A mixed methods survey of social anxiety, anxiety, depression and wig use in alopecia

Abstract

ObjectivesThis study aimed to examine levels of social anxiety, anxiety and depression reported by people with alopecia as a result of a dermatological condition and associations with wig use. The study also sought to report on experiences of wearing wigs in social situations and the relationship with social confidence.DesignA cross-sectional survey was sent by email to the Alopecia UK charity mailing list and advertised on social media.ParticipantsInclusion criteria were a diagnosis of alopecia, aged 13 or above and sufficient English to complete the survey. Exclusion criteria included experiencing hair loss as a result of chemotherapy treatment or psychological disorder. Participants (n=338) were predominantly female (97.3%), Caucasian (93.5%) and aged between 35 and 54 years (49.4%) with a diagnosis of alopecia areata (82.6%).Main outcome measuresThe Social Phobia Inventory measured symptoms of social anxiety, and the Hospital Anxiety and Depression Scale was used to measure symptoms of anxiety and depression. Survey questions were designed to measure the use of wigs. Open-ended questions enabled participants to comment on their experiences of wearing wigs.ResultsClinically significant levels of social anxiety (47.5%), anxiety (35.5%) and depression (29%) were reported. Participants who reported worries about not wearing a wig reported significantly higher levels of depression: t(103)=3.40, p≤0.001; anxiety: t(109)=4.80, p≤0.001; and social anxiety: t(294)=3.89, p≤0.001. Wearing wigs was reported as increasing social confidence; however, the concealment it afforded was also reported as both reducing fear of negative evaluation and maintaining anxiety.DiscussionOverall, 46% of participants reported that wearing a wig had a positive impact on their everyday life with negative experiences related to fears of the wig being noticed. Psychological interventions alongside wig provision would be beneficial for people living with alopecia.

Living with alopecia areata: an online qualitative survey study

“…Although they were accurately identified by others as having a disease, participants nonetheless felt unentitled to the sympathy offered, or to their own distressing feelings, because AA is a disease of ‘just hair’ unlike the ‘life‐threatening’ cancer so frequently assumed by sympathizers. As found in previous studies, the use of wigs and other products to camouflage hair loss often exacerbated feelings of inauthenticity, leading to anxiety that this ‘fraud’ (e.g. P77, female) would be exposed.…”

“…It has been suggested that good social support may help to ameliorate the psychological impact of AA, but this can be difficult to access as AA is associated with impaired social functioning, and unsupportive responses from doctors have been reported . Wigs and make‐up are commonly used to conceal hair loss, but the psychological effects of such practices are complex; masking of hair loss can increase self‐confidence but concerns about wigs being noticed or coming off can simultaneously increase anxiety, create feelings of inauthenticity and affect interactions with others, leading to avoidance of social activities . Therefore, the social context may be significant in understanding both distress and coping in people with AA.…”

The psychological and aesthetic impact of age‐related hair changes in females

“…It has been suggested that patients may not acknowledge the range of disease severity of AGA or that patients may incorporate their psychosocial stress in their assessments of hair loss. Some have opted for wigs, although the financial burden of affording wigs can lead to additional distress in patients with preexisting social stress . Therefore, patients whose QOL has been severely impacted by AGA with minimal hair loss may benefit from counseling and early intervention …”

Hair growth control by innate immunocytes: Perifollicular macrophages revisited

“…Here, we argue that there may be no better example in the human system of an easily accessible, continuously remodelled (mini‐)organ than the hair follicle (HF) in which to explore the role of primary adult human MACs in tissue remodelling in health and disease. The HF not only provides protection from the environment but also contributes to skin and body homeostasis, harbours an unusually rich microflora, is an important non‐classical site of major (neuro‐)hormones and is a densely innervated sensory organ that doubles as a major instrument of communication and interpersonal signalling …”