Helen L. Richards

Body Image Focus Groups with Boys and Men

In this exploratory study, boys and men (aged eight, thirteen, and sixteen years, and young adults) gave accounts of body shape ideals, body esteem, exercise, and diet in a series of focus groups. Men and boys in all groups presented discourses where being lean and muscular was linked to being healthy and fit. Being fat was related to weakness of will and lack of control by all age groups, and discourses of blame were used to describe those who were overweight. Sixteen-year-olds described peer pressure to be slender and muscular, and two young men had experienced teasing about their body size. Adult men and teenagers explicitly linked having a well-toned, muscular body with feelings of confidence and power in social situations. Data are discussed in relation to recent suggestions that Western cultural attitudes to the male body are in a state of change and that men are becoming more concerned with body image.

Patients with psoriasis and their compliance with medication

BACKGROUND Poor compliance with treatment advice in chronic conditions, such as psoriasis, represents a major challenge to health care professionals. Previous research suggests that the rate of noncompliance in chronic conditions may be as high as 40%. OBJECTIVE This study was designed to examine self-reported compliance in patients with psoriasis. METHODS We undertook an anonymous postal survey sent to consecutive patients with psoriasis attending a tertiary psoriasis specialty clinic. RESULTS Thirty-nine percent of participants reported that they did not comply with the treatment regimen recommended. The noncompliant group had a higher self-rated severity of psoriasis (t = -2.16, P =. 03), were younger (t = 3.28, P =.001), and had a younger age at onset (t = 2.35, P =.02) than those who were compliant. The noncompliant group reported that psoriasis had a greater impact on daily life (t = -2.23, P =.028), but general well-being was not significantly different from those who complied (t =.47, P = not significant). CONCLUSION Patients who reported intentional noncompliance with treatment advice were more likely to believe that both psoriasis and its treatment interfered with their quality of life but not overall well-being. The impact of treatment on daily life highlights the importance of joint decision making in planning treatment.

The contribution of perceptions of stigmatisation to disability in patients with psoriasis

OBJECTIVE The aim of the present study was to assess the significance of general and psoriasis specific psychological variables in patients with psoriasis and to examine the relative importance of disease status and these psychological variables in predicting psoriasis-related disability. METHOD A total of 115 patients with psoriasis underwent clinical assessment and completed a number of psychological and psoriasis specific questionnaires. RESULTS High levels of self-reported distress were identified with 43% and 10% of patients scoring as probable cases on the Hospital Anxiety and Depression Scale (HADS) subscales of anxiety (mean 9.3+/-4.9) and depression (mean 4.8+/-3.7), respectively. Multiple regression analysis indicated that clinical severity of psoriasis and anatomical area of involvement had no impact on psychological distress and disability. Perceptions of stigmatisation were significantly related to both psychological distress and degree of disability (Ps<.001) and accounted for a significant amount of the variance in disability over and above general psychological distress (F change=11.03; P<.001). CONCLUSION Psychological factors were much stronger determinants of disability in patients with psoriasis than disease severity, location or duration. This has important implications in relation to the clinical management of psoriasis.

A cognitive‐behavioural symptom management programme as an adjunct in psoriasis therapy

Summary Background Patients with psoriasis may experience significant psychological and social disabilities. Stress or distress are proposed aggravators of the disease process in psoriasis. Preliminary studies to date have suggested that adjunctive psychological therapies may be effective in the clinical management of psoriasis.

Adherence to treatment in patients with psoriasis

Non‐adherence to medication is a chronic problem that impacts on healthcare professionals and patients alike. In psoriasis, a condition that presents patients with frequent and disabling physical, psychological and social effects, studies consistently suggest that up to 40% of patients do not use their medication as directed. Thus it is probable that poor adherence contaminates the clinical picture of response effectiveness in everyday practice. This educational paper reviews research that investigates adherence to medication in patients with psoriasis. It provides an overview of contributing factors and mediating variables. It is proposed that three specific facets appear to optimize patient adherence: an effective doctor–patient relationship; optimism with the treatment prescribed; and a limited ‘nuisance’ value of treatment in terms of side‐effects and hassle of use. Various strategies to address adherence are suggested and it is argued that in order to enhance our understanding of adherence in patients with psoriasis, there needs to be an increasing focus on patients’ beliefs about their condition and its management.

The impact of psychological and clinical factors on quality of life in individuals with atopic dermatitis

OBJECTIVE The aim of the study was to assess the influence of general and dermatitis-specific psychological and clinical factors on quality of life in adults with atopic dermatitis (AD). METHOD A total of 125 adults recruited through the National Eczema Society of U.K. (NES) completed a number of psychological and dermatological questionnaires, including the Dermatology Life Quality Index (DLQI), the Stigmatisation and Eczema Questionnaire (SEQ), the Hospital Anxiety and Depression Scale (HADS), the Fear of Negative Evaluation Scale (FNE) and the Rosenberg Self-Esteem Scale (RSE). RESULTS Pearsons correlational analyses suggested that perceptions of stigma were significantly associated with psychological factors as well as quality of life (Ps<.01). An association was also found between perceived stigma and disease severity (-.28, P<.01). Almost 46% of participants were identified as having probable mood disorder. Regression analysis indicated that perceptions of stigma and depression accounted for 44.5% of the variance in quality of life in this sample [F(3,121)=34.18, P<.001], when disease severity was controlled for. CONCLUSION Psychological factors and disease severity were strong predictors of quality of life in adults with AD. AD-related perceptions of stigma were of particular importance in predicting AD-related quality of life over and above more general psychological factors, such as depression. These findings have important implications for the psychological and clinical management of AD.

Development of the PSORIQoL, a psoriasis-specific measure of quality of life designed for use in clinical practice and trials

Summary  Background Patients with psoriasis have significant impairment in their quality of life (QoL). Several patient‐completed instruments are available to measure outcome in dermatological conditions but these primarily focus on severity of disease rather than on QoL.

Psychological influences in psoriasis

It has long been recognized that living with a chronic condition, such as psoriasis, can have considerable impact on the individual concerned. In turn there is increased understanding that the psychological distress encountered as a result of this experience can have implications for the course of the disease. This short review takes this as a starting point and reviews psychological influences in psoriasis. The nature of the link between psoriasis and stress is explored and its implications for the patient are discussed in psychological and clinical terms. There seems little doubt that stress, either environmental or psoriasis induced, impacts on our patients and has important implications for the management of psoriasis.

Alcohol consumption and psychological distress in patients with psoriasis

Background  Psoriasis has been associated with excessive alcohol consumption and psychological distress.

Detection of psychological distress in patients with psoriasis: low consensus between dermatologist and patient.

Background  Researchers have indicated that 30–40% of patients with psoriasis suffer significant psychological distress. For the appropriate clinical management of the patient with psoriasis it is important that dermatologists are able to recognize this distress.