Illness Severity and Coping in Psoriasis Patients: A 1-Year Follow-up

Abstract

Objective: The aim of this longitudinal study is to compare different dimensions of coping in psoriasis patients dependent on the development of the severity of this chronic skin disease. For this purpose we examined the patients’ coping and their skin state in a 1-year follow-up. Methods: We assessed the severity of psoriasis with the Psoriasis Area and Severity Index (PASI) and the Self-Administered PASI (SPASI), and coping with the ‘Trier Coping with Illness Scales’ in 262 inpatients. The severity of psoriasis estimated with the (S)PASI was defined as ‘mild’ ([S]PASI 0.0 - 5.0), ‘moderate’ ([S]PASI > 5.0 - 12.0), or ‘severe’ ([S]PASI > 12.0). We divided the sample into five patient groups based on the somatic course of the (S)PASI in the 1-year follow-up: ‘improved’, ‘equally mild’, ‘equally moderate’, ‘equally severe’, and ‘worse’. Results: Psoriasis patients of the ‘improved’ and ‘equally mild’ groups showed a significant increase on the scale ‘Search for Social Integration’ (p = 0.041 and p = 0.005) and a significant decrease in the dimensions ‘Threat Minimization’ (p = 0.040 and p = 0.022) and ‘Search for Information and Exchange of Experiences’ (p = 0.003 each) in the follow-up. However, significantly higher values in the dimensions ‘Rumination’ (p = 0.029) and ‘Search for Support in Religion’ (p = 0.001) in the follow- up were revealed for the patients of the ‘worse’ group. Conclusion: The analysis firstly shows a clear empirically-based challenge in which areas patients with ‘equally severe’ or ‘worse’ psoriasis should be supported, i.e. the fields ‘Search for Social Integration’, ‘Threat Minimization’, and ‘Search for Information and Exchange of Experiences’. In addition, results suggest that special psychological or psychotherapeutic efforts are necessary to help this group to develop an alternative behavior to the depression-associated ‘rumination’.

Acceptance of chronic illness in psoriasis vulgaris patients

“…There is lack of consensus on the strict divisions on psoriasis severity based on PASI scale. Literature data describe severe psoriasis starting from 10 to 17 points 43,48–51 . Based on the available data we have chosen PASI equal to 11 to divide patients into two groups according to severity of the disease.…”

“…However, there were no significant differences in levels of anxiety, depression and worrying, potential chronicity, causes, consequence and coping. Schmid‐Ott et al 48 . revealed that patients with equally severe or worse psoriasis should be supported in the following fields ‘Search for Social Integration’, ‘Threat Minimization’ and ‘Search for Information and Exchange of Experiences’.…”

“…So, it seems very reasonable to include therapeutic psychological interventions based on cognitive behavioural therapy (CBT) into a routine antipsoriatic approach. The following techniques should be employed in CBT: thought monitoring, thought construction, thought blocking, using distraction, relaxation 32,48 …”

“…Literature data describe severe psoriasis starting from 10 to 17 points. 43,[48][49][50][51] Based on the available data we have chosen PASI equal to 11 to divide patients into two groups according to severity of the disease. PASI was found to be a positive predictor of acceptance of illness, i.e.…”

“…However, there were no significant differences in levels of anxiety, depression and worrying, potential chronicity, causes, consequence and coping. Schmid-Ott et al 48 revealed that patients with equally severe or worse psoriasis should be supported in the following fields 'Search for Social Integration', 'Threat Minimization' and 'Search for Information and Exchange of Experiences'. The obtained results underline the complexity of the problem in psoriatic patients and strongly suggest that psychological intervention with clear cut problems and objective evaluation outcomes should be incorporated into management of this group of patients.…”