CLINICAL REPORT
89 ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Psychological Health Status and Health-related Quality of Life in Adults with Atopic Dermatitis: A Nationwide Cross-sectional Study in South Korea
Sul Hee LEE 1, Si Hyung LEE 2, Sung Yul LEE 3, Bora LEE 4, Sang-Hoon LEE 1 and Young Lip PARK 1
1
Department of Dermatology, 2 Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Bucheon, 3 Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, and 4 Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
Atopic dermatitis( AD) is a chronic inflammatory skin disorder. Patients with AD often experience psychological distress and poor health-related quality of life( HRQoL). The aim of this study was to investigate the association of several psychological health statuses and poor HRQoL in an adult population with AD in South Korea. A total of 37,578 adults who participated in the Korean National Health and Nutrition Examination Survey, a nationwide, population-based, crosssectional health survey between 2008 and 2013 were included. HRQoL was assessed by EuroQoL( EQ) 5-dimension questionnaire and EQ-visual analogue scale scores. Multiple logistic regression analysis was performed to identify the association of stress, sleep duration, depressive mood, depression, suicidal ideation, and HRQoL with AD relative to matched controls. After adjusting in patients with AD confounding factors, stress, depressive mood, depression, suicidal ideation and poor HRQoL were significantly associated with AD. Dermatologists should be concerned with improving HRQoL and managing the psychological health status of adult patients with AD.
Key words: atopic dermatitis; health-related quality of life; psychological health status.
Accepted Sep 13, 2017; Epub ahead of print Sep 13, 2017 Acta Derm Venereol 2018; 98: 89 – 97.
Corr: Young Lip Park, Department of Dermatology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Republic of Korea. E-mail: ylpark @ schmc. ac. kr
Atopic dermatitis( AD) is a chronic inflammatory skin disorder characterized by recurrent pruritic eczematous lesions, which are often associated with other atopic manifestations such as asthma and rhinitis( 1, 2). There is worldwide geographical variability in the prevalence of AD, with an incidence ranging from 1 % to 20 %( 3). Although it appeared to plateau at 10 – 20 % in many developed countries, the incidence continues to increase in many developing countries( 2). The prevalence of AD in adults is reportedly approximately 10 % according to United States( US) population-based studies( 4), and ranges from 1.8 % to 4.6 % according to several Asian population-based studies( 5 – 8). With an increasing prevalence in developing countries, and as one of the most common chronic diseases in developed countries, AD is currently considered a global public health concern.
However, the burden of patients with skin problems has been underestimated because dermatological diseases are usually non-fatal and thus are considered of low importance compared with other, life-threatening diseases. Even in clinics, dermatologists treating patients with AD tend to focus on improving the skin condition itself and often overlook patients’ quality of life( QoL) and other psychological concerns. Although AD is not lifethreatening, it is closely related to patients’ QoL because of the irritating and disfiguring nature of the disease. In fact, skin diseases were recently demonstrated to be the fourth-most burdensome non-fatal disease according to the Global Burden of Disease Study( 9). The burden includes the tremendous social and economic costs related not only to the direct cost of treatment, but also to indirect costs, such as loss of employment and productivity, and substantially reduces the health-related QoL( HRQoL) of patients with AD( 10 – 12).
Recently, many researchers have focused on the psychological health status and HRQoL of patients with dermatological diseases; these factors have been highlighted worldwide( 9, 10, 13). In many cases, AD is known to accompany many other psychological problems including stress, sleep disturbance, depression, and suicidal ideation, which are, in turn, associated with patients’ HRQoL( 10, 12). Such negative impacts of AD on the psychological health and HRQoL of patients have been demonstrated previously( 10, 12, 14, 15).
However, there have been few comprehensive studies investigating the associations of AD with HRQoL and psychological comorbidities using population-based study designs( 8, 16, 17). In addition, previous studies have mostly included paediatric and adolescent AD patients, whereas studies focusing on adult populations have been less common( 16, 18).
The aim of this study was to investigate whether various psychological health statuses, including depression, anxiety, sleep disturbance, and suicidal ideation, are associated with AD in an adult Korean population using a population-based design. In addition, the study explored the association between AD and HRQoL using the EuroQoL 5-dimension questionnaire( EQ-5D), currently the
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2797 Acta Derm Venereol 2018; 98: 89 – 97