Transcript 26 - Future Academy

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 Greece
The 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
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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)
Gender
Female
Age
Adulthood
Relationship
Status
Single
Rating one’s
skin condition
as severe
Having a
visible
blemish
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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
Research Aim
Research Question
• 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 acnerelated QOL
• 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
• 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: Participants
 Ages: 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
Feelings of
Stigmatization
Questionnaire (FSQ;
Ginsburg & Link, 1989)
Acne-related
Quality of Life
(Acne-QoL; Botek,
Girman, Light,
Lookingbill, Martin &
Thiboutot, 2001)
• 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)
• 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
• 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 FSQ
Chronbach’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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Results
Mean 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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References
Adams, J., Heading, G., Magin, P., Pond, D., & Smith, W. (2008). Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelaue:
Results of a qualitative study. Scand J Caring Sci, 22, 430-436.
Benrud-Larson, L., Boling, C., Heinberg, L., Reed, J., White, B. & Wigley, E. (2003). Body image dissatisfaction among women with scleroderma: extent and relationship to
psychosocial functions. Health Psychology, 22, 130-139.
Borah, G., & Rankin, M. (2003). Perceived functional impact of abnormal facial appearance. Plastic and Reconstructive Surgery, 111(7), 2140-2146.
Botek, A., Girman, A., Light, J., Lookingbill, D., Martin, A., & Thiboutot, D. (2001). Health-related quality of life among patients with facial acne- assessment of a new acnespecific questionnaire. Clinical Dermatology, 26, 380-385.
Cho,H.S. Kim, K., Kim, J., Lee, S., Jung, S., & Seung, N. Quality of life of acne patients. (2006). Korean J Dermatol, 44(6), 688-685.
Del Rosso, J., La Riche, C., Ritvo, E., & Stillman, M. (2011). Psychosocial judgments and perceptions of adolescents with acne vulgaris: a blinded controlled comparison of
adult and peer evaluations. BioPsychoSocial Medicine, 5(11), 1-14.
Feldman, S., Kerchner, K., Krejci-Manwaring, J., Rapp, D., & Rapp, S. (2006). Social sensitivity and acne: the role of personality in negative social consequences and quality
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Finlay, A., Klassen, J., Mallon, E., Newton, I., Ryan, S., & Stewart-Brown, R. (1999). The quality of life in acne” a comparison with general medical conditions using generic
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Fortune, D., Giffiths, C., Main, C., & Richards, H. (2001). The contribution of perceptions of stigmatisation to disability in patients with psoriasis. Journal of Psychosomatic
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Ginsburg I.H., & Link B.G. (1989). Feelings of stigmatization in patients with psoriasis. J Am Acad Dermatol, 20, 53–63.
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Gupta, M. (2005). Psychiatric comorbidity in dermatological disorders. In L. Papadopoulos & C. Walker (Eds.), Psychodermatology: the psychological impact of
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Harcourt, D., & Rumsey, N. (2005). The psychology of appearance. UK: Open University Press.
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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), 377386.
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.
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Spence, R. (2008). The challenge of reconstruction for severe facial burn deformity. Plastic Surgical Nursing, 28(2), 71-76.
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Predictors of Quality of Life for Adults with
Acne: The Contribution of Perceived Stigma
Johanna K. Liasides, M.Sc., The American College of Greece
Fotini-Sonia Apergi, Psy.D., The American College of Greece
The Annual International Conference on
Cognitive - Social, and Behavioural Sciences
icCSBs 2015 January