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A cross-sectional study of psychological morbidity in patients with acne, psoriasis and atopic dermatitis in specialist dermatology and general practices


*Corresponding author, Discipline of General Practice, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW 2308, Australia, tel. +61 249 686734; fax +61 249 686727; E-mail:


Background  There is considerable evidence for an association of skin diseases with psychological morbidity. This relationship is best established for acne, psoriasis and atopic eczema. Previous studies have mostly been performed in specialist dermatological practice, and there is a lack of studies that include patients from general practice and a lack of controlled studies employing multivariate analysis.

Aims/objectives  This study aims to examine the relationship of acne, psoriasis and atopic eczema with psychological morbidities in patients recruited from general practice as well as specialist dermatology practice.

Methods and subjects  In this cross-sectional study, 108 patients from general and specialist dermatology practices with the three diseases had disease severity assessed and completed measures of minor psychological disturbance (General Health Questionnaire-12), anxiety and depression (Hospital Anxiety and Depression Scale), public self-consciousness and social anxiety (Fenigstein Self-Consciousness Scale), and neuroticism and extraversion/introversion (Eysenck Personality Inventory). Demographic data were also collected, along with self-ratings of disease severity. Control subjects were 96 patients without skin disease recruited from the same general practices as the subjects.

Results  On univariate analyses, patients with skin disease had higher levels of minor psychological disturbance, public self-consciousness and neuroticism than did controls. There were no differences in psychological measures between specialist and general practice patients or between patients with different skin diseases. On multivariate analyses, the significant differences did not persist.

Conclusions  This study demonstrates confounding in the relationship of skin diseases with psychological morbidity. The complex relationship of skin disease and psychological morbidity should be re-examined.

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