Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders.

Autor:	Paller AS; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois., Rangel SM; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Chamlin SL; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois., Hajek A; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Phan S; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Hogeling M; Department of Medicine/Dermatology, University of California, Los Angeles., Castelo-Soccio L; Department of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Lara-Corrales I; Department of Pediatric Dermatology, The Hospital for Sick Children, Toronto, Ontario, Canada., Arkin L; Department of Pediatric Dermatology, University of Wisconsin School of Medicine and Public Health, Madison., Lawley LP; Department of Dermatology, Emory University, Atlanta, Georgia., Funk T; Department of Dermatology, Oregon Health & Science University, Portland, Oregon., Castro Porto Silva Lopes F; Department of Medicine/Dermatology, Dell Medical School, University of Texas at Austin., Antaya RJ; Department of Dermatology, Yale University, New Haven, Connecticut., Ramien ML; Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada., Vivar KL; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois., Teng J; Department of Dermatology, Stanford University School of Medicine, Stanford, California., Coughlin CC; Department of Medicine/Dermatology, Washington University School of Medicine in St Louis, St Louis, Missouri., Rehmus W; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada., Gupta D; Department of Pediatric Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle., Bercovitch L; Department of Pediatric Dermatology, Hasbro Children's Hospital, Brown University, Providence, Rhode Island., Stein SL; Departments of Medicine/Dermatology and Pediatrics, University of Chicago, Chicago, Illinois., Boull C; Department of Dermatology, University of Minnesota, Minneapolis., Tom WL; Department of Pediatric Dermatology, Rady's Children's Hospital, University of California, San Diego., Liang MG; Department of Pediatric Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Hunt R; Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston., Luu M; Department of Pediatric Dermatology, Children's Hospital Los Angeles, Los Angeles., Holland KE; Department of Pediatric Dermatology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee., Schoch JJ; Department of Pediatric Dermatology, University of Florida, Gainesville., Cella D; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Lai JS; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Griffith JW; Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	JAMA dermatology [JAMA Dermatol] 2024 Jun 01; Vol. 160 (6), pp. 621-630.
DOI:	10.1001/jamadermatol.2024.0594
Abstrakt:	Importance: Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study. Objective: To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. Design, Setting, and Participants: A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent. Main Outcomes and Measures: Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes). Results: The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = -0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = -0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety. Conclusions and Relevance: The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.
Databáze:	MEDLINE
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