Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders

Amy S. Paller, Stephanie M. Rangel, Sarah L. Chamlin, Aleena Hajek, Sheshanna Phan, Marcia Hogeling, Leslie Castelo-Soccio, Irene Lara-Corrales, Lisa Arkin, Leslie P. Lawley, Tracy Funk, Fabiana Castro Porto Silva Lopes, Richard J. Antaya, Michele L. Ramien, Karina L. Vivar, Joyce Teng, Carrie C. Coughlin, Wingfield Rehmus, Deepti Gupta, Lionel BercovitchSarah L. Stein, Christina Boull, Wynnis L. Tom, Marilyn G. Liang, Raegan Hunt, Minnelly Luu, Kristen E. Holland, Jennifer J. Schoch, David Cella, Jin Shei Lai, James W. Griffith

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Importance: Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study. Objective: To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. Design, Setting, and Participants: A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent. Main Outcomes and Measures: Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes). Results: The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = -0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = -0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety. Conclusions and Relevance: The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.

Original languageEnglish (US)
Pages (from-to)621-630
Number of pages10
JournalJAMA Dermatology
Volume160
Issue number6
DOIs
StatePublished - Jun 19 2024

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© 2024 American Medical Association. All rights reserved.

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study

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