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