Predictors of Quality of Life for Adults with Acne: The

Contribution of Perceived Stigma

Johanna K. Liasidesa, M.Sc., Fotini-Sonia Apergia, Psy.D.,

aThe American College of GreeceThe Annual International Conference on

Cognitive - Social, and Behavioural Sciences icCSBs 2015 January

Introduction: Appearance Based Prejudice and Visible

Differences• Social psychological research studies have shown that individuals with visible differences are subject to appearance based prejudice and discrimination (Borah & Rankin, 2003; Houston & Bull, 1994)

• The most commonly reported stigmatizing behavior directed towards people with visible differences is (Spence, 2008):• Negative attention • Avoidance

• Experimental studies have further shown participants’ preferential attitude towards clear skin (Del Rosso et al., 2011)

• Negative attitudes towards blemished skin may translate to stigmatizing behavior and discriminatory practices (Adams et al., 2008)

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Introduction: The Effect of Perceived Stigma on Well-

being Dermatological stigma has been associated with psychological distress and disability in patients with psoriasis, eczema, vitiligo and atopic dermatitis (Griffiths et al., 2007; Fortune et al., 2012), i.e.: Low self-esteem Depressive feelings and loneliness Guilt and shame Appearance anxiety

There is a marked lack of studies which investigate the effects of perceived stigma among individuals with acne

The Feelings of Stigmatization Questionnaire (FSQ;

Ginsburg & Link, 1989) has yet to be modified for patients with acne icCSBs 2015 January

Introduction: Psychosocial Impact of Skin Conditions

The emergence of skin conditions has been associated with: Lowered quality of life (Cho et al., 2006; Finlay et al. 1999)

Quality of life measures are often used in dermatological research but not by dermatologists in clinical practice to guide treatment planning (Finlay, 2005)

Patients with acne report similar levels of social and emotional problems compared to other chronic physical conditions (Finlay et al., 1999)

Concerns about body image (Benrud-Larson et al., 2003)

Lowered self-esteem (Harcourt & Rumsey, 2005; Kent & Thompson, 2001)

Interpersonal difficulties (Harcourt & Rumsey, 2005; Papadopoulos & Walker, 2003)

Psychological co-morbidities such as anxiety and depressive disorders (Gupta, 2005; Harcourt & Rumsey, 2005)

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Introduction: Predictors of Maladjustment to Visible

Differences (Papadopoulos & Walker, 2005)

Having a visible

blemish

AgeAdulthood

GenderFemale

Relationship StatusSingle

Rating one’s skin

condition as severe

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Introduction: Realities and Myths about Acne

Acne is considered a psychophysiological disorder which predominately affects the adolescent population but may persist or develop in adulthood (Papadopoulos & Walker, 2005)

Myths and misconceptions about acne influence how acne sufferers think and feel about themselves (Papadopoulos & Walker, 2005) Myth 1: Acne solely occurs in adolescence Myth 2: People with acne are not properly able to take care

of themselves Myth 3: Constantly clearing or scrubbing one’s face is helpful

in improving acne Adults with acne may feel a loss of their former

identity and powerless in improving their skin condition; their behavior and feelings about themselves may be determined by the condition of their skin (Murray & Rhodes, 2005)

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Introduction: Research Aims

Problem Statement

• As dermatology patients complain that their psychological distress is extensive and often overlooked, it is concerning that there is a paucity of research investigating factors associated with acne-related QOL

Research Aim

• To compile a preliminary list of risk factors for psychosocial distress as a result of having acne in adulthood, while specifically examining the role of an under investigated variable - perceived stigma

Research Question

• What is the predictive capacity of perceived stigma, self-rated severity, location and previous history of acne, gender, age, relationship status and education for the QOL of adult dermatology patients?

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Methodology: ParticipantsAges: 18-56 (M= 26.37, SD=7.97) Six private

dermatologists were approached and asked to distribute questionnaires to their patients with acne

Convenience

sampling Inclusion criteria:

current acne sufferers aged 18+

Exclusion criteria: current diagnosis of mental illness

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Methodology: Participants

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Methodology: Participants

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Methodology: Measures

General Background

Questionnaire

• 9-item• Socio-demographic characteristics (gender, age, education, relationship

status)• Dermatological characteristics (location of acne, self and doctor rated

severity of acne, history of acne)

Feelings of Stigmatization

Questionnaire (FSQ; Ginsburg & Link, 1989)

• Self-report questionnaire designed to measure feelings of perceived stigma in individuals with psoriasis and eczema;

• Modified to measure FSQ in individuals with acne;• Consists of 32 items which reflect six factors of perceived stigma;• Good internal consistency scores ranging from α=.84 to α=.94;• After cultural adaption, Chronbach’s α=.85

Acne-related Quality of Life (Acne-QoL; Botek,

Girman, Light, Lookingbill, Martin &

Thiboutot, 2001)

• Self-report questionnaire designed to measure QOL among individuals with facial acne;

• Modified to measure QOL in individuals with multi-domain acne;• Consists 19 items which relate to four domains of Acne-QoL;• Good internal consistency scores ranging from α= .70 to α=.95;• After cultural adaptation, α=.84 to α=.94

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Methodology: Procedure

1 • Ethical Approval

2• Test Modification

3• Cultural Adaptation

4• Reliability Analysis

5• Data Collection

6• Data Analysis

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Results: Preliminary Analysis

Reliability of culturally adapted FSQ and Acne-QOL:

Chronbach’s α = .85 for FSQChronbach’s alpha ranged from .84 to .94 for Acne-QoL

Diagnostics indicated that the assumptions of parametric and regression data were met

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ResultsMean Scores and Standard Deviation for Measures of Perceived Stigma and

Acne-Related Quality of Life

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Results

Results

Note. B: unstandardized coefficient; SE B: Std. Error; β: standardized coefficient*p < .05. **p < .01. ***p < .001.

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Results

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Implications for Policy/Practice

• Although it is important to take into account the individual differences of adults with acne, the preliminary list of risk factors of psychological distress for afflicted individuals compiled in this study could be clinically useful in providing red flags for dermatologists treating adults with acne. That is, by being informed of the factors which place adults with acne more at risk of being handicapped by their skin condition, dermatologists can provide more holistic treatment by referring them to a mental health professional when needed;

• The introduction of QOL measures to dermatologists in this study is also helpful in increasing their awareness of the possible uses of such instruments in clinical practice

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Implications for Policy/Practice

• Following the footsteps of Hrehorow et al.’s (2012) recent research, other studies could attempt to discern the most prominent aspects of the stigmatization experience in individuals with skin conditions, in order to gain a better understanding and create more appropriate interventions addressing the nature of their stigmatization;

• Determining the correlates of perceived stigma will also aid in identifying individuals who are at risk of encountering stigmatization as a result of their cutaneous pathology

Conclusion• This research study provides initial evidence

that adults who feel stigmatized are at risk for developing psychological distress as a result of having acne;

• According to the results, the risk factors of secondary importance may include an individual’s self-rated severity of acne (rating one’s skin condition as worse), gender (being female), age (being a younger adult) and not having a previous history of acne;

• Future researchers could add other psychosocial variables to their regression model, such as self-esteem and coping styles, in order to explain the remaining variance of Acne-QOL

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Gupta, M. (2005). Psychiatric comorbidity in dermatological disorders. In L. Papadopoulos & C. Walker (Eds.), Psychodermatology: the psychological impact of skin disorders. (pp. 29-39). UK: Cambridge University Press.Harcourt, D., & Rumsey, N. (2005). The psychology of appearance. UK: Open University Press.Houston, V., & Bull, R. (1994). Do people avoid sitting next to someone who is facially disfigured? European Journal of Social Psychology, 24, 279-284.Kent, G., & Thompson, A. (2001). Adjusting to disfigurement: Processes involved in dealing with being visibly different. Clinical Psychology Review, 21(5), 663-682.Kent, G. (2002). Testing a model of disfigurement: effects of a skin camouflage service on well-being and appearance anxiety. Psychology and Health, 17(3), 377-386. Murray, C.D., & Rhodes, K. (2005). The experience and meaning of adult acne. British Journal of Health Psychology, 10(2), 183-202.Papadopoulos, L., & Walker, C. (2003). Understanding skin problems: Acne, eczema, psoriasis and related conditions. U.K.: John Wiley & Sons Ltd. Papadopoulos, L., & Walker, C. (2005). Psychodermatology: The psychological impact of skin disorders. UK: Cambridge University Press. Spence, R. (2008). The challenge of reconstruction for severe facial burn deformity. Plastic Surgical Nursing, 28(2), 71-76.

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Johanna K. Liasides, M.Sc., The American College of GreeceFotini-Sonia Apergi, Psy.D., The American College of Greece

Predictors of Quality of Life for Adults with Acne: The

Contribution of Perceived Stigma

The Annual International Conference on Cognitive - Social, and Behavioural Sciences

icCSBs 2015 January