JAMA Dermatology

<jats:sec id="ab-doi240010-4"><jats:title>Importance</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240010-5"><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240010-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240010-7"><jats:title>Main Outcomes and Measures</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec id="ab-doi240010-8"><jats:title>Results</jats:title><jats:p>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 <jats:italic>d</jats:italic> = −0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen <jats:italic>d</jats:italic> = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety.</jats:p></jats:sec><jats:sec id="ab-doi240010-9"><jats:title>Conclusions and Relevance</jats:title><jats:p>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.</jats:p></jats:sec>

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Development of the PROMIS pediatric stigma and extension to the PROMIS pediatric stigma: skin item banks.

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Development and validation of Skindex-Teen, a quality-of-life instrument for adolescents with skin disease.

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Neurorehabil Neural Repair

Fitting linear mixed-effects models using lme4.

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Internalized skin bias: validation study to explore the impact of the internalization of social stigma on those with hidradenitis suppurativa.

Internalized stigma in hidradenitis suppurativa: a multicenter cross-sectional study.

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Child Adolesc Psychiatry Ment Health

Effects of short-term interventions to reduce mental health-related stigma in university or college students: a systematic review.

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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.
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.
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.
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).
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.
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.

Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders.

Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders

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