Evaluating an anxiety scale and Personality traits in Atopic Dermatitis and its relation with severity markers

2013/2014 Luís Manuel Ferreira Pinto Evaluating an anxiety scale and Personality traits in Atopic Dermatitis and its relation with severity markers março, 2014 Mestrado Integrado em Medicina Área: Imunologia Trabalho efetuado sob a Orientação de: Doutora Maria Cristina Ramos Machado Lopes Abreu Trabalho organizado de acordo com as normas da revista: Australasian Journal of Dermatology Luís Manuel Ferreira Pinto Evaluating an anxiety scale and Personality traits in Atopic Dermatitis and its relation with severity markers março, 2014 A todos os que tornaram este sonho possível Tiago Magalhães President 8th YES Meeting Fábio Carneiro Vice-President 8th YES Meeting The organizing committe of the 8th YES Meeting hereby declares that LUIS MANUEL FERREIRA PINTO FACULTY OF MEDICINE, UNIVERSITY OF PORTO has participated in the Eighth YES - Young European Scientist - Meeting, from the 19th to the 22nd September 2013, held at CIM - Centro de Investigação Médica, FMUP - Faculdade de Medicina da Universidade do Porto, Portugal as a presenting student and presented the work: personality, anxiety, depression and atopiC dermatitis severity: a Cross seCtional study Luís Ferreira-Pinto (1) Cláudia Leite (1) Luís Delgado (1) André Moreira (1) Isabel Lourinho (1) Cristina Lopes (1) (2) 1 - Faculty of Medicine, University of Porto, Portugal 2- Allergy Unit, Hospital Pedro Hispano, Matosinhos, Portugal AD is a multifactorial, chronic and relapsing skin disease. characterized by intense pruritus, and eczematous lesions , BACKGROUND METHODS PERSONALITY, ANXIETY, DEPRESSION AND ATOPIC DERMATITIS SEVERITY A CROSS SECTIONAL STUDY AIM Evaluate the association between anxiety and depression levels, personality traits and disease severity in adult patients previously diagnosed with AD. CAPSULE SUMMAR Y A total of 31 patients (mean age of 29 yo), recruited from the community and allergy and dermatology outpatient settings were included. Anxiety and depression levels were evaluated through HADS –Hospital Anxiety and Depression Scale Personality traits were evaluated through NEO Five-Factor-Inventory. RESULTS CONCLUSION REFERENCES Schut, C., Weik, U., Tews, N. et al. (2013) Psychophysiological effects of stress management in patients with atopic dermatits: a randomized controlled trial, Acta Derm Venereol., 93 (1) : 57-61. Buggiani, G., Ricceri, F., Lotti, T. (2008) Atopic dermatitis, Dermatol Ther., 21 (2) : 96-100. Wittkowski, A., Richards, H.L., Griffiths, C.E., Main, C.J. (2004) The impact of psychological and clinical factors on quality of life in individuals with atopic dermatitis, J Psychosom Res., 57 (2) : 195-200. Severity of AD was assessed through SCORAD and patients’ quality of life through DLQI – Dermatolo gy Life Quality Index. Graph 1: Atopic Dermatitis severity (through SCORAD) Graph 2: Quality of Life (through DLQI) Mean Duration of Disease 19 years Atopy Undetermined 10% Yes 73% No 17% Asthma Yes 72% No 28% Table 1: Sample summary descriptive statistics Graph 3: Relation between duration of disease and DLQI Graph 4: Relation between duration of disease and SCORAD We evaluated Atopic Dermatitis severity and its relation with personality traits, anxiety and depression. Interestingly anxiety presented no significant association while depression and several personality traits were closely related to SCORAD and DLQI A linear regression model for Anxiety and Depression and its relation with SCORAD presented a p=0,34 for depression while anxiety presented no statistical association. In a linear model using personality traits, Extroversion and Agradability suggested na association with SCORAD (p=0,054 and p=0,063 respectively) Previous studies clearly stated a relation between Psoriasis or other imune-mediated diseases and several psychological factos; our study corroborates these findings concerning AD. While anxiety presented no association, depression showed an importante impact on severity of AD in our sample. Further studies are needed in order to establish a cause-effect relationship. Both extroversion and agradability suggested a relationship with AD severity. We expect this to become statistical significant by the time all the patients are fully evaluated. variables. Statistical analysis was performed using SPSS 21.0®. Significant differences were considered with p-values under 0.05. The study was approved by the local ethics committee. All participants provided their oral informed consent and were free to withdraw from the study if desired. RESULTS From the 69 invited patients, a total of 44 (64%) were included, mostly female (61%), mean age (SD) of 31 years (13), 7% were less than 18. The majority (73%) was atopic and slightly more than half (61%) had asthma. Most patients had moderate (41%) to severe (34%) AD, with 66% of them presenting the disease for more than 10 years. Most patients had a moderate (36%) or severe (32%) impact on QoL. (Table 1). Anxiety was present in 34% of patients (n=15), mostly mild (n=9). Only 14% of patients (n= 6) presented depression (five mild, one moderate). As for personality traits, most patients scored normal in all five dimensions. (Table 2). When comparing extraversion scores in patients scoring high or very high in neuroticism with those scoring low or very low, the first group presented lower extraversion scores (with only 43% of patients scoring high in extraversion vs 78% in the second group). SCORAD evaluation No significant differences were found between SCORAD concerning patient’s gender (p=0.275). Atopic status or asthma, (p=0.313 and p=0.9941 respectively) patients’ age (p=0.163) and disease duration (p=0.885). Anxiety, Depression and Personality traits Anxiety score presented no significant correlation with SCORAD (p = 0.331); however, a positive correlation between depression and SCORAD scores was suggested (p = 0.068, r = 0.28). Significant differences in SCORAD means were only found between groups with different scores in conscientiousness, with patients scoring ‘Normal’ presenting with a significantly higher value when comparing to patients scoring ‘High’ (post-Hoc Bonferroni correction; p=0.037). No significant differences were found between SCORAD means and neuroticism, extroversion, openness or agreeableness scores. Patients scoring low in Extraversion presented a higher SCORAD mean when compared to those scoring normal or high (p=0.065) (table 3). Multiple linear regression model for QoL Considering QoL, SCORAD was the main determinant for QoL (p = 0.002) with an adjusted R2 of 0.185. Disease duration was also an important determiner of QoL (p = 0.098) and, along with SCORAD, an adjusted R2 of 0.220 was achieved. Anxiety, depression and personality traits presented no significant association with QoL. DISCUSSION We found that patients scoring higher in HADS-D apparently had a higher scores in SCORAD. No study, so far, has succeeded in presenting a relation between a more severe disease and higher levels of depression. While anxiety levels were clearly higher in AD patients when comparing to healthy controls in previous studies 22, no study had yet proved any relation with AD severity. Similarly, our results suggested that anxiety levels may not differ concerning disease severity. Our study presented a prevalence of anxiety and depression of 34% and 14% respectively. When comparing with previously published results of the Portuguese population’s scores, AD patients presented higher mean scores in both anxiety and depression than healthy individuals 18. In fact, when evaluating patients scoring moderate or severe in HADS-A and HADS-D, AD patients presented similar scores to epileptic patients (13% vs 14% for anxiety and 2% vs 7% for depression). When comparing our sample of Portuguese AD patients with AD patients from Germany 23 and United Kingdom 24 our sample scored lower in both anxiety and depression. Nevertheless those differences may had occurred due to different selection criteria (free-will vs paid participation) as well as cultural differences (baseline anxiety and depression values may vary according to different cultures). When assessing possible variables that could be directly influencing the severity of AD, neither age, duration of the disease, patient’s gender, asthma or atopic status presented a significant correlation with SCORAD. This may be explained by the fact that personal experience of disease may be independent from individuals’ genetic features and most likely be influenced by psychological traits and life events. Regarding personality traits, little is known about their influence in disease severity. No study has yet been published comparing the 5-main domains of personality assessed by NEO-FFI and their relation with AD severity. Our results suggest that Conscientiousness may be an important determiner in disease severity, exerting a protector effect. This can be explained by the fact that the trait of conscientiousness describes an individual’s tendency to adhere to socially prescribed rules and norms for impulse control, to being task and goal-directed. This personal abilities may gain significant importance when dealing with a chronic and relapsing disease such as AD. As well, patients scoring low in extraversion tended to have higher SCORAD mean values: these patients also presented higher scores in Neuroticism, a negative emotional personality trait determining a risk profile for anxiety and depression. However, future studies with more participants are required in order to fully evaluate personality and establishing a personality profile that can be either protective or deleterious to AD severity. Since recruitment of participants was mainly held through advertisement in media, a selection bias may have occurred. In fact, in what personality traits are concerned, patients presenting higher levels of extroversion and openness to experience were more likely to be enrolled. Also, our sample included mainly patients with long-term disease; hereby, even though disease duration presented no correlation with SCORAD, it may have influenced anxiety and depression levels due to AD. The psychological characterization of AD patients not only concerning psychological stress but also personality traits must be considered in AD management. Psychotherapeutic interventions may be considered an important therapeutic strategy to achieve disease control Table 1 - Sample descriptive statistics (n = 44) Age (years) a 31 (13) Male b 17 (39) Female b 27 (61) Disease duration c 18 (2; 40) AD Severity b Mild 11 (25) Moderate 18 (41) Severe 15 (34) Atopic status b Atopic patients 32 (73) Non-atopic patients 12 (27) Asthma status b Asthmatic patients 27 (61) Non-asthmatic patients 17 (39) DLQI b No impact 2 (5) Mild impact 11 (25) Moderate impact 16 (36) Severe impact 14 (32) Extremely severe impact 1 (2) Anxiety b Normal 29 (66) Mild 9 (21) Moderate 5 (11) Severe 1 (2) Depression c Normal 38 (86) Mild 5 (11) Moderate 1 (2) a Mean (SD) b N (%) c Median (min, max) DLQI – Dermatology Life Quality Index Table 2 - Distribution of scores in the 5-main personality domains of NEO-FFI (n = 44) Very Low Low Normal High Very High Neuroticism 2 (5) 7 (16) 21 (48) 9 (21) 5 (11) Extroversion 1 (2) 1 (2) 18 (41) 14 (32) 10 (23) Openness 0 (0) 3 (7) 25 (57) 12 (27) 4 (9) Agreeableness 4 (9) 9 (21) 24 (55) 6 (14) 1 (2) Conscientiousness 1 (2) 11 (25) 20 (46) 11 (25) 1 (2) Values shown are N (%) Table 3 - One-way ANOVA comparing mean SCORAD values in each category of the 5-main domains of personality traits SCORAD mean p-value Neuroticism Low 47 0.960 Normal 45 High 44 Extraversion Low 83 0.065 Normal 37 High 47 Openness Low 42 0.722 Normal 48 High 41 Agreeableness Low 55 0.186 Normal 38 High 48 Conscientiousness Low 41 0.035 Normal 56 High 31 p-value was obtained through a one-way ANOVA test patients scoring very low and low or very high and high were grouped into low and high respectively REFERENCES 1. 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