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Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders. JAMA Dermatol 2024 Jun 01;160(6):621-630

Date

04/24/2024

Pubmed ID

38656377

Pubmed Central ID

PMC11044010

DOI

10.1001/jamadermatol.2024.0594

Scopus ID

2-s2.0-85191840834 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

IMPORTANCE: Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study.

OBJECTIVE: To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease.

DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent.

MAIN OUTCOMES AND MEASURES: Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes).

RESULTS: The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = -0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = -0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.

Author List

Paller AS, Rangel SM, Chamlin SL, Hajek A, Phan S, Hogeling M, Castelo-Soccio L, Lara-Corrales I, Arkin L, Lawley LP, Funk T, Castro Porto Silva Lopes F, Antaya RJ, Ramien ML, Vivar KL, Teng J, Coughlin CC, Rehmus W, Gupta D, Bercovitch L, Stein SL, Boull C, Tom WL, Liang MG, Hunt R, Luu M, Holland KE, Schoch JJ, Cella D, Lai JS, Griffith JW, Pediatric Dermatology Research Alliance

Authors

Kristen E. Holland MD Associate Professor in the Dermatology department at Medical College of Wisconsin
Stephen R. Humphrey MD Associate Professor in the Dermatology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Anxiety
Canada
Child
Chronic Disease
Cross-Sectional Studies
Depression
Female
Humans
Male
Mental Health
Patient Reported Outcome Measures
Quality of Life
Severity of Illness Index
Skin Diseases
Social Stigma
Stereotyping
United States