Peer-relationship-problems account for quality of life impairments in pediatric psoriasis

Highlights

• Psoriasis has been reported to affect health-related quality of life however, previous research has been based on adult or paediatric samples not representative of the paediatric population.

• Psoriasis in children and adolescents represents a significant burden affecting HRQoL.

• The effect of pediatric psoriasis on HRQOL remains even when controlling for mental health.

• Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers.

Abstract

Objective

Most research on HRQoL-impairments in psoriasis has been conducted in adult patients, small pediatric patient samples or samples not representative of the pediatric population at large. We thus aimed to comprehensively describe HRQoL in pediatric psoriasis compared to psoriasis-free children and adolescents, identify domains most commonly affected and analyze its impact on HRQoL while controlling for important other predictors of HRQoL in a representative pediatric sample.

Methods

The impact of lifetime-prevalence of psoriasis on total and subscale HRQoL was analyzed by complex sample general linear models alone and adjusted for sociodemographic and clinical variables in a population-based sample (n = 6518) of children and adolescents aged 11–17.

Results

Total HRQoL and the physical domain were significantly affected by lifetime-psoriasis in univariate analysis. In multivariate analyses, lifetime-psoriasis significantly impacted on total HRQoL and the subscale ‘quality of relationships with friends/peers’. Although substantial amounts of variance in HRQoL were explained by mental health, independent effects of lifetime-psoriasis remained after adjustment for this covariate. Total explained variance in total HRQoL was 20%.

Conclusion

Our findings suggest psoriasis to be a significant burden as it affects HRQoL even when controlling for mental health. Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers. How this exactly occurs needs to be explored in future research. Meanwhile clinicians need to be more attentive to this effect of psoriasis.

Introduction

Psoriasis is a chronic, immune-mediated skin disorder that affects 1–3% of the population worldwide [1]. It is associated with cardiovascular disease [2] and increased mortality [3]. The majority of cases occurs during adulthood, however, about a third of patients may show the condition during the first two decades of their lives [4]. Exact population-based estimates of incidence and prevalence of juvenile psoriasis are, however, scarce. A British population-based study reported a lifetime prevalence of 0.6% for children aged 0–9 years and of 1.4% for children and adolescents aged 10–19 years [5], an Italian study a lifetime prevalence of 2.1% in children aged 12–17 years [6] and a German study a total prevalence of 0.12%–1.24% in individuals aged 1 to 18 years [7].

Psoriasis' socioeconomic burden is substantial [8], [9] and detrimental effects on health-related quality of life (HRQoL) have been documented. It has been shown to impose major limitations on all key dimensions of health-related quality of life (HRQoL) in adults [10], [11], [12], [13] as well as children [14], [15], [16], [17]. Major limitations may also arise from perceived disfigurement and social stigmatization [8], [18], [19], [20]. Because the disease is usually persistent (psoriasis is often a lifelong skin disease although complete remission can occur), patients with a diagnosis of psoriasis usually need lifelong care and the impact on quality of life may consequently persist.

Most research on the impact of psoriasis on HRQoL has been conducted in adult patient samples [10], [11], [12], [13], in (small) pediatric patient samples [14], [16], [17] or samples not representative of the pediatric population at large [15]. Varni [15] for instance, compared pediatric individuals with psoriasis with psoriasis-free individuals that were not matched for important sociodemographic data and the measurement of HRQoL was partly based on self-report and partly on parent proxy-report. What is still missing is a comprehensive analysis of population-based data looking at how psoriasis affects self-reported generic HRQoL in comparison to children and adolescents free from psoriasis.

Psoriasis has also been shown to be associated with mental health problems in adults [19], [21] as well as children [22]. Several studies have observed a modifying effect of mental health on the relationship between chronic disease and HRQoL [23], [24], [25], [26] with one study even concluding that most of the impact of a chronic condition on HRQoL was confined to cases with co-occurring mental health problems [27].

It was the aim of the present analyses to

• comprehensively describe HRQoL in pediatric psoriasis in comparison to children and adolescents free from psoriasis

• identify domains most commonly affected

• analyze the impact of psoriasis on HRQoL while controlling for theoretically and empirically important other predictors of HRQoL

in a population-based representative sample of children and adolescents.