Anxiety and depression in patients with chronic dermatologic diseases in Jordan: a cross-sectional study
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20261095Keywords:
Skin disease, Anxiety, Depression, Quality of life, Jordan, PsychodermatologyAbstract
Background: Skin diseases can deeply affect patients’ mental health and social well-being, often more than what clinical assessments suggest. In the Middle East, data on the psychological burden of these conditions remain limited. This study aimed to evaluate anxiety and depression levels among Jordanian patients with common dermatologic conditions and explore their relationship with disease severity.
Methods: A total of 100 patients diagnosed with psoriasis, atopic dermatitis, acne vulgaris, rosacea, and alopecia areata were recruited, with 20 patients representing each condition. Disease severity was assessed using standardized scoring tools, including psoriasis area and severity index (PASI), scoring atopic dermatitis (SCORAD), global acne grading system (GAGS), clinician erythema assessment (CEA), and severity of alopecia tool (SALT). Psychological status was evaluated using the hospital anxiety and depression scale (HADS).
Results: Psychological symptoms were prevalent across all dermatologic conditions. Patients with mild acne and rosacea demonstrated the highest anxiety scores, while those with severe alopecia areata experienced the highest levels of depression. No direct correlation was observed between disease severity and psychological distress.
Conclusions: Chronic dermatologic conditions may be associated with significant psychological distress regardless of their clinical severity. These findings highlight the importance of incorporating mental health assessment into routine dermatologic care.
Metrics
References
Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. Am J Clin Dermatol. 2003;4(12):833-42. DOI: https://doi.org/10.2165/00128071-200304120-00003
Dalgard F, Gieler U, Holm JØ, 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. DOI: https://doi.org/10.1016/j.jaad.2008.07.013
Arck PC, Slominski A, Theoharides TC, Peters EM, Paus R. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126(8):1697-704. DOI: https://doi.org/10.1038/sj.jid.5700104
Lönndahl L, Abdelhadi S, Holst M, Lonne-Rahm SB, Nordlind K, Johansson B. Psychological Stress and Atopic Dermatitis: A Focus Group Study. Ann Dermatol. 2023;35(5):342-7. DOI: https://doi.org/10.5021/ad.22.035
Slominski A, Wortsman J. Neuroendocrinology of the skin. Endocr Rev. 2000;21(5):457-87. DOI: https://doi.org/10.1210/er.21.5.457
Misery L, Finlay AY, Martin N, Boussetta S, Nguyen C, Myon E, et al. Atopic dermatitis: impact on the quality of life of patients and their partners. Dermatology. 2007;215(2):123-9. DOI: https://doi.org/10.1159/000104263
Picardi A, Abeni D, Melchi CF, Puddu P, Pasquini P. Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol. 2000;143(5):983-91. DOI: https://doi.org/10.1046/j.1365-2133.2000.03831.x
Fredriksson T, Pettersson U. Severe psoriasis--oral therapy with a new retinoid. Dermatologica. 1978;157(4):238-44. DOI: https://doi.org/10.1159/000250839
Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1):23-31. DOI: https://doi.org/10.1159/000247298
Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol. 1997;36(6):416-8. DOI: https://doi.org/10.1046/j.1365-4362.1997.00099.x
Stein L, Kircik L, Fowler J, Tan J, Draelos Z, Fleischer A, et al. Efficacy and safety of ivermectin 1% cream in treatment of papulopustular rosacea: results of two randomized, double-blind, vehicle-controlled pivotal studies. J Drugs Dermatol. 2014;13(3):316-23.
Olsen EA, Hordinsky MK, Price VH, Roberts JL, Shapiro J, Canfield D, et al. Alopecia areata investigational assessment guidelines--Part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51(3):440-7. DOI: https://doi.org/10.1016/j.jaad.2003.09.032
Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527-34. DOI: https://doi.org/10.1038/jid.2013.446
Almaaita TJ, Abdallat SA. Prevalence of skin diseases in Jordanian children. Rawal Med J. 2012;37(4):374-6.
Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135(4):984-91. DOI: https://doi.org/10.1038/jid.2014.530
Al-Refu K. Vitiligo in children: a clinical-epidemiologic study in Jordan. Pediatr Dermatol. 2012;29(1):114-5. DOI: https://doi.org/10.1111/j.1525-1470.2011.01478.x
Jafferany M. Psychodermatology: a guide to understanding common psychocutaneous disorders. Prim Care Companion J Clin Psychiatry. 2007;9(3):203-13. DOI: https://doi.org/10.4088/PCC.v09n0306
Kimball AB, Jacobson C, Weiss S, Vreeland MG, Wu Y. The psychosocial burden of psoriasis. Am J Clin Dermatol. 2005;6(6):383-92. DOI: https://doi.org/10.2165/00128071-200506060-00005
Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The Burden of Atopic Dermatitis: Summary of a Report for the National Eczema Association. J Invest Dermatol. 2017;137(1):26-30. DOI: https://doi.org/10.1016/j.jid.2016.07.012
Dreno B, Poli F. Epidemiology of acne. Dermatology. 2003;206(1):7-10. DOI: https://doi.org/10.1159/000067817
Powell FC. Clinical practice. Rosacea. N Engl J Med. 2005;352(8):793-803. DOI: https://doi.org/10.1056/NEJMcp042829
Al-Mutairi N, Eldin ON. Clinical profile and impact on quality of life: Seven years experience with patients of alopecia areata. Indian J Dermatol Venereol Leprol. 2011;77:489-93. DOI: https://doi.org/10.4103/0378-6323.82411
Fleming P, Bai JW, Pratt M, Sibbald C, Lynde C, Gulliver WP. The prevalence of anxiety in patients with psoriasis: a systematic review of observational studies and clinical trials. J Eur Acad Dermatol Venereol. 2017;31(5):798-807. DOI: https://doi.org/10.1111/jdv.13891
Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010;146(8):891-5. DOI: https://doi.org/10.1001/archdermatol.2010.186
Sampogna F, Tabolli S, Abeni D; IDI Multipurpose Psoriasis Research on Vital Experiences (IMPROVE) investigators. Living with psoriasis: prevalence of shame, anger, worry, and problems in daily activities and social life. Acta Derm Venereol. 2012;92(3):299-303. DOI: https://doi.org/10.2340/00015555-1273
Richards HL, Fortune DG, Griffiths CE, Main CJ. The contribution of perceptions of stigmatisation to disability in patients with psoriasis. J Psychosom Res. 2001;50(1):11-5. DOI: https://doi.org/10.1016/S0022-3999(00)00210-5
Rieder E, Tausk F. Psoriasis, a model of dermatologic psychosomatic disease: psychiatric implications and treatments. Int J Dermatol. 2012;51(1):12-26. DOI: https://doi.org/10.1111/j.1365-4632.2011.05071.x
Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019;80(4):1073-113. DOI: https://doi.org/10.1016/j.jaad.2018.11.058
Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41(3 Pt 1):401-7. DOI: https://doi.org/10.1016/S0190-9622(99)70112-X
Silverberg JI. Public Health Burden and Epidemiology of Atopic Dermatitis. Dermatol Clin. 2017;35(3):283-9. DOI: https://doi.org/10.1016/j.det.2017.02.002
Misery L, Seneschal J, Corgibet F, Halioua B, Marquié A, Merhand S, et al. Impact of Atopic Dermatitis on Patients and their Partners. Acta Derm Venereol. 2023;103:adv5285. DOI: https://doi.org/10.2340/actadv.v103.5285
Chamlin SL, Chren MM. Quality-of-life outcomes and measurement in childhood atopic dermatitis. Immunol Allergy Clin North Am. 2010;30(3):281-8. DOI: https://doi.org/10.1016/j.iac.2010.05.004
Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract. 2006;60(8):984-92. DOI: https://doi.org/10.1111/j.1742-1241.2006.01047.x
Marron SE, Cebrian-Rodriguez J, Alcalde-Herrero VM, Garcia-Latasa de Aranibar FJ, Tomas-Aragones L. Psychosocial Impact of Atopic Dermatitis in Adults: A Qualitative Study. Actas Dermosifiliogr (Engl Ed). 2020;111(6):513-7. DOI: https://doi.org/10.1016/j.adengl.2019.03.030
Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-32. DOI: https://doi.org/10.1016/j.jaad.2014.03.023
WHO. Global report on atopic dermatitis: burden, care, and future outlook. World Health Organization. 2022. Available at: https://www.who.int/publications/i/item/9789241565653. Accessed on 22 February 2025.
Tan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(1):3-12. DOI: https://doi.org/10.1111/bjd.13462
Tasoula E, Gregoriou S, Chalikias J, Lazarou D, Danopoulou I, Katsambas A, et al. The impact of acne 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. DOI: https://doi.org/10.1590/S0365-05962012000600007
Krowchuk DP. Managing acne in adolescents. Pediatr Clin North Am. 2000;47(4):841-57. DOI: https://doi.org/10.1016/S0031-3955(05)70243-1
Thomas DR. Psychosocial effects of acne. J Cutan Med Surg. 2004;8(4):3-5. DOI: https://doi.org/10.1007/s10227-004-0752-x
Rohan J. Acne vulgaris: psychosocial impact in adolescents. Med Sci Ukr. 2021;17:4. DOI: https://doi.org/10.32345/2664-4738.4.2021.13
Layton A, Eady EA, Peat M, Whitehouse H, Levell N, Ridd M, et al. Identifying acne treatment uncertainties via a James Lind Alliance Priority Setting Partnership. BMJ Open. 2015;5(7):e008085. DOI: https://doi.org/10.1136/bmjopen-2015-008085
Two AM, Wu W, Gallo RL, Hata TR. Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 2015;72(5):749-58. DOI: https://doi.org/10.1016/j.jaad.2014.08.028
Elewski BE, Draelos Z, Dreno B, Picardo M. Rosacea-global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group. J Eur Acad Dermatol Venereol. 2011;25(2):188-200. DOI: https://doi.org/10.1111/j.1468-3083.2010.03751.x
Huynh TT. Burden of Disease: The Psychosocial Impact of Rosacea on a Patient's Quality of Life. Am Health Drug Benefits. 2013;6(6):348-54.
Bewley A, Fowler J, Schöfer H, Kerrouche N, Rives V. Erythema of Rosacea Impairs Health-Related Quality of Life: Results of a Meta-analysis. Dermatol Ther (Heidelb). 2016;6(2):237-47. DOI: https://doi.org/10.1007/s13555-016-0106-9
van Zuuren EJ. Rosacea. N Engl J Med. 2017;377(18):1754-64. DOI: https://doi.org/10.1056/NEJMcp1506630
Gallo RL, Granstein RD, Kang S, Mannis M, Steinhoff M, Tan J, et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-55. DOI: https://doi.org/10.1016/j.jaad.2017.08.037
Abedini R, Hallaji Z, Lajevardi V, Nasimi M, Karimi Khaledi M, Tohidinik HR. Quality of life in mild and severe alopecia areata patients. Int J Womens Dermatol. 2017;4(2):91-4. DOI: https://doi.org/10.1016/j.ijwd.2017.07.001
Sharma A, Kumari S, Sharma AK, Ankita, Mishra R, Sharma B. Insight into alopecia: a narrative review of prevalence, pathogenesis and psychological consequences. Pharm Sci Anal Res J. 2025;7:3. DOI: https://doi.org/10.63235/PSARJ.180129
Muntyanu A, Gabrielli S, Donovan J, Gooderham M, Guenther L, Hanna S, et al. The burden of alopecia areata: A scoping review focusing on quality of life, mental health and work productivity. J Eur Acad Dermatol Venereol. 2023. DOI: https://doi.org/10.1111/jdv.18926
Huang KP, Mullangi S, Guo Y, Qureshi AA. Autoimmune, psychiatric, and medical comorbidities associated with alopecia areata in the United States. JAMA Dermatol. 2013;149(7):789-94. DOI: https://doi.org/10.1001/jamadermatol.2013.3049
Williamson D, Gonzalez M, Finlay AY. The effect of hair loss on quality of life. J Eur Acad Dermatol Venereol. 2001;15(2):137-9. DOI: https://doi.org/10.1046/j.1468-3083.2001.00229.x