Introduction
Methods
Identifying the research questions
Identifying relevant studies
Selecting the literature
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Population: Patients experiencing skin diseases diagnosed as psoriasis, atopic dermatitis, eczema, vitiligo or chronic urticaria.
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Range of concepts: The psychosocial adaptation of patients in different skin conditions. According to previous research and team discussion, the following concepts were often used to reflect psychosocial impacts of patients with skin diseases: anxiety/depression, body image, stigma, self-esteem, social support, family function, financial costs and work. Some studies even equated the PA of patients with the QOL.
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Context: Adult population for 18 years old or older.
Charting the data
Collating, summarizing, and reporting the literature
Results
Study characteristics (N = 69) | N (%) |
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Publication years | |
2009–2013 | 16 (23.19) |
2014-June 2018 | 53 (76.81) |
Country of origin | |
UK | 8 (11.59) |
USA | 8 (11.59) |
Poland | 8 (11.59) |
India | 6 (8.70) |
German | 5 (7.25) |
China | 4 (5.80) |
Japan | 4 (5.80) |
Denmark | 2 (2.90) |
Korea | 2 (2.90) |
Italy | 2 (2.90) |
Greece | 2 (2.90) |
Malaysia | 2 (2.90) |
Canada | 2 (2.90) |
Spain | 2 (2.90) |
Singapore | 2 (2.90) |
Portugal | 2 (2.90) |
Sweden | 2 (2.90) |
Netherlands | 1 (1.45) |
Turkey | 1 (1.45) |
Iran | 1 (1.45) |
Finland | 1 (1.45) |
Ireland | 1 (1.45) |
Egypt | 1 (1.45) |
Study types | |
Cross-sectional study | 43 (62.32) |
Randomized controlled trial | 5 (7.25) |
Review | 5 (7.25) |
Systematic review | 3 (4.35) |
Case-control study | 2 (2.90) |
Prospective cross-sectional study | 2 (2.90) |
Case series study | 2 (2.90) |
Experimental design | 2 (2.90) |
Qualitative study | 2 (2.90) |
Letter | 2 (2.90) |
Develop a rating scale | 1 (1.45) |
Study population | |
Psoriasis | 44 (63.77) |
Atopic dermatitis | 10 (14.49) |
Vitiligo | 9 (13.04) |
Eczema | 3 (4.35) |
Skin disease | 3 (4.35) |
Various concepts of psychosocial adaptation for patients with skin disease
Domain | Related concept | Measurement methods (N: number of studies reporting) |
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psychosocial | Quality of life | Dermatology Life Quality Index (DLQI) (N = 32) European Quality of Life-5 Dimensions (EQ-5D) (N = 7) Short Form Health Survey (SF-36) (N = 2) General Health Questionnaire (GHQ) (N = 1) World Health Organization Quality of Life-BREF (N = 1) Short form of the General Health Questionnaire (GHQ-28) (N = 1) Short-Form 12 health status instrument (N = 1) Eczema Quality of Life Scale (EQOLS) (N = 1) Revised Dyadic Adjustment Scale (R-DAS) (N = 1) |
Subjective Burden | Skindex-29 (N = 2) Skindex-16 (N = 2) Skindex-19 (N = 1) | |
psychological | Anxiety and depression | Hospital Anxiety and Depression Scale (HADS) (N = 13) Beck Depression Inventory (BDI) (N = 8) 42-item Depression, Anxiety and Stress Scale (DASS-42) (N = 2) Social Anxiety Questionnaire (SAQ) (N = 2) Center for Epidemiologic Studies Depression Scale (CES-D) (N = 2) Self-Rating Depression Scale (SDS)&Self-Rating Anxiety (SAS) (N = 1) Patient Health Questionnaire Depression Scale (PHQ-9) (N = 1) Generalized Anxiety Disorder Scale (GAD-7) (N = 1) Arabic version of the Depression, Anxiety and Stress Scale (N = 1) Penn State Worry Questionnaire (N = 1) State-Trait-Anxiety Inventory (N = 1) |
Body image | Body Emotions Scale (BES) (N = 2) Appearance Schemas Inventory-Revised (ASI-R) (N = 2) Body Image Scale (BIS) (N = 2) Body Dysmorphic Disorder Questionnaire (BDDQ) (N = 1) Female Genital Self-image Score (FGSIS) (N = 1) Acceptance of Life with the Disease Scale (ALDS) (N = 1) Perceived Health Status (PHS) (N = 1) Multidimensional Body-Self Relations Questionnaire (MBSRQ) (N = 1) Skin Satisfaction Questionnaire (SSQ) (N = 1) Derriford Appearance Scale (DAS-24) (N = 1) | |
Self-esteem | Rosenberg Self-esteem Scale (RSES) (N = 5) Fears of Compassion Scales (FCS) (N = 1) Brief Fear of Negative Evaluation Scale (Brief FNE) (N = 1) | |
Stigmatization | Stigmatization Scale (N = 3) Stigmatization and Psoriasis Questionnaire (SPQ) (N = 1) Psoriasis disease stigma questionnaire (PSQ) (N = 1) Internalized Stigma Scale (ISS) (N = 1) | |
Alexithymia | Toronto Alexithymia Scale (TAS) (N = 1) | |
social | Social support | Berlin Social Support Scales (BSSS) (N = 1) Social support rating scale (SSS) (N = 1) Disease-Related Social Support Scale (DRSS) (N = 1) Multidimensional Scale of Perceived Social Support (MSPSS) (N = 1) |
Social interaction | Social Readjustment Rating Scale (N = 1) Participation Scale Questionnaire (N = 1) | |
Social acceptance | Marlowe–Crowne Social Desirability Scale (MC-SDS) (N = 1) | |
Occupational effect | Work Productivity and Activity Impairment (WPAI) (N = 4) Work Productivity and Activity Impairment Questionnaire: Psoriasis (WPAI-PSO) (N = 1) Work Productivity and Activity Impairment-General Health (WPAI-GH) (N = 1) Work Limitation Questionnaire (WLQ) (N = 1) Total work productivity impairment (TWPI) (N = 1) Total activity impairment (TAI) (N = 1) | |
Economic burden | Direct costs (N = 1) Direct Costs of AD: medications, over-the-counter costs, medical testing and procedure expenses, physician visits, out-of-pocket expenses, transportation, and childcare increased as severity of AD worsened (N = 1) Indirect Costs of AD (productivity loss of caregivers) (N = 1) Lost productivity (N = 1) | |
Physical | Disease severity | Psoriasis Area and Severity Index (PASI) (N = 16) Psoriasis Disability Index (PDI) (N = 3) Vitiligo area scoring index (VASI) (N = 1) Distress Thermometer (DT) (N = 1) Physician global assessment (PGA) (N = 1) Severity scoring of AD (SCORAD) (N = 1) Physicians Global Assessment (PGA) score (N = 1) Hand eczema severity:10-point visual analogue scale (VAS) (N = 1) Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) index (N = 1) Impact of chronic Skin Disease on Daily Life (ISDL) (N = 1) Self-Administered Psoriasis Area and Severity Index (SAPASI) (N = 1) |
Clinical feature | Itching/pruritus: Visual Analogue Scale (VAS) (N = 2) Juckreiz-Kognitions-Fragebogen questionnaire (N = 1) SCORAD index (N = 1) | |
Distribution and extent | Body Surface Area (BSA) (N = 6) Body surface involvement (N = 1) | |
Others | Sexual life | Massachusetts General Hospital-Sexual Functioning Questionnaire (MGH-SFQ) (N = 2) Female Sexual Function Index (FSFI) (N = 1) International Index of Erectile Function (IIEF) (N = 1) |
Stress | Psoriasis Life Stress Inventory (PLSI) (N = 1) Stress Self-assessment Scale (N = 1) | |
Personality | Eysenck Personality Questionnaire (EPQ) (N = 1) Eysenck Personality Inventory (N = 1) | |
Life course | Course of life questionnaire (COLQ) (N = 1) Modified psoriasis life stress inventory (N = 1) | |
Loneliness | UCLA loneliness scale (UCLA-Version 3) (N = 1) | |
Sleep Quality | Medical Outcomes Study Sleep Scale (MOS-SS) (N = 1) | |
Disease control | Urticaria Control Test (UCT) (N = 1) | |
Knowledge | Psoriasis Knowledge Assessment Questionnaire (N = 1) | |
Biological Markers | CRP and cytokines IL-1β, IL-6, TNFα, and IL-17 (N = 1) | |
Mindfulness | Five Facet Mindfulness Questionnaire (N = 1) |
Related factors of psychosocial adaptation for patients with skin disease
Author, year | Study population and sample size | Research topic | Demographic factors | Disease related factors | Psychological factors | Social factors | Others |
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Nayak et al.(2018) | Psoriasis(n = 102) | Quality of Life | Disease severity (−)* | Family income (+)* | |||
Kwan et al.(2018) | Psoriasis(n = 102) | Quality of life | Age (+)* | Disease severity (−)* | Depression/Anxiety (−)* | ||
Itakura et al.(2018) | Chronic urticaria, AD, psoriasis (n = 1443, 1668,435) | Quality of life | Work productivity (+)* | ||||
Lee et al.(2018) | Atopic Dermatitis (n = 677) | Quality of life | Depression (−)* Suicidal ideation (−)* | Sleep disturbance (+)* | |||
Bidaki et al.(2018) | Vitiligo (n = 126) | Social acceptance | Woman* Marital status* | Lesions distribution (face and neck) * Disease duration less than 5 years* | |||
Hebert et al.(2018) | Atopic dermatitis (n = 76) | Economic burden | Disease serverity (+)* Itching (+)* | Lost productivity Outpatient expense | |||
Norreslet et al.(2018) | Atopic dermatitis (n = 23) | Work life | Job choice Change or loss of job Disability pension | ||||
Lakuta et al.(2018) | Psoriasis (n = 193) | Stigmatization Depression Social anxiety | Location and extent of psoriasis* | ||||
Kwak et al.(2017) | Atopic dermatitis (n = 662) | Occupational characteristics | Work format/hours Job classification Employment status | ||||
Kwan et al.(2017) | Psoriasis (n = 102) | Quality of life | India ethnicity Education (−)* | Depression (−)* | Employ status Monthly income (+)* | ||
Nazik et al.(2017) | Psoriasis (n = 92VS98) | Quality of life | Disease severity (−)* | Self esteem (+)* Body image (−)* | |||
Alpsoy et al.(2017) | Psoriasis (n = 1485) | Internalized stigma | Education (−)* Family history* | Disease severity (+)* Lesions distribution (visible parts of body) * Disease duration (+)* | Income level (−)* | Quality of life (−)* | |
Dieris-Hirche et al.(2017) | Atopic dermatitis (n = 181) | Suicidality | Age (−)* | Disease severity (+)* | Depression/Anxiety (+)* | Family support (−)* | |
Lakuta et al.(2017) | Psoriasis (n = 148) | Depressive | Female* | Disease duration (−)* | Stigma (+)* | Social support (−)* | |
Rosinska et al.(2017) | Psoriasis (n = 54) | Depressive | Female* | Body image (−)* | |||
Nicholas et al.(2017) | Atopic Dermatitis | depression and suicidality | Female* Age (+)* | Disease serverity (−)* | |||
Lamb et al.(2017) | Psoriasis (n = 607) | Anxiety and Depression | Female* Asian ethnicity* Topical treatment only* | Disease serverity (+)* | |||
Lakuta et al.(2017) | Psoriasis (n = 193) | Social anxiety and depression | Female* | Disease serverity (+)* Disease duration (+)* | |||
Geale et al.(2017) | Psoriasis (n = 2674) | Quality of life | Disease severity (−)* | ||||
Lesner et al.(2017) | Psoriasis (n = 682) | Quality of life | Marital status* | Itch intensity* | Depression/Anxiety* Suicidal ideation* | ||
Kimball et al.(2016) | Psoriasis (n = 694) | Work productivity | Sleep problems* | Pruritus (−)* | |||
Zhu et al.(2016) | Psoriasis (n = 108) | Stigma | Social support (−)* Social interaction (−)* | Quality of life (−)* | |||
Sarhan et al.(2016) | Vitiligo (n = 50VS25) | Quality of life | Lesions distribution* | Sexual life* | |||
Korman et al.(2016) | Psoriasis (n = 694) | Quality of life | Disease severity (−)* Scaling, itching, pain* | Work productivity (+)* | |||
Bonotis et al.(2016) | Vitiligo (n = 216) | Quality of life | Sex* Personality* | Self esteem (−)* | |||
Cazzaniga et al.(2016) | Chronic hand eczema (n = 199) | Quality of life Psychosocial adjustment | Job loss and change | High rate of sick leave Intense use of health care services | |||
Tee et al.(2016) | Psoriasis (n = 100) | Quality of life | Disease severity (−)* | Depression/Anxiety (−)* | |||
Molina-Leyva et al.(2016) | Psoriasis (n = 79VS79) | Erectile Dysfunction | Smoking BMI | Depression/Anxiety (−)* | |||
Ji et al.(2016) | Psoriasis (n = 191VS191) | Erectile Dysfunction | Age* Hypertention Hyperlipidemia* | Depression* | |||
Innamorati et al.(2016) | Psoriasis (n = 100VS97) | Quality of life | BMI* | Depression* | |||
Korman et al.(2016) | Psoriasis (n = 681) | Quality of life | Disease severity (−)* | Work productivity (+)* | |||
Molina-Leyva et al. (2015) | Psoriasis (n = 133) | Sexual Function | Distribution of lesions* | ||||
Ahmed et al.(2015) | hand eczema (n = 1023) | Self-esteem | |||||
Korman et al.(2015) | Psoriasis (n = 700) | Quality of life | Disease severity (−)* Scaling, itching, pain* | Work productivity (+)* | |||
Schmitt et al.(2015) | Psoriasis (n = 201) | Quality of life | Work productivity Indirect costs | ||||
Ayala et al.(2014) | Psoriasis (n = 787) | Work-related problem | Sex* Low education* | Disease serverity (+)* Localization* | Shame* Anger* Self-esteem* | ||
Khoury et al.(2014) | Psoriasis (n = 8) | Body image | Exercise (+)* | Body coverage (−)* | Social support (+)* | Sexual inhibitions (+)* | |
Mattila et al. (2013) | Psoriasis (n = 262) | Work | Change of occupation Sick leave days Early retirement from work | ||||
Yano et al. (2013) | Atopic Dermatitis (n = 112) | Work productivity and activity impairment | Disease serverity (+)* | Quality of life (+)* | |||
Chen et al. (2013) | Psoriasis (n = 12,300VS61,500) | Sexual dysfunction | Male* Aged* | ||||
Lewis-Beck et al. (2013) | Psoriasis (n = 199) | Quality of life | Itching intensity (−)* Pain (−)* Scaling (−)* | Work productivity (+)* | |||
Chrostowska-Plak et al. (2013) | Atopic Dermatitis (n = 89) | Quality of life | Pruritus (−)* | Depression (−)* | |||
Schneider et al. (2013) | Psoriasis (n = 50) | Social anxiety Social avoidance | Disease severity (+)* | Feelings of helplessness (+)* | Social support (−)* | Quality of life (−)* | |
Premkumar et al. (2013) | Psoriasis (n = 300) | Quality of life | Aged* Low education* | Disease severity (−)* | Stigma (−)* | ||
Sampogna et al. (2012) | Psoriasis (n = 936) | Quality of life | Female* Low education* | Disease severity (−)* | Depression/Anxiety (−)* | Shame, angry and problems in daily activities and social life | |
Janowski et al. (2012) | Psoriasis (n = 113) | Quality of life /Adaptation | Gender* | Social support (+)* | |||
Levy et al.(2012) | Psoriasis (n = 90) | Quality of life | Direct costs* Lose productivity* | Economy burden | |||
Chan et al. (2012) | Vitiligo (n = 145) | Depression | Age (+)* Sex* | Self-esteem (+)* | |||
Brito et al. (2012) | Psoriasis (n = 101patients + 78 partners) | Adjustment | Body image (+)* | Relationship between patients and partners | |||
Pereira et al. (2012) | Psoriasis (n = 101) | Adjustment | Disease severity (−)* | Depression/Anxiety (−)* | Family coping in patients and their partners | ||
Pichaimuthu et al. (2011) | Vitiligo and psoriasis (n = 300) | Stigma | Participant restrictions (+)* |
Demographic factors
Disease-related factors
Psychological factors
Social factors
Interventions of psychosocial adaptation for patients with skin disease
Author, year | Study population (sample size) | Type of Intervention | Follow up | Outcome |
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Rzepecki et al.(2018) | Vitiligo | Adjuvant care: group therapy cognitive behavioral therapy self-help programs | ||
Nagarajan et al.(2018) | Psoriasis and control,(n = 52VS52) | Video-assisted teaching program regarding psoriasis on the level of knowledge and relaxation therapy | 3 months | Improving the knowledge and quality of life of patients with psoriasis. |
Keyworth et al.(2018) | Psoriasis (n = 217) | Health risk communication: message framing theory Gain-frame messages and loss-frame messages | Alcohol reduction: loss-framed messages appear to be more effective for cardiovascular disease risk reduction information. Psoriasis symptom reduction: gain-framed messages are more effective. Messages about cardiovascular disease result in higher emotional responses compared to messages about psoriasis symptom reduction. | |
Paul et al.(2018) | Psoriasis (n = 94) | Mindfulness-based cognitive therapy (MBCT) (n = 25) Mindfulness-based self-compassion therapy (MBSCT) (n = 25) Self-help MBSCT (MBSCT-SH) (n = 22) Treatment-as-usual (TAU) (n = 22) | 12 months | Improving the long-term psychological and physical outcomes of individuals with psoriasis. |
Zill et al.(2018) | Psoriasis | Cognitive behavioral techniques: Mindfulness and meditation Emotional writing Individual and group setting | Most studies reported positive but nonsignificant effects on the different patient-reported outcomes. | |
Heratizadeh et al.(2017) | Atopic dermatitis intervention group (n = 168) intervention group (n = 168) | Educational training: a comprehensive 12-h training manual | 12 months | Itching (catastrophizing cognitions):Juckreiz- Kognitions -Fragebogen questionnaire Social anxiety: Marburger Hautfragebogen questionnaire Subjective burden by symptoms of the disease: Skindex-29 questionnaire Improvement of disease signs and symptoms: SCORAD index |
Hashimoto et al.(2017) | Atopic dermatitis (n = 12) | Psychological and educational interventions: The psychological interventions included supportive, cognitive, behavioral, and psychodynamic psychotherapies, cognitive-behavioral therapy, and physical training such as progressive muscle relaxation. Lectures, audiotapes, books, videotapes, and question-and-answer sessions for the educational interventions contained information on the disease, treatment options, and strategies for management and prevention. | The data did not have sufficient power to provide evidence-based conclusions. | |
Van et al. (2016) | Psoriasis care as usual (CAU, n = 66) (ICBT+ CAU (n = 65) | Internet-based cognitive behavioral therapy (ICBT) | 6 months | Results underline the promise of therapist-guided, individually tailored ICBT to improve physical functioning and reduce the impact of psoriasis on daily activities in patients with a psychological risk profile. Establishing a good therapeutic relationship early on may be an important factor that influences treatment outcomes in personalized ICBT interventions. Further research is needed to evaluate ICBT effectiveness in additional samples and to explore its underlying mechanisms. |
Jha et al.(2016) | Vitiligo (n = 13) | Behavior therapy techniques: Psycho-education Breathing/relaxation and imagery Self-statements Exposure and desensitization | 3 months | The feasibility of such therapy would depend upon the willingness and ability of both the dermatologist and the patient to set aside the time required. Interventions with less frequent sessions of shorter duration may ensure better patient compliance. |
Shah et al.(2014) | Vitiligo CBSH+(n = 24) CBSH (n = 25) Control (n = 26) | Cognitive behavioral self-help intervention (CBSH) had three parts: Psycho-education, including a description of how social anxiety is likely to be maintained in vitiligo; Symptom monitoring with an emphasis on the recognition of self-focused attention and triggers of anxiety; Guided imagery based relaxation and techniques for switching attention. | 2 months | The findings demonstrate that augmented CBSH provides a relatively simple and accessible intervention that can result in a clinically significant reduction in social anxiety. The augmented intervention has potential and might be further developed and evaluated in subsequent trials. |
Bundy et al.(2013) | Psoriasis eTIPs (n = 67) Control (n = 68) | Electronic Cognitive behavioral therapy intervention for Psoriasis (eTIPs), 6-week programme | 6 months | This first online CBT intervention for people with skin disease showed improvement in anxiety and quality of life in patients with psoriasis. |