, Department of Dermatology, Aydin, Turkey 3 Dermatology, Silopi State Hospital, S ß ırnak, Turkey *Correspondence: E. S ß avk. E-mail: [email protected] 2
Abstract Background Psoriasis is a chronic dermatosis which may cause significant impairment of the patient’s quality of life. Objective The purpose of this study was to investigate the social problem-solving skills, perceived stress, negative life events, depression and life satisfaction in psoriasis patients. Methods Data were gathered by means of questionnaires and clinical evaluations from 51 psoriatic patients and 51 matched healthy controls. Results Average disease duration was 16.47 years and average Psoriasis Area and Severity Index score was 3.67. Compared with the controls, the patients displayed lower social problem-solving skills. They displayed higher negative problem orientation and impulsive-careless problem-solving style scores than the controls. Patients tended also to show more avoidant problem-solving style and lower life satisfaction than controls. There was no difference between psoriatic patients and controls in terms of depression, perceived stress and negative life events. Higher social problem-solving skills were associated with lower depression, perceived stress and fewer numbers of negative life events but higher level of life satisfaction. Limitations The patient group largely included mild and moderate psoriatic cases. Conclusion The findings of the study suggest that problem-solving training or therapy may be a suitable option for alleviating levels of psychological distress in patients suffering from psoriasis. Received: 21 August 2013; Accepted: 26 November 2013
Conflicts of interest None declared.
Funding sources None declared.
Introduction Psoriasis vulgaris is a common dermatosis, with an incidence in Western industrialized countries of 2–3%. In more than 90% of cases, the disease is chronic.1 As in many other chronic diseases patients with psoriasis vulgaris also have a significantly impaired quality of life.2 Depending on its severity, the disease can lead to a substantial burden in terms of disability and/or psychosocial stigmatization.3 Psoriasis detracts from not only patients’ physical health but also their career choices, relationships, social activities and self-esteem.4–8 Intertwined with this is the fact that psoriatic patients are also often dissatisfied with current therapeutic approaches, and their compliance is poor.9 Investigations indicate that physical and psychological comorbidities, stressful life circumstances and psychological distress prevail in persons suffering from psoriasis.10 Sexual dysfunction problems and psychological distress is common in this patient
JEADV 2014, 28, 1553–1559
group.11 In one study involving 1580 dermatology patients, Finzi et al.12 documented that psychological distress was present in 57% of the sample. Compared with controls, studies documented a higher prevalence of childhood and adult traumatic or adverse life experiences in patients suffering from psoriasis.13–15 Psoriasis has negative implications for physical, psychological and social well-being. Detrimental effects of the disease result in diminished sense of quality of life.6,16 Perceived or mental stress has been shown to be associated with poorer quality of life in persons with psoriasis.17 Furthermore, there seems to be a relationship between severity of psoriatic symptoms and psychological distress. Sampogna et al.18 with a cross-sectional research design have shown that an improvement in clinical severity and symptoms is associated with a decreased frequency of psychiatric disturbance. Longitudinal research designs are needed to clarify the nature of this relationship. For the European Consensus
© 2014 European Academy of Dermatology and Venereology
Eskin et al.
1554
group of experts on psoriasis increasing patients’ quality of life constitutes a major treatment goal for the management of psoriasis.19 The science of psychology indicates that what is important for better adjustment is not to lead a life without stress and burden, but to have adequate coping resources. Problem-solving is one of the most important coping resources that individuals can make use of during times of stressful life circumstances.20 That is, individuals with adequate social problem-solving ability are more resistant against a wide range of stressful life situations than those with inadequate problem-solving. Hence, people with deficient problem-solving skills are more prone to experience psychological distress than the ones with efficient problem-solving skills.21,22 Coping has been shown to be a significant predictor of mental health and overall quality of life in patients with psoriasis.23 Social problem-solving refers to solving problems in the real world and a person attempts to find effective coping responses for problematic life situations. The social problem-solving model24–26 assumes two general processes: (i) problem orientation and (ii) problem-solving style. The problem orientation refers to functional and dysfunctional cognitive-motivational aspects of individuals when confronted with problems. The positive problem orientation (PPO) involves a general tendency to perceive problems as a challenge, and a belief that problems can be solved. Negative problem orientation (NPO) is a dysfunctional or inhibitive cognitive-motivational style which involves a tendency to perceive problems as a threat to one’s own wellbeing, doubt one’s own abilities to successfully resolve problems, and become frustrated and upset when confronted with problems. The problem-solving style refers to cognitive and overt behavioural activities of individuals attempting to find out a solution to a problem. Rational problem-solving (RPS) is a functional or constructive way of dealing with problem situations. It refers to a rational, deliberate, systematic and skillful application of effective problem-solving principles. RPS includes such principles as problem definition and formulation, goal setting, generation of alternative solutions, decision-making, and solution implementation and verification. Avoidant problem-solving style (AS) is a dysfunctional dimension characterized by procrastination, passivity or inaction and dependency. Individuals who use this problem-solving style avoid problems in their lives, postpone attempts to solve them and do not take responsibility for problems and their solutions. Finally, impulsivity/carelessness style (ICS) is also a dysfunctional problem-solving style characterized by individual attempts that are narrow, impulsive, hurried and incomplete. Investigating psychosocial aspects of psoriasis in a group of psoriatic patients and healthy controls, our study has four objectives: 1 To compare social problem-solving skills of psoriatic patients to healthy controls.
JEADV 2014, 28, 1553–1559
2 To compare the two groups on levels of perceived stress, depression, and life satisfaction. 3 To examine the relationships between social problem-solving and indices of distress and life satisfaction. 4 To identify the independent predictors of depression, perceived stress and life satisfaction.
Methods Psychological characteristics of psoriasis patients were compared with healthy controls. All patients were dermatologically examined. An ethical approval was granted by the Adnan Menderes University Faculty of Medicine’s Ethics Committee with a protocol number of 2009/00281. Patients with a diagnosis of psychotic disorder, bipolar disorder, or mental retardation; individuals who cannot read and write and people who are younger than 18 and older than 65 years were excluded. Fifty-one psoriasis patients seeking treatment at Adnan Menderes University Research Hospital Department of Dermatology were compared with a total of 51 age, sex, education and civil status matched healthy controls. Patients consisted of 27 men and 24 women with a mean age of 46.1 14.3. The two groups differed only on work status and education variables. Compared with the patient group, most of the control group was employed and they had also higher number of school years than the patient group (Table 1). Measures
A. A questionnaire consisting of demographic characteristics, dermatologic features of patients and the following parts was used to collect the data. 1 Social problem-solving inventory (SPSI-R). The SPSI-R consisted of 52 statements responded using a five-point Likert scale ranging from 0 to 4 which was organized into five subscales: PPO (5 items), NPO (10 items), RPS (20 items), ICS (10 items) and AS (7 items). Scale scores range from 0 to the number of items multiplied by 4. An overall problem-solving score is also computed. Higher scores indicated better problem-solving skills.25–27 2 Beck depression inventory (BDI). A 21-item BDI was used to assess the frequency and the intensity depressive symptoms on a four-point scale ranging from 0 to 3. The total BDI scores range from 0 to 63. Higher scores indicate greater depression.28,29 3 Perceived stress scale (PSS). Perceived stress was assessed by seven positive and seven negative 14 items PSS by using a five-point Likert scale ranging from 0 to 4. The total PSS scores range from 0 to 56 with higher scores indicating greater stress perceptions.30,31 4 Negative life events (NLE). Participants were asked to indicate whether or not they have experienced (yes = 1; no = 0) the 25 negative events during the past 6 months (i.e. quarrel with spouse, having beaten by spouse, cursed by spouse,
© 2014 European Academy of Dermatology and Venereology
Social problem-solving in psoriasis
1555
Table 1 Demographic characteristics of participants by group Psoriatic (n = 51)
Control (n = 51)
N or M
% or SD
N or M
% or SD
Man
27
26.5
22
21.6
Woman
24
23.5
29
28.4
46.1
14.3
42.3
42
41.2
9
8.8
Yes
43
No
8 2.4
1.4
Variables
v2 or t
df
P
Gender
Age
0.98
1
0.428
10.4
1.55
100
0.124
42
41.2
0.00
1
1.000
9
8.8
42.2
39
38.2
0.99
1
0.455
7.8
12
11.8 0.7
1.49
80
0.139
13.86
1
0.000
4.25
1
0.119
5.54
100
0.000
Civil status Married Single, divorced or widowed Have child
Number of children
2.0
Work status Employed
16
19.5
36
43.9
Not employed for a paid job (unemployed, housewifeor student)
22
26.8
8
9.8
Low
11
21.6
9
17.6
Medium
40
78.4
38
74.5
4
7.8
Perceived family income
High Education (number of school years)
being forced to sexual intercourse, etc.) Items are summed to obtain a life events score that ranges from 0 to 25. 5 Life satisfaction (LS). The six-item LS scale responded on five-point Likert scales was used to assess life satisfaction (5 = strongly agree; 1 = strongly disagree). Higher scores indicate higher life satisfaction.32,33 B. Cutaneous examination: Total skin examination by a dermatologist was completed for each patient to determine the clinical form of psoriasis, involvement of the nails, joints, visible areas and disease severity. Clinical severity of psoriasis was evaluated with the Psoriasis Area and Severity Index (PASI) which is the most extensively studied and most thoroughly validated tool. Statistical analysis
The data were analysed by using the SPSS-15 (IBM SPSS, Armonk, NY, USA). Since data were normally distributed, parametric tests were used. Chi-squared and t-tests were used to compare the groups. The MANOVA was employed to examine the effects of group (patient vs. control) and participant gender on problem-solving, depression, perceived stress, life events and life satisfaction. Correlation analyses were used to examine the relationships among problem-solving, depression, perceived stress, life events and life satisfaction. Linear regression analyses were done to determine the independent predictors of depression, life satisfaction and perceived stress.
Results Psoriatic disease duration varied between 3 months and 53 years (16.47 11.82) and the PASI scores were between 0
JEADV 2014, 28, 1553–1559
0
0.00
7.67
3.16
11.08
3.05
and 20 (3.67 3.81). Other clinical features of patients are given in Table 2. PASI scores had no statistically significant associations with other psychological and clinical variables except presence of flare. PASI and a deterioration of the disease within the last 6 months were significantly positively correlated, r = 0.68, df = 50, P < 0.001. Flare had no statistically significant relationship with any of the other variables. Other clinical features including clinical type and symptomatology as shown in Table 2 had no effects on psychological parameters either. Means and standard deviations of SPSI-R, LS, NLE, PSS and BDI are given in Table 3. The MANOVA produced a significant main effect for group, F(9, 90) = 2.67, P < 0.01. Univariate F tests showed group differences on total SPSI-R (F = 10.36, P < 0.005), NPO (F = 9.88, P < 0.005) and ICS (F = 13.52, P < 0.001) scores. Patients scored significantly lower than the controls on the total SPSI-R, but they scored higher than the controls on NPO and ICS subscales. The MANOVA yielded a nonsignificant effect for gender F(9, 90) = 1.39, P > 0.05 and a nonsignificant effect for group by gender interaction F(9, 90) = 0.36, P > 0.05. Correlation coefficients among the measures are given in Table 4. As the Table displays total SPSI-R scores correlated significantly negatively with BDI, PSS and LE, but positively with LS scores. BDI scores correlates significantly positively with PSS and LE scores, but negatively with LS scores. PSS correlates significantly positively with LE, but negatively with LS scores. LE correlates significantly positively with LS scores.
© 2014 European Academy of Dermatology and Venereology
Eskin et al.
1556
The results from the six regression analyses are presented in Table 5. As the table shows the predictors of depression, life satisfaction and perceived stress in both patients and healthy Table 2 Number and percentages of clinical features of psoriatic patients Variables
Yes n
No %
Discussion
n
%
Cutaneous lesions Guttate lesions Plaques
2
3.9
49
96.1
45
88.2
6
11.8
9
17.6
42
82.4
10
19.6
41
80.4
Palmoplantar involvement Scalp involvement Inverse psoriasis
0
0.0
51
14
27.5
37
0
0.0
51
27
52.9
24
6
11.8
45
88.2
Pruritus
26
51.0
25
49.0
Family history of psoriasis
12
23.5
39
76.5 43.1
Involvement of visible areas Erythrodermia
100 72.5 100
Extracutaneous involvement Nail lesions Joint disease
47.1
Disease status within previous 6 months Improved
29
56.9
22
Worsened
15
29.4
36
70.6
7
13.7
44
86.3
9
17.6
42
82.4
Any
42
82.4
9
17.6
Retinoids
33
64.7
18
35.3
Methotrexate
23
45.1
28
54.9
Cyclosporine
10
19.6
41
80.4
7
13.7
44
86.3
17
33.3
34
66.7
Stable Treatment Topical only Systemic treatment
Biologics Phototherapy
controls are identical. PSS and NLE made independent contributions for the prediction of depression and, depression was the only independent predictor of LS. Total SPSI-R scores and NLEs were the independent predictors of perceived stress in both patients and controls.
On average the patients were suffering from psoriasis for 16 years. The mean PASI scores were approximately 4 which meant that the severity of the disease was in the mild-to-moderate range (PASI< 10), with only three patients having PASI scores within the range of moderate-to-severe psoriasis (PASI = 10–20).34 Psoriasis may have significant negative effects on patients’ quality of life though PASI is
DOI: 10.1111/jdv.12355
ORIGINAL ARTICLE
Social problem-solving, perceived stress, negative life events, depression and life satisfaction in psoriasis an3 €cß u €kaydog M. Eskin,1 E. S ß avk,2,* M. Uslu,2 N. Ku 1
Adnan Menderes University, Faculty of Medicine, Department of Psychiatry, Aydin, Turkey Adnan Menderes University, Faculty of Medicine, Department of Dermatology, Aydin, Turkey 3 Dermatology, Silopi State Hospital, S ß ırnak, Turkey *Correspondence: E. S ß avk. E-mail: [email protected] 2
Abstract Background Psoriasis is a chronic dermatosis which may cause significant impairment of the patient’s quality of life. Objective The purpose of this study was to investigate the social problem-solving skills, perceived stress, negative life events, depression and life satisfaction in psoriasis patients. Methods Data were gathered by means of questionnaires and clinical evaluations from 51 psoriatic patients and 51 matched healthy controls. Results Average disease duration was 16.47 years and average Psoriasis Area and Severity Index score was 3.67. Compared with the controls, the patients displayed lower social problem-solving skills. They displayed higher negative problem orientation and impulsive-careless problem-solving style scores than the controls. Patients tended also to show more avoidant problem-solving style and lower life satisfaction than controls. There was no difference between psoriatic patients and controls in terms of depression, perceived stress and negative life events. Higher social problem-solving skills were associated with lower depression, perceived stress and fewer numbers of negative life events but higher level of life satisfaction. Limitations The patient group largely included mild and moderate psoriatic cases. Conclusion The findings of the study suggest that problem-solving training or therapy may be a suitable option for alleviating levels of psychological distress in patients suffering from psoriasis. Received: 21 August 2013; Accepted: 26 November 2013
Conflicts of interest None declared.
Funding sources None declared.
Introduction Psoriasis vulgaris is a common dermatosis, with an incidence in Western industrialized countries of 2–3%. In more than 90% of cases, the disease is chronic.1 As in many other chronic diseases patients with psoriasis vulgaris also have a significantly impaired quality of life.2 Depending on its severity, the disease can lead to a substantial burden in terms of disability and/or psychosocial stigmatization.3 Psoriasis detracts from not only patients’ physical health but also their career choices, relationships, social activities and self-esteem.4–8 Intertwined with this is the fact that psoriatic patients are also often dissatisfied with current therapeutic approaches, and their compliance is poor.9 Investigations indicate that physical and psychological comorbidities, stressful life circumstances and psychological distress prevail in persons suffering from psoriasis.10 Sexual dysfunction problems and psychological distress is common in this patient
JEADV 2014, 28, 1553–1559
group.11 In one study involving 1580 dermatology patients, Finzi et al.12 documented that psychological distress was present in 57% of the sample. Compared with controls, studies documented a higher prevalence of childhood and adult traumatic or adverse life experiences in patients suffering from psoriasis.13–15 Psoriasis has negative implications for physical, psychological and social well-being. Detrimental effects of the disease result in diminished sense of quality of life.6,16 Perceived or mental stress has been shown to be associated with poorer quality of life in persons with psoriasis.17 Furthermore, there seems to be a relationship between severity of psoriatic symptoms and psychological distress. Sampogna et al.18 with a cross-sectional research design have shown that an improvement in clinical severity and symptoms is associated with a decreased frequency of psychiatric disturbance. Longitudinal research designs are needed to clarify the nature of this relationship. For the European Consensus
© 2014 European Academy of Dermatology and Venereology
Eskin et al.
1554
group of experts on psoriasis increasing patients’ quality of life constitutes a major treatment goal for the management of psoriasis.19 The science of psychology indicates that what is important for better adjustment is not to lead a life without stress and burden, but to have adequate coping resources. Problem-solving is one of the most important coping resources that individuals can make use of during times of stressful life circumstances.20 That is, individuals with adequate social problem-solving ability are more resistant against a wide range of stressful life situations than those with inadequate problem-solving. Hence, people with deficient problem-solving skills are more prone to experience psychological distress than the ones with efficient problem-solving skills.21,22 Coping has been shown to be a significant predictor of mental health and overall quality of life in patients with psoriasis.23 Social problem-solving refers to solving problems in the real world and a person attempts to find effective coping responses for problematic life situations. The social problem-solving model24–26 assumes two general processes: (i) problem orientation and (ii) problem-solving style. The problem orientation refers to functional and dysfunctional cognitive-motivational aspects of individuals when confronted with problems. The positive problem orientation (PPO) involves a general tendency to perceive problems as a challenge, and a belief that problems can be solved. Negative problem orientation (NPO) is a dysfunctional or inhibitive cognitive-motivational style which involves a tendency to perceive problems as a threat to one’s own wellbeing, doubt one’s own abilities to successfully resolve problems, and become frustrated and upset when confronted with problems. The problem-solving style refers to cognitive and overt behavioural activities of individuals attempting to find out a solution to a problem. Rational problem-solving (RPS) is a functional or constructive way of dealing with problem situations. It refers to a rational, deliberate, systematic and skillful application of effective problem-solving principles. RPS includes such principles as problem definition and formulation, goal setting, generation of alternative solutions, decision-making, and solution implementation and verification. Avoidant problem-solving style (AS) is a dysfunctional dimension characterized by procrastination, passivity or inaction and dependency. Individuals who use this problem-solving style avoid problems in their lives, postpone attempts to solve them and do not take responsibility for problems and their solutions. Finally, impulsivity/carelessness style (ICS) is also a dysfunctional problem-solving style characterized by individual attempts that are narrow, impulsive, hurried and incomplete. Investigating psychosocial aspects of psoriasis in a group of psoriatic patients and healthy controls, our study has four objectives: 1 To compare social problem-solving skills of psoriatic patients to healthy controls.
JEADV 2014, 28, 1553–1559
2 To compare the two groups on levels of perceived stress, depression, and life satisfaction. 3 To examine the relationships between social problem-solving and indices of distress and life satisfaction. 4 To identify the independent predictors of depression, perceived stress and life satisfaction.
Methods Psychological characteristics of psoriasis patients were compared with healthy controls. All patients were dermatologically examined. An ethical approval was granted by the Adnan Menderes University Faculty of Medicine’s Ethics Committee with a protocol number of 2009/00281. Patients with a diagnosis of psychotic disorder, bipolar disorder, or mental retardation; individuals who cannot read and write and people who are younger than 18 and older than 65 years were excluded. Fifty-one psoriasis patients seeking treatment at Adnan Menderes University Research Hospital Department of Dermatology were compared with a total of 51 age, sex, education and civil status matched healthy controls. Patients consisted of 27 men and 24 women with a mean age of 46.1 14.3. The two groups differed only on work status and education variables. Compared with the patient group, most of the control group was employed and they had also higher number of school years than the patient group (Table 1). Measures
A. A questionnaire consisting of demographic characteristics, dermatologic features of patients and the following parts was used to collect the data. 1 Social problem-solving inventory (SPSI-R). The SPSI-R consisted of 52 statements responded using a five-point Likert scale ranging from 0 to 4 which was organized into five subscales: PPO (5 items), NPO (10 items), RPS (20 items), ICS (10 items) and AS (7 items). Scale scores range from 0 to the number of items multiplied by 4. An overall problem-solving score is also computed. Higher scores indicated better problem-solving skills.25–27 2 Beck depression inventory (BDI). A 21-item BDI was used to assess the frequency and the intensity depressive symptoms on a four-point scale ranging from 0 to 3. The total BDI scores range from 0 to 63. Higher scores indicate greater depression.28,29 3 Perceived stress scale (PSS). Perceived stress was assessed by seven positive and seven negative 14 items PSS by using a five-point Likert scale ranging from 0 to 4. The total PSS scores range from 0 to 56 with higher scores indicating greater stress perceptions.30,31 4 Negative life events (NLE). Participants were asked to indicate whether or not they have experienced (yes = 1; no = 0) the 25 negative events during the past 6 months (i.e. quarrel with spouse, having beaten by spouse, cursed by spouse,
© 2014 European Academy of Dermatology and Venereology
Social problem-solving in psoriasis
1555
Table 1 Demographic characteristics of participants by group Psoriatic (n = 51)
Control (n = 51)
N or M
% or SD
N or M
% or SD
Man
27
26.5
22
21.6
Woman
24
23.5
29
28.4
46.1
14.3
42.3
42
41.2
9
8.8
Yes
43
No
8 2.4
1.4
Variables
v2 or t
df
P
Gender
Age
0.98
1
0.428
10.4
1.55
100
0.124
42
41.2
0.00
1
1.000
9
8.8
42.2
39
38.2
0.99
1
0.455
7.8
12
11.8 0.7
1.49
80
0.139
13.86
1
0.000
4.25
1
0.119
5.54
100
0.000
Civil status Married Single, divorced or widowed Have child
Number of children
2.0
Work status Employed
16
19.5
36
43.9
Not employed for a paid job (unemployed, housewifeor student)
22
26.8
8
9.8
Low
11
21.6
9
17.6
Medium
40
78.4
38
74.5
4
7.8
Perceived family income
High Education (number of school years)
being forced to sexual intercourse, etc.) Items are summed to obtain a life events score that ranges from 0 to 25. 5 Life satisfaction (LS). The six-item LS scale responded on five-point Likert scales was used to assess life satisfaction (5 = strongly agree; 1 = strongly disagree). Higher scores indicate higher life satisfaction.32,33 B. Cutaneous examination: Total skin examination by a dermatologist was completed for each patient to determine the clinical form of psoriasis, involvement of the nails, joints, visible areas and disease severity. Clinical severity of psoriasis was evaluated with the Psoriasis Area and Severity Index (PASI) which is the most extensively studied and most thoroughly validated tool. Statistical analysis
The data were analysed by using the SPSS-15 (IBM SPSS, Armonk, NY, USA). Since data were normally distributed, parametric tests were used. Chi-squared and t-tests were used to compare the groups. The MANOVA was employed to examine the effects of group (patient vs. control) and participant gender on problem-solving, depression, perceived stress, life events and life satisfaction. Correlation analyses were used to examine the relationships among problem-solving, depression, perceived stress, life events and life satisfaction. Linear regression analyses were done to determine the independent predictors of depression, life satisfaction and perceived stress.
Results Psoriatic disease duration varied between 3 months and 53 years (16.47 11.82) and the PASI scores were between 0
JEADV 2014, 28, 1553–1559
0
0.00
7.67
3.16
11.08
3.05
and 20 (3.67 3.81). Other clinical features of patients are given in Table 2. PASI scores had no statistically significant associations with other psychological and clinical variables except presence of flare. PASI and a deterioration of the disease within the last 6 months were significantly positively correlated, r = 0.68, df = 50, P < 0.001. Flare had no statistically significant relationship with any of the other variables. Other clinical features including clinical type and symptomatology as shown in Table 2 had no effects on psychological parameters either. Means and standard deviations of SPSI-R, LS, NLE, PSS and BDI are given in Table 3. The MANOVA produced a significant main effect for group, F(9, 90) = 2.67, P < 0.01. Univariate F tests showed group differences on total SPSI-R (F = 10.36, P < 0.005), NPO (F = 9.88, P < 0.005) and ICS (F = 13.52, P < 0.001) scores. Patients scored significantly lower than the controls on the total SPSI-R, but they scored higher than the controls on NPO and ICS subscales. The MANOVA yielded a nonsignificant effect for gender F(9, 90) = 1.39, P > 0.05 and a nonsignificant effect for group by gender interaction F(9, 90) = 0.36, P > 0.05. Correlation coefficients among the measures are given in Table 4. As the Table displays total SPSI-R scores correlated significantly negatively with BDI, PSS and LE, but positively with LS scores. BDI scores correlates significantly positively with PSS and LE scores, but negatively with LS scores. PSS correlates significantly positively with LE, but negatively with LS scores. LE correlates significantly positively with LS scores.
© 2014 European Academy of Dermatology and Venereology
Eskin et al.
1556
The results from the six regression analyses are presented in Table 5. As the table shows the predictors of depression, life satisfaction and perceived stress in both patients and healthy Table 2 Number and percentages of clinical features of psoriatic patients Variables
Yes n
No %
Discussion
n
%
Cutaneous lesions Guttate lesions Plaques
2
3.9
49
96.1
45
88.2
6
11.8
9
17.6
42
82.4
10
19.6
41
80.4
Palmoplantar involvement Scalp involvement Inverse psoriasis
0
0.0
51
14
27.5
37
0
0.0
51
27
52.9
24
6
11.8
45
88.2
Pruritus
26
51.0
25
49.0
Family history of psoriasis
12
23.5
39
76.5 43.1
Involvement of visible areas Erythrodermia
100 72.5 100
Extracutaneous involvement Nail lesions Joint disease
47.1
Disease status within previous 6 months Improved
29
56.9
22
Worsened
15
29.4
36
70.6
7
13.7
44
86.3
9
17.6
42
82.4
Any
42
82.4
9
17.6
Retinoids
33
64.7
18
35.3
Methotrexate
23
45.1
28
54.9
Cyclosporine
10
19.6
41
80.4
7
13.7
44
86.3
17
33.3
34
66.7
Stable Treatment Topical only Systemic treatment
Biologics Phototherapy
controls are identical. PSS and NLE made independent contributions for the prediction of depression and, depression was the only independent predictor of LS. Total SPSI-R scores and NLEs were the independent predictors of perceived stress in both patients and controls.
On average the patients were suffering from psoriasis for 16 years. The mean PASI scores were approximately 4 which meant that the severity of the disease was in the mild-to-moderate range (PASI< 10), with only three patients having PASI scores within the range of moderate-to-severe psoriasis (PASI = 10–20).34 Psoriasis may have significant negative effects on patients’ quality of life though PASI is
