Executive Summary - World Psoriasis Happiness … / WORLD PSORIASIS HAPPINESS REPORT 2017 EXECUTIVE SUMMARY 2) Psoriasis reduces the happiness of women more than men While both men

1 / WORLD PSORIASIS HAPPINESS REPORT 2017

ARTICLE TITLE / CHAPTER 00

Editors: LEO Innovation Lab and The Happiness Research Institute Copenhagen, Denmark, October 2017

Executive Summary

© LEO Innovation Lab in cooperation with The Happiness Research Institute, 2017. All rights reserved. Any part of this report can be reproduced only with the explicit acknowledgement of the copyright owner. The following reference should be included: LEO Innovation Lab, The Happiness Research Institute (2017), World Psoriasis Happiness Report 2017. ISBN 978-87-970163-0-5

Available at https://psoriasishappiness.report/


During the last decade, there’s been a global paradigm shift in our understanding of progress. A nation’s progress cannot and should not be reduced to gross domestic product (GDP) per capita. Instead, the ultimate goal of public policies should be to improve quality of life.

In 2011, the United Nations passed the resolution on happiness. The same year, the OECD included life satisfaction as a parameter for the development of the member countries. It concluded that subjective well-being measures

are valid and reliable and can be used to inform policy makers and citizens.

The World Psoriasis Happiness Report 2017 aims to shed light on what impacts the subjective well-being - interpreted as happiness - of people living with psoriasis.1

We received input from 121,800 people with self-reported psoriasis across 184 countries on how living with this chronic illness impacts their well-being.

EXECUTIVE SUMMARY


Executive Summary

The countries included in the detailed analysis in Chapters 2 and 3 have been grouped based on the definitions of EUROVOC and World Happiness Report2 in the following regions3:

Regions Countries

LATIN AMERICA Brazil, Colombia and Mexico

WESTERN EUROPE France, Germany, UK and Ireland

THE NORDICS Norway and Denmark

RUSSIAN FEDERATION Russian Federation

SOUTHERN EUROPE Spain, Portugal, Italy and Greece

NORTHERN AMERICA & AUSTRALIA USA, Canada and Australia

1 As presented in more detail in the Report, the diagnosis was self-reported by the participants in the study.2 The thesaurus of the European Union & Helliwell, J., Layard, R., & Sachs, J. (2017). World Happiness Report 2017, New York: Sustainable

Development Solutions Network.3 It is important to stress that these regions only serve as categories for the 19 countries included in the analysis, and thus only as indications

of the regional performance. For a complete assessment of the regional performance we would need more country cases within each geographical region.


1) Psoriasis has an impact on happiness

Our study shows that living with psoriasis impacts people’s quality of life across a wide spectrum of subjective well-being indicators. When people report severe symptoms, they also report lower levels of happiness.

Using the World Happiness Report 2017 as a benchmark, our study shows that people living with severe psoriasis in some countries report 30% lower levels of happiness than

their fellow citizens. What stands out is the particular ranking of all 19 countries according to their average happiness levels.

Countries that don’t make the top 10 in the annual UN World Happiness Reports – such as Colombia, Brazil, Mexico and Spain – rank as the top countries, when considering the group of people living with psoriasis. Correspondingly, Norway and Denmark – the two happiest countries

in the world according to the World Happiness Report – are listed as number 9 and 14, respectively. With an average happiness score of 5.65 for people living with psoriasis in Denmark and 5.99 in Norway, the selected countries in the Nordics become subject to the largest happiness gaps considering that the general populations in these countries report an average happiness level of 7.5.

The ten key insights in this report

Psoriasis happiness ranking

6.05.55.04.54.03.53.02.52.01.51.00.50

4,6005,0738,31710,2442,2273,4379,0384,2344181,2365472,4822,5131,0251,1963,2872,048531654

6.5 7.0

MexicoColombiaSpainBrazilCanadaUnited StatesRussian FedPortugalNorwayIrelandGreeceFranceGermanyDenmarkAustraliaItalyUnited KingdomJapanChina

6.806.686.436.316.096.026.026.005.995.865.795.765.705.655.565.485.395.264.28

n

‘It is surprising to see that Norway and Denmark, which have recently been named as the world’s happiest countries in the two most recent annual UN World Happiness Reports, had the biggest happiness gaps among those living with psoriasis, compared to other countries in our research,’ said Meik Wiking, CEO of the Happiness Research Institute. ‘There were similar, large gaps in other countries that have consistently scored high on the UN’s global happiness index, so it could indicate that the negative impact of chronic health conditions may be flying under the policy radar of otherwise healthy and happy societies and leaving people behind.’

EXECUTIVE SUMMARY


EXECUTIVE SUMMARY

2) Psoriasis reduces the happiness of women more than men

While both men and women with psoriasis are very much affected physically, emotionally and psychologically, the impact on women is greater. Compared to their countrymen and countrywomen, men and women living with

severe psoriasis report respectively 11.3% and 18.5% lower levels of happiness. However, for moderate severity the difference was marginal. In addition, women consistently reported higher levels of stress and loneliness than men.

Happiness gap per severity and gender

Aver

age

happ

ines

s ga

p

Mild Moderate Severe

5%

0%

-5%

-10%

-15%

-20%

-25%

-11.3%

-18.5%

-3.4%

-7.4%

0.5%

-2.7%

Femalen = 5,148

Malen = 4,801

Femalen = 5,553

Malen = 5,511

Femalen = 1,479

Malen = 1,300




The different symptoms of psoriasis - such as scaling, itchiness and trouble walking - have very different effects on happiness. While ‘scaling’ is associated with 11.7% lower

happiness levels, ‘trouble walking’ is associated with 22% lower happiness levels compared to the average population. This pattern is consistent across the different levels of severity.

3) Different symptoms have different impacts on happiness

-18.3%Avg.

Hap

pine

ss G

ap fo

r peo

ple

repo

rtin

g th

e fo

llow

ing

sym

ptom

s

0%

-2%

-4%

-6%

-8%

-10%

-12%

-14%

-16%

-18%

-20%

-22%

-11.7%

-14.3%

-17.6%

-12.4%

-15.5%

-17.6%

-22%

Scaling FragileSkin

Pain in Lesion

Trouble Sleeping

Itching Bleeding Pain in Joints

Trouble Walking

n = 6,903

EXECUTIVE SUMMARY

Looking at the relationship between happiness levels and where on the body people have psoriasis, we find that psoriasis on the scalp is associated with a happiness gap of -7.5% while psoriasis on the genitals is associated to happiness gap of -12.9%.

This may be due to that psoriasis on intimate areas of the body may create physical or psychological challenges impacting people’s love lives.

4) Different affected body areas have different impacts on happiness

Happiness gaps and body areas affected

EXECUTIVE SUMMARY


Thighs

Knees

Lower legs

Stomach

Back

Chest

Face

Skin folds

Neck

Arms

Shoulders

Scalp

Feet

-12.8%

-11.9%

-11.5%

Anal area -11.2%

-10.4%

Hands -10.1%

-9.8%

Nails -9.2%

-9.3%

-9.0%

-9.6%

-8.9%

-8.5%

-8.4%

-7.5%

Genitals -12.9%

-12% n = 43,686


We analysed a wide range of factors that impact well-being and found that stress is the best psychological predictor of unhappiness for people living with psoriasis. In all countries, the average stress level of people living with psoriasis exceeds that of the general population in the United States (15.2 on a scale from 0 to 40)4. Also, in the majority of countries the average level is even higher than what is considered high stress (scores above 20). In addition, we find that

stress is a non-discriminating factor, in the sense that it affects people living with psoriasis regardless of demographics, socioeconomic status and severity.

Furthermore, of all daily emotions and experience - both positive and negative - distress is the most common among people with psoriasis. 60% report feeling distressed in a moderate to extreme degree in their daily life.

5) Stress is the strongest psychological predictor of unhappiness for people living with psoriasis

EXECUTIVE SUMMARY

10 12 14 16 18 20 22 24 26 28 30

Aver

age

happ

ines

s le

vels

Average stress levels

8.0

7.5

7.0

6.5

6.0

5.5

5.0

4.5

4.0

Happiness and stress - country correlation

20: H

igh

stre

ss

n=9,565

4 Cohen, Sheldon & Janicki-Deverts, Denise (2012) Who’s Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 2009.


Aver

age

Stre

ss S

core

Spai

n

Russ

ian

Fede

ratio

n

Col

ombi

a

Mex

ico

Port

ugal

Italy

Braz

il

Uni

ted

Stat

es

Aust

ralia

Uni

ted

King

dom

Irela

nd

Can

ada

Ger

man

y

Den

mar

k

Fran

ce

Gre

ece

20

15

10

5

0

15.2: US general population

20: High Stress

19.7 19.9 20.2 20.3 20.8 20.8 20.9 21.1 21.3 21.4 21.7 22.0 22.9 23.219.7 20.1

Spai

n

Russ

ian

Fede

ratio

n

Col

ombi

a

Mex

ico

Port

ugal

Italy

Braz

il

Uni

ted

Stat

es

Aust

ralia

Uni

ted

King

dom

Irela

nd

Can

ada

Ger

man

y

Den

mar

k

Fran

ce

Gre

ece

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

43%

48%50%

53% 53%

59%

63% 63%65% 66% 66%

70%

81%

91%

44%

49%

Percentage of people who feel distressed in a moderate to extreme degree in their daily life - per country

Stress levels per country

EXECUTIVE SUMMARY

n = 9,656

n = 5,161


Uni

ted

Stat

es

Uni

ted

King

dom

Den

mar

k

Mex

ico

Aust

ralia

Irela

nd

Gre

ece

spai

n

Ger

man

y

port

ugal

Braz

il

Russ

ian

Fede

ratio

n

Can

ada

Fran

ce

Italy

Col

umbi

a

50%

40%

30%

20%

10%

0%

48% 48% 40% 35% 34% 33% 32% 31% 28% 25% 25% 24% 24% 21%48% 41%

Percentage of people living with loneliness per country

Using the most conservative threshold for loneliness, we find that 33% of all people living with psoriasis are lonely. It impacts their happiness levels and it is the second strongest predictor of unhappiness after stress.

The levels of loneliness vary a lot between the different countries from 21% in Portugal to 48% in the United Kingdom. Furthermore, loneliness is not only non-discriminating in terms of countries, it also affects people regardless of their age, disease severity and socioeconomic status.

The percentage of people living with loneliness varies a lot between the different countries

33%33% of all people living with psoriasis are lonely

21% to 48%From 21% in Portugal to 48% in the United Kingdom

6) Loneliness is widespread among people living with psoriasis

n = 5,108

EXECUTIVE SUMMARY



Our study shows that living with psoriasis has a major negative impact on happiness, well-being and quality of life. Compared to national averages, people living with severe psoriasis are subject to happiness gaps, from 7.3 % less happy in Portugal to 37.4% in Australia.

However, the happiness gaps vary a lot, including cases of positive happiness gaps, notably in Portugal and Greece.

We have identified two assumptions that could explain the variation: • The culture assumption: the countries characterized by small happiness gap are characterized as collectivistic; correspondingly, the countries characterized by large happiness gap can at the same time be characterized as individualistic.

• The social comparison assumption: people with a debilitating condition find it harder to live in an otherwise happy country - explaining the higher prevalence of mental health issues and even suicide rates in richer and happier regions.

7) Countries vary in the level of well-being inequality due to psoriasis

Happiness gaps for severe psoriasis - per country

EXECUTIVE SUMMARY


-5%-10%-15%-20%-25%-30%-35%-40%-45%-50%

Avg. Happiness Gaps

Severe psoriasis

5%0%

PortugalColombia

GreeceSpain

MexicoBrazil

IrelandUnited States

United Kingdom Russian Federation

Italy France

Denmark NorwayCanada

GermanyAustralia

-7.31%-8.99%-8.63%-9.09%-15.11%-25.12%-26.02%-27.36%-27.58%-27.61%-30.04%-31.00%-34.31%-35.32%-35.51%-37.95%-37.41%

17625161

33224625872

1821142561801506924

1296863

n


feel that their healthcare professionals do not fully understand

the impact psoriasis has on their mental well-being and experience

happiness gaps of 21%.

48%Av

erag

e Ha

ppin

ess

Gap

% of people who agree / disagree with statement

0%

-5%

-10%

-15%

-20%

-25%

Happiness gap: -3%% of people: 52%

Happiness gap: -21%% of people: 48%

Agree Disagree

‘My healthcare professional fully understands the impact psoriasis has on my mental well-being’

Our data suggest that increasing the understanding of how psoriasis impacts well-being - especially stress and loneliness - may take us quite far in bridging these health related happiness gap.

48% feel that their healthcare professionals do not fully understand the impact psoriasis has on their mental well-being and experience happiness gaps of 21%. Meanwhile, the 52% who feel that their healthcare professionals fully understand the impact psoriasis has on their mental well-being only experience happiness gaps of 3%.

8) Happiness gaps may be reduced by improving the understanding of how psoriasis impacts well-being

EXECUTIVE SUMMARY

25% 30% 35% 40%

Latin America

Southern Europe

North America & Australia

Western Europe

How many can be lifted out of misery by eliminating extreme stress

0% 5% 10% 15% 20%

Method: These numbers reflect the percentage of people who can be lifted out of misery based on the total number of people in misery. In Western Europe 11.3% of the total population can be lifted out of misery be eliminating extreme stress, and considering that 31.7% are living in misery, a 35.6% of the people in misery can be lifted out of that situation - 0.113/0.317 * 100 = 0.356n= 7,310

35.60%

29.70%

20.90%

25.40%

In order to identify the most affected people – which we label as people in misery – we pinpoint those who have assigned themselves low scores on our main well-being measure – Cantril’s Ladder. (the 11-point scale where scores range from 0 - 10.) Our approach is consistent to that of the The World Happiness Report, where people in misery are identified as everyone who scores themselves between 0 and 4 on the same scale5.

We find that people experiencing stress while living with psoriasis are 23% more likely to be in misery (report a happiness score of 0-4). At

the same time, analysing what factors would reduce the number of people living in misery makes a compelling case for particularly reducing stress levels across all regions.

If we could ensure that no people living with psoriasis experience extreme stress6, we could reduce the number of people living in misery by up to 35.6%. The evidence again suggests that the effects vary between regions, however, it is clear that reducing the most extreme cases of stress can lift a lot of people out of misery, regardless the region we investigate.

9) Up to 35.6% of people with psoriasis can be lifted out of misery by reducing extreme stress

EXECUTIVE SUMMARY


5 This approach is also consistent with the Gallup classification, where 0-4 are defined as ‘suffering’6 Extreme stress is a conservative stress threshold: Scores above the median score in each region. For Latin America, this encompasses all

respondents with a score above 21; in Southern Europe 22; in Northern America and Australia 23 and in Western Europe 24. As these stress-thresholds are much higher than the threshold provided by the original measure (A stress score of 20) we choose to label this new threshold ‘extreme stress’.


EXECUTIVE SUMMARY

The prevalence of loneliness and effect varies between regions. However, the impact of loneliness should not be neglected as up to 12.9% people with psoriasis can be lifted out of misery by reducing the extreme loneliness.

If we consider loneliness and stress as ‘psychological drivers’, a reduction of these together would lift more people out of misery than anything else – no matter which region we target.

10) Up to 12.9% of people with psoriasis can be lifted out of misery by reducing extreme loneliness

Limitations of methodology - summary

Latin America

Southern Europe

North America & Australia

Western Europe

How many can be lifted out of misery by eliminating loneliness

n = 7,310

10% 12% 14% 16% 20%18%0% 2% 4% 6% 8%

12.90%

18.60%

7.50%

13.40%

Diagnosis and severity classificationThe participants in the study self-reported both their diagnosis and severity of psoriasis. Data collection and samplingAll data is collected by Self-Administered Questionnaires (SAQs), provided through an app and a web-based (browser enabled)

app. Therefore we must consider both coverage errors (where we fail to reach some certain segments) and non-response bias (due to preferences for certain modes among respondents). Furthermore, survey modes also become important to consider when we compare our data to data collected by different modes. Because a

robust and demographically well-distributed sample can reduce the impact of these errors, we will continue to further refine our methodology to include control variables and weights.

See the full report for more details on Limitations of the study and Methodology.

Documents

Executive Summary - World Psoriasis Happiness … / WORLD PSORIASIS HAPPINESS REPORT 2017 EXECUTIVE SUMMARY 2) Psoriasis reduces the happiness of women more than men While both men