Association Between Poorer Quality of Life and Psychiatric Morbidity in
Patients With Different Dermatological Conditions
, BD, MPH, A
, MD, M
, MD, C. F
, MD, MPH, C
, MD, MPH
To determine the relationship between skin-related quality of life and psychiatric morbidity in patients with different
We recruited all adults attending the outpatient clinics of the Dermatological Institute IDI-IRCCS,
Rome, Italy, during 14 predetermined days. Eligible patients, who gave their informed consent, completed the Skindex-29 and the
12-item General Health Questionnaire (GHQ-12). We used a stringent cut-off threshold (
5 on the GHQ-12) for identification of
psychiatric morbidity. Skindex-29 scale scores were computed separately for GHQ noncases and GHQ cases.
of 2,136 patients were included in the analysis. For all skin conditions, GHQ cases had substantially poorer score in all 3 domains of
quality of life, Symptoms, Emotions, and Functioning. Most differences remained significant after adjusting for clinical severity, age, sex,
and education in multiple regression models. These differences were not as marked in the Symptoms scale for some conditions known
to be nearly asymptomatic (eg, alopecia, vitiligo, nevi), suggesting that, although patients with psychiatric morbidity might be more
burdened by their symptoms, nevertheless they do not perceive nonexistent symptoms.
In most skin conditions we
considered, psychiatric morbidity was strongly associated with poorer quality of life. Although the cross-sectional nature of our study does
not allow identification of the direction of this association, care for the psychological condition of patients might have an impact on their
quality of life.
quality of life, psychiatric morbidity, dermatology, Skindex-29, GHQ-12.
12-item General Health Questionnaire.
any studies pointed out complex, mutual relationships
between psyche and skin. There is extensive literature
on the relationship between emotional stress and skin diseases
(1). Furthermore, dermatologists commonly think that psychi-
atric disorders are frequent in their patients (2), and several
studies confirm this opinion (3–7). In addition to any causal
mechanism linking psychiatric morbidity and dermatological
diseases, it is important to consider the consequences of the
interrelation between these two conditions. For example, psy-
chiatric morbidity is associated with increased subjective per-
ception of pruritus (8), is higher among patients whose skin
condition does not improve with treatment (9), and may affect