Cross-sectional study of perceived stress, self-esteem, body image disturbance and suicidal ideation in patients of acne vulgaris


  • Geetanjali S. Ghorpade Department of Psychiatry, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
  • Kranti S. Kadam Department of Psychiatry, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
  • Amey Y. Angane Department of Psychiatry, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
  • Vishnu B. Unnithan Department of Psychiatry, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India



Acne vulgaris, Perceived stress, Self-esteem, Body image disturbance, Suicidal ideation


Background: Acne vulgaris is characterized by chronic inflammation of the pilosebaceous units. It has been strongly associated with social impairment among adolescents. The study aims to assess the level of perceived stress, self-esteem, body image disturbance and suicidal ideation in patients of acne vulgaris; uncover any underlying association or correlation between these and the severity of acne vulgaris and further examine the association and co-relation of body image disturbance with perceived stress and self-esteem.

Methods: Cross-sectional observational study of 72 patients with acne vulgaris was undertaken by purposive sampling technique. After taking informed consent, subjects were assessed on perceived stress scale-10, Rosenberg’s self-esteem scale, appearance anxiety inventory and Columbia-suicide severity rating scale. Spearman's correlation coefficient helped to examine the correlations.

Results: 31.94% patients had severe acne, 72.22% of patients had high body image disturbance. More than half the patients of acne had high level of perceived stress. Almost three quarters of the patients had low self-esteem. 5.55% patients had suicidal ideation. No significant association was seen between severity of acne with perceived stress, self-esteem, body image disturbance and suicidal ideation. Body image disturbance was significantly associated with perceived stress and self-esteem. A positive correlation between body image disturbance and perceived stress and a negative correlation between body image disturbance and self-esteem was obtained.

Conclusions: All patients, irrespective of the objective severity of acne, can experience high perceived stress and low self-esteem along with body image disturbances. This warrants consultant liaison between dermatologists and psychiatrists in routine practice for psychosocial intervention.


Do JE, Cho SM, In SI, Lim KY, Lee S, Lee ES. Psychosocial aspects of acne vulgaris: A community-based study with Korean adolescents. Ann Dermatol. 2009;21:125-9.

Adityan B, Kumari R, Thappa DM. Scoring systems in acne vulgaris. Indian J Dermatol Venereol Leprol. 2009;75:323-6.

Knowchuck RP. Managing acne in adolescents. Pediatr Clin N Am. 2000;47:841-57

Halvorsen JA, Stern RS, Dalgard F, Thoresen M, Bjertness E, Lien L. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: A population-based study. J Invest Dermatol. 2011;131:363-70.

Lowe JG. The stigma of acne. Br J Hosp Med. 1993;49:809-12.

Cash T, Phillips K, Santos M, Hrabosky J. Measuring “negative body image”: validation of the Body Image Disturbance Questionnaire in a nonclinical population. Body Image. 2004;1:363-72.

Dalgard FM, Gieler UM, Holm JO, Bjertness E, Hauser S. Self-esteem and body satisfaction among late adolescents with acne: results from a population survey. J Am Acad Dermatol. 2008;59(5):746-51.

Phillips KA, Dufresne RG. Body dysmorphic disorder: a guide for dermatologists and cosmetic surgeons. Am J Clin Dermatol. 2000;1:235-43

O’Carroll PW, Berman AL, Maris RW, Moscicki EK, Tanney BL, Silverman MM. Beyond the Tower of Babel: a nomenclature for suicidology. Suicide Life-Threat Behav. 1996;26:237-52.

Wichstrom L. Predictors of adolescent suicide attempts: a nationally representative longitudinal study of Norwegian adolescents. J Am Acad Child Adol Psych. 2000;39:603-10.

Sundström A, Alfredsson L, Sjölin-Forsberg G, Gerdén B, Bergman U, Jokinen J. Association of suicide attempts with acne and treatment with isotretinoin: Retrospective Swedish cohort study. BMJ. 2010;341:c5812.

Gupta MA, Gupta AK. Psychiatric and psychological comorbidity in patients with dermatologic disorders: epidemiology and management. Am J Clin Dermatol. 2003;4:833-42.

Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. 2003;139:897-900.

Zouboulis CC, Bohm M. Neuroendocrine regulation of sebocytes-a pathogenetic link between stress and acne. Exp Dermatol. 2004;13:31-5.

Dhabhar FS. Stress-induced augmentation of skin function: The role of stress hormones, leukocyte trafficking, and the augmentation of skin immune function. Ann N Y Acad Sci. 2003;992:205-17.

Garg A, Chren MM, Sands LP, Matsui MS, Marenus KD, Feingold KR et al. Psychological stress perturbs epidermal permeability barrier homeostasis: Implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137(1):53-9.

Koblenzer CS. Psycho dermatology of women. Clin Dermatol. 1997;15:127-41.

Hosthota A, Bondade S, Basavaraja V. Impact of Acne Vulgaris on Quality of Life and Self-Esteem. Cutis. 2016;98(2):121-4.

Saboo AV, Agarwal NA. Study of correlation between stress and acne vulgaris in young unmarried females. J Evid Based Med Healthc. 2019;6(6):345-7.

Tasoula E, Gregoriou S, Chalikias J, Lazarou D, Danopoulou I, Katsambas A et al. The impact of cne vulgaris on quality of life and psychic health in young adolescents in Greece: Results of a population survey. An Bras Dermatol. 2012;87(6):862-9.

Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6(6):121-7.

Angane AY, Kadam KS, Ghorpade GS, Unnithan VB. Unraveling the net of Self-Esteem, Stress and Coping Skills in the era of Internet Addiction. Ann Indian Psychiatry. 2020;4:70-5.

Sinclair SJ, Blais MA, Gansler DA, Sandberg E, Bistis K, Locicero A. Psychometric Properties of the Rosenberg Self-Esteem Scale: Overall and Across Demographic Groups Living Within the United States. Eval Health Prof. 2010;33(1):56-80.

Veale D, Eshkevari E, Kanakam N, Ellison N, Costa A, Werner T. The Appearance Anxiety Inventory: Validation of a Process Measure in the Treatment of Body Dysmorphic Disorder. Behav Cogn Psychother. 2014;42(5):605-16.

Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168:1266-77.

Golchai J, Khani SH, Heidarzadeh A, Eshkevari SS, Alizade N, Eftekhari H. Comparison of anxiety and depression in patients with acne vulgaris and healthy individuals. Indian J Dermatol. 2010;55:352-4.

Vilar GN, Santos LA, Sobral Filho JF. Quality of life, self-esteem and psychosocial factors in adolescents with acne vulgaris. An Bras Dermatol. 2015;90(5):622-9.

Ribas J, Oliveira CMPB. Acne vulgaris and well-being in medical students. An Bras Dermatol. 2008;83:520-5

Costa A, Alchorne MMA, Goldschmidt MCB. Etiopathogenic features of acne vulgaris. An. Bras. Dermatol. 2008;83:451-9.

Zari S, Alrahmani D. The Association Between Stress and Acne Among Female Medical Students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. 2017;10:503-6.

Bowe WP, Doyle AK, Crerand CE, Margolis DJ, Shalita AR. Body Image Disturbance in Patients with Acne Vulgaris. J Clin Aesthet Dermatol. 2011;4(7):35-41.

Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54(3):420-6

Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998;139:846-50.

Dunn LK, O'Neill JL, Feldman SR. Acne in adolescents: Quality of life, self-esteem, mood and psychological disorders. Dermatol Online J. 2011;17(1):1.

Evans, J. Straightforward Statistics for the Behavioral Sciences. Pacific Grove, California: Brooks/Cole Publishing. 1996: 600.






Original Research Articles