Coping Methods, Lack of Support Are Predictors of Self-Stigma for Patients with Skin Disease

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Social stigma, lack of social support, and coping methods are all the major predictors of self-stigma among patients with skin diseases such as psoriasis and atopic dermatitis, according to recent findings.¹

These and others were the conclusions of new research led by Caroline F. Z. Stuhlmann, from the German Center for Health Services Research in Dermatology at the University Medical Center Hamburg-Eppendorf (UKE) in Germany.

Stuhlmann et al. conducted their systematic literature review given that a major contributor of skin disease burden is the reported experience of stigmatization. Despite the presence of recent literature review research, it had not been considered systematic and the review’s aim was not on self-stigmatization of patients with chronic and visible skin conditions.²

“The main objective for this systematic literature review was to aggregate existing research on correlates and mechanisms that contribute to self-stigmatization among people with one of the five aforementioned chronic skin diseases and to, ultimately, identify targets for the DEVISE project intervention,” Stuhlmann and colleagues wrote. “To our knowledge, no prior reviews have specifically addressed the mechanisms of self-stigmatization in people with skin diseases.”¹

Trial Design

The research team used 4 databases to carry out its comprehensive search, implementing OVID, PubMed, Web of Science, and PsycINFO (via EBSCO) for its aim of identifying peer-reviewed research related to psychosocial factors, self-stigma, and specific skin diseases. Some of the specific conditions they looked at included psoriasis, atopic dermatitis, alopecia areata, vitiligo, and hidradenitis suppurativa (HS).

The team assigned 2 independent reviewers to screen article titles and abstracts based on their pre-specified criteria for inclusion. Such criteria included studies which involved adult subjects and concerning at least 1 of the 5 targeted visible chronic skin diseases as defined by the International Statistical Classification of Diseases and Related Health Problems 11th Edition.

The studies evaluated by the team also were required to have evaluated self-stigma or related concepts. Some related types of topics included self-devaluation, internalized stigma, body dissatisfaction, body image, or shame over one’s body.

The included research was also required to have evaluated psychosocial factors, some of which would have been sociodemographic like patient gender and age. Other factors the studies were required to have evaluated included clinical elements such as severity of patient disease and duration, as well as psychological elements including public stigma, methods for coping, cognitions, or social support.

The team did not place any restrictions on studies’ publication date, though articles included in their review were limited to ones which had been written in either English or German. By February 2022, their final search was finished. The investigators implemented the Johanna Briggs Institute Checklist for Analytical Cross Sectional Studies for the purposes of assessing the quality of research.

Study Findings

Overall, the investigators concluded with an analysis of 27 studies. The research evaluated also yielded an average quality score of 7.04 on an 8-point scale.

Some of the major elements which the research team found had contributed to patients’ self-stigma included ineffective coping strategies (such as difficulties with acceptance), social stigma, and insufficient support in one’s social circle. Although the team did note the overall quality of the research had been high, they found that all but 1 study implemented a cross-sectional design.

They added that the lack of such a design may limits the ability of such studies to determine cause-and-effect associations which are identified between these predictive factors and patients’ levels of self-stigma.

“Future studies should consider investigating the rich data characteristic of qualitative studies for further insight into themes relevant to self-stigma,” they wrote. “However, without access to the transcripts or raw interview data, we would need to rely on the interpretations of themes presented by authors for each of the qualitative studies, which could diminish the quality of the present findings.”

References

1. ^{Stuhlmann CFZ, Traxler J, Paucke V, da Silva Burger N, Sommer R. Predictors and mechanisms of self-stigma in five chronic skin diseases: A systematic review. J Eur Acad Dermatol Venereol. 2024; 00: 1–9. https://doi.org/10.1111/jdv.20314.}
2. ^{Germain N, Augustin M, François C, Legau K, Bogoeva N, Desroches M, et al. Stigma in visible skin diseases—a literature review and development of a conceptual model. J Eur Acad Dermatol Venereol. 2021; 35(7): 1493–1504.}