Florence Dalgard

The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants––3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67–3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68–2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33–2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.

Epidemiology of itch: adding to the burden of skin morbidity.

Itch is the most frequent symptom in dermatology and has been researched more extensively in recent years. Nevertheless, there are few true epidemiological studies on itch. The aim of this paper is to review the current state of research on the epidemiology of chronic itch in Western and non-Western populations. The electronic databases PubMed, Medline and the Cochrane Library were searched. Conference proceedings and national and international studies were included. It is difficult to compare existing studies due to differing methodology and lack of standardized measures. The symptom of itch is a challenge, not only to clinicians, but also within the structure of regional health systems, and with regards to accessibility to specialized medical doctors in non-Western countries. Published studies show that the symptom of itch is highly prevalent; it should therefore receive adequate attention from physicians and other healthcare providers, including healthcare planners.

Self‐reported skin morbidity in Oslo. Associations with sociodemographic factors among adults in a cross‐sectional study

Background  Previous studies on prevalence of skin diseases in the population have been based on clinical examination of a sample of the population. A questionnaire on self‐reported skin complaints has recently been developed and validated for use in population surveys, but has not been used until now.

Smokers Report More Psoriasis, but Not Atopic Dermatitis or Hand Eczema: Results from a Norwegian Population Survey among Adults

Background: Many reports indicate that skin diseases are affected by lifestyle factors. Objective: To examine the relationship between reported skin diagnoses, smoking and alcohol consumption in an urban population. Methods: Cross-sectional questionnaire-based health study among 18,747 adults in Oslo. Results: For current smokers, odds ratio for reporting psoriasis was 1.49 (95% CI 1.11–2.00) for males, and 1.48 (95% CI 1.15–1.91) for females, as compared to never smokers. There was no association between reported atopic dermatitis or hand eczema and smoking. High consumption of cigarettes was associated with an increased reporting of psoriasis in men, but not women. Reporting drinking alcohol 4–7 times per week was crudely associated with reporting psoriasis in men, but not in the adjusted model. Conclusion: Cigarette smoking was associated with reported psoriasis, but not with atopic dermatitis or hand eczema.

Self‐reported skin complaints: validation of a questionnaire for population surveys

Background  Estimation of skin diseases in the community is challenging because we do not easily have access to the nonhealthcare‐seeking population. A potential tool is a questionnaire asking for self‐reported skin complaints. Such an instrument has not yet been developed.

Self-reported skin morbidity and mental health. A population survey among adults in a Norwegian city.

Background  Several studies among dermatological patients have shown a link between various chronic dermatological diseases and mental morbidity.

Do mental health and behavioural problems of early menarche persist into late adolescence? A three year follow-up study among adolescent girls in Oslo, Norway.

Early menarche has been linked to mental health and behavioural problems in several studies. Most of these studies are cross-sectional, the data gathered during puberty. Thus, there is a lack of research on the long-term effect of early menarche on mental health. The main aim of this study was to explore whether the differences in mental health problems between girls with early and late menarche persist into late adolescence. The data consisted of responses from a large school-based survey of all 10th grade girls (15 years of age) in Oslo, Norway. Of the 1860 participating girls in the 2001 survey, 1377 were included in the three year follow-up study in 2004, giving a response rate of 74%. Mental distress was measured with the Hopkins Symptom Check list 10-version. Additional items assessed were number of sexual partners, weight and body satisfaction. All information was self-reported, including age of menarche. We found a clear gradient in the cross sectional analyses at baseline of higher odds for mental distress at lower age of menarche even after adjustment for socio demographic and other factors. In the analysis of the follow-up data there was no statistically significant difference in mental distress across age of menarche, even though the differences in body and weight satisfaction and average body mass index remained at the same level between baseline and follow-up. We therefore conclude that the effects of age of menarche on mental health problems are a transitory problem during puberty.

Itch and mental distress: a cross-sectional study among late adolescents.

Itch is known to be associated with psychological factors in adults, but has not been explored among adolescents. A cross-sectional, questionnaire-based population study involving adolescents born mostly in 1986 was carried out in 2004. A total of 4744 individuals were invited and the participation rate was 80%. The Hopkins Symptom Checklist-10 was used to measure mental distress. The prevalence of itch was 8.8%. Itch was associated with mental distress, gender, socio-demographic factors, asthma, rhinoconjunctivitis and eczema. In a logistic regression model adjusting for possible confounders (including eczema), an association between itch and mental distress was found (odds ratio=3.1). In a subgroup analysis of those without eczema, the association was stronger. When the severity of itch increased, in both genders mental distress also increased. Mental distress and eczema are the variables in the study that contributes most to the distribution of itch at population level among adolescents in Oslo, Norway.

Self reported skin morbidity and ethnicity: a population-based study in a Western community

BackgroundRecent studies have shown ethnic differences concerning cardio-vascular disease, diabetes and mental health. Little is known about ethnic differences in skin morbidity. The purpose of this study was to describe possible ethnic differences in self-reported skin morbidity in a Western urban community.MethodsThe design was cross sectional. 40 888 adults in Oslo, Norway, received a postal questionnaire providing information on socio-demographic factors and self-reported health, including items on skin complaints.Results18770 individuals answered the questionnaire. In the sample 84% were from Norway. The largest immigrant group was from Western countries (5%) and the Indian Subcontinent (3%). Itch was the most prevalent reported skin symptom (7%), and was significantly more reported by men from East Asia (18%) and Middle East/North Africa (13%). The same observations were seen for reported dry and sore skin. Hair loss was a dominating complaint for men from the Indian Subcontinent and the Middle East/North Africa (23% and 25%) and for women from the same ethnic groups. Women from Sub-Saharan Africa reported significantly more pimples than in the other groups (17%).ConclusionThe study showed that there were significant differences in self-reported skin complaints among ethnic groups. Issues concerning the cultural value of some skin symptoms should be examined further.

Are Itch and Chronic Pain Associated in Adults? Results of a Large Population Survey in Norway

Background: Few large-scale epidemiological studies have been performed on the prevalence of itch. Itch and pain are common and complex symptoms which contribute to the burden of disease. Although there is antagonistic interaction between itch and pain, there are also many similarities in their pathophysiology. Objective: To investigate possible associations between chronic itch and chronic pain in a large population. Methods: The design was cross-sectional. 18,770 adults completed a self-administered questionnaire addressing sociodemographic factors, psychosocial factors and self-reported health including chronic itch and chronic pain. Results: Individuals reporting pain and itch were more likely to be women (80 and 60%, respectively, compared to 55% in the total sample), had a lower income (49 and 37% compared to 32%), were more likely to be depressed (36 and 20% compared to 11%) and reported poorer well-being (74 and 34% compared to 25%). In an adjusted logistic regression, chronic pain was strongly associated with chronic itch (OR = 1.79, 95% CI = 1.43–2.24). Conclusion: This study demonstrates the association of chronic itch and chronic pain and points out the need of further studies that focus on both symptoms in dermatological diseases.