The Association of Alopecia Areata-Related Emotional Symptoms with Work Productivity and Daily Activity Among Patients with Alopecia Areata

Abstract

Introduction Patients with alopecia areata (AA) experience psychological and psychosocial symptoms including depression, anxiety, anger, social withdrawal, embarrassment, and low self-esteem. While multiple studies have measured the detrimental emotional impact of AA on patient quality of life, evidence of its effect on work productivity loss (WPL) and daily activities is limited. This study aimed to assess the extent of AA-related emotional symptom (ES) burden on work productivity and activity impairment. Methods A cross-sectional survey of dermatologists and their adult patients with AA was conducted in the USA in 2019. Dermatologists provided assessments of patients’ clinical characteristics, while patients completed sociodemographic questionnaires along with two validated patient-reported outcome measures of the Work Productivity and Activity Impairment (WPAI) and the AA Patient Priority Outcomes (AAPPO) ES subscale. The WPAI assessed AA-related WPL (employed respondents) and activity impairment (all respondents), and the AAPPO-ES assessed AA-related frequency of feeling self-conscious, embarrassed, sad, or frustrated. Multiple linear regression models were fitted to both WPAI scores with the AAPPO ES as an independent variable. Results A total of 242 patients with a mean (SD) age of 39.2 (13.3) years, treated by 59 dermatologists, were evaluated. Mean (SD) ES score was 2.0 (1.1). Mean (SD) work productivity loss [ n = 170] and activity impairment [ n = 242] were 12.2% (17.4%) and 13.3% (18.3%), respectively. After adjusting for covariates, WPL increased by 4.1% [95% confidence interval (CI) 1.6–6.7%; p = 0.002] and activity impairment increased by 3.1% (95% CI 0.7–5.4%; p = 0.010) for every 1-point increase in ES. For an average patient, a 1-SD decrease (about 1 point) on the ES scale substantially reduced WPL and activity impairment (by at least 25%). Conclusions Patients with AA reported significant increases in WPL and activity impairment associated with worsening AA-related ES. These findings underscore the substantial emotional and psychosocial burden among patients with AA and a need for improved treatment options. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00864-1.

Economic burden of alopecia areata: A study of direct and indirect cost in Japan using real‐world data

“…Our study found that productivity loss was largely a result of impaired productivity while at work (presenteeism) with only small losses resulting from absences from work (absenteeism). This was comparable with results found in the US 27,28 . The trend is also similar to reports in Japan for other chronic skin conditions such as atopic dermatitis 39,41–43 and psoriasis 44,45 .…”

“…This was comparable with results found in the US. 27,28 The trend is also similar to reports in Japan for other chronic skin conditions such as atopic dermatitis 39,[41][42][43] and psoriasis. 44,45 43 In our study, the respective values were 0.9 ± 2.8%, 23.9 ± 25.7%, 24.3 ± 25.8%, and 35.0 ± 29.5%.…”

“…The majority of US patients surveyed rated their financial burden as moderate or serious 24 . However, the impact on patients and the wider society goes beyond the direct health‐care cost as AA can impact on all aspects of personal life, finances, and may lead to significant productivity losses 27,28 …”

Experiencing Workplace Bullying in Patients with Alopecia Areata: A Cross-Sectional Survey Study

“…One recent study demonstrated that employers feel less comfortable hiring individuals with AA [3]. These employer attitudes in combination with workplace bullying may contribute to the higher rates of work absenteeism, work productivity loss, and unemployment in patients with AA [6,7]. The culmination of psychosocial obstacles in the workplace and potentially lost income can compound the financial burden and distress experienced by this patient population [7][8][9].…”

“…These employer attitudes in combination with workplace bullying may contribute to the higher rates of work absenteeism, work productivity loss, and unemployment in patients with AA [6,7]. The culmination of psychosocial obstacles in the workplace and potentially lost income can compound the financial burden and distress experienced by this patient population [7][8][9]. Thus, future work needs to identify how to reduce bullying against patients with AA through education and awareness and to explore the impact of improved treatments and psychosocial support.…”