Low Stress Resilience In Adolescence Associated with Increased Psoriasis Risk Among Men

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Low resilience to stress during adolescence is linked with greater risk of incident psoriasis among males, according to new findings, suggesting that psoriasis patients have an inherent psychological vulnerability which may need to be addressed.¹

These conclusions were the result of new research led by M. Laskowski, of the department of dermatology and venereology at the Institute of Clinical Sciences at the University of Gothenburg’s Sahlgrenska Academy in Sweden. Psychological stress has been suggested to be linked to inflammation, yet stress resilience among those with psoriatic disease has been sparsely studied.²

“Using the stress resilience score obtained at conscription as a standardized marker for stress will obviate the risk of recall bias often seen in previous studies,” Laskowksi and colleagues wrote. “To the best of our knowledge, this is the first study exploring the association between stress resilience levels in early age and incident psoriasis and psoriatic arthritis.”

Background and Methods

The investigators looked at the 2-day military training process required for all Swedish males that had been required at age 18 until the year 2010. They looked at the enlistment process’s standardized physical and psychological assessments, documented within the Swedish Military Conscription Register (SMCR), as well as the self-administered questionnaires recruits had been given asking about elements of their family and social lives.

The International Classification of Diseases (ICD) was used by clinicians to assess psychiatric and physical conditions, with stress resilience being reported on by psychologists through use of standardized, semi-structured interviews looking at subjects’ command fitness and mental capacity. The specific methods did remain classified, however, though it was noted by the investigators that resilience scores were found using a 9-point Standard Nine (Stanine) scale, with lower scores suggesting less resilience.

Diagnoses identified in Sweden in both outpatient and inpatient healthcare episodes are known to be reported to the Swedish National Patient Register (NPR) as a requirement. The investigators found diagnoses of psoriasis and psoriatic arthritis through the ICD-8 through ICD-10 classifications, allowing for evaluation of cases of new-onset psoriasis and psoriatic arthritis cases from 1968 - 2019.

Levels of resilience to stress from the SMCR were stratified by the team into scores labeled as lower (scores 1–3), medium (scores 4–6), and higher (scores 7–9). They collected data on participants’ parental education levels through the Longitudinal Integration Database for Health Insurance and Labour Market Studies, with 3 distinct categories based upon the highest level achieved being utilized.

The investigators followed the men included from the point of their conscription until a new-onset of psoriasis or psoriatic arthritis, death or emigration, or at the latest until 31 December 2019. They also used cox regression models adjusted for confounding variables at the point of conscription to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for incident psoriasis and psoriatic arthritis.

Findings

The specific cohort in the research team’s study highlighted males who had been assessed by the military enlistment process between 1968 - 2005, with 1,949,891 individuals in total. The team noted that each year, around 2%–3% of such men had been exempted from their required enlistment resulting from imprisonment or severe chronic conditions as well as disabilities.

Overall, those in the lowest level of stress resilience cohort were found to have faced a higher risk of psoriasis and psoriatic arthritis development, with the investigators noting hazard ratios (HR) of 1.31 (95% CI 1.26–1.36) as well as 1.23 (95% CI 1.15–1.32), respectively, versus the highest stress resilience cohort. The hazard ratios for psoriasis and psoriatic arthritis among individuals who had been hospitalized and in the lowest stress resilience cohort were 1.79 (1.63–1.98) and 1.53 (1.32–1.77), respectively.

“These novel results, based on standardized measurements of stress resilience in men, support that patients with psoriasis have an inherent psychological vulnerability,” they wrote. “Considering the known association between stress resilience and psychiatric disease this highlights the importance of addressing psychological well-being in the management of psoriasis.”

References

1. ^{Laskowski M, Schiöler L, Åberg M, Abuabara K, Wennberg A-M, Gustafsson H, et al. Influence of stress resilience in adolescence on long-term risk of psoriasis and psoriatic arthritis among men: A prospective register-based cohort study in Sweden. J Eur Acad Dermatol Venereol. 2024; 00: 1–8. https://doi.org/10.1111/jdv.20069.}
2. ^{Ciaffi J, Brusi V, Lisi L, Mancarella L, D'Onghia M, Quaranta E, et al. Living with arthritis: a “training camp” for coping with stressful events? A survey on resilience of arthritis patients following the COVID-19 pandemic. Clin Rheumatol. 2020; 39: 3163–3170.}