title: Well being, psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study.
abstract: BACKGROUND
  There is a vast literature describing the association between psoriasis, atopic dermatitis (AD) and psychological distress. Some of these studies were uncontrolled and others used non-dermatological diseases as control, but only a few used chronic skin diseases as controls.
  
  
  OBJECTIVE
  To compare well being, psychopathology and coping strategies of psoriatic, AD and healthy controls in a prospective case-control study.
  
  
  METHODS
  Thirty-seven psoriatic patients and 31 AD patients were recruited from the Hadassah Ein Karem Hospital, Jerusalem, Israel, outpatient and inward clinic. The participants in the control group were 31 healthy workers and volunteers with no dermatological diseases from Kaplan Hospital, Rehovot, Israel. We used self-report questionnaires [Mental Health Inventory (MHI) and Adjustment to Chronic Skin Diseases Questionnaire (ACSD)], a projective technique (Hand Test) and assessment tools (Clinical Global Impression).
  
  
  RESULTS
  Psoriatic patients experienced reduced well being (P = 0.007) and more anxiety and depression (P = 0.018) than normal controls. Psoriatic patients also displayed more severe psychopathology (P = 0.039) a more passive attitude towards life, and loss of meaning in life (P = 0.001) as measured by the projective technique compared with AD patients and normal controls.
  
  
  CONCLUSIONS
  We propose two explanations, derived from the psychological and the psycho-neuro-immunological domains. First, greater mental distress in psoriasis is because of the greater stigma it bears compared with AD. Alternatively, we hypothesize that the psoriatic inflammatory process may possibly have a direct central nervous system effect.
authors.affiliation: Department of Dermatology, Hadassah University Medical Center, Jerusalem, Israel.
authors.forename: V
authors.initials: V
authors.lastname: Leibovici
authors.forename: L
authors.initials: L
authors.lastname: Canetti
authors.forename: S
authors.initials: S
authors.lastname: Yahalomi
authors.forename: R
authors.initials: R
authors.lastname: Cooper-Kazaz
authors.forename: O
authors.initials: O
authors.lastname: Bonne
authors.forename: A
authors.initials: A
authors.lastname: Ingber
authors.forename: E
authors.initials: E
authors.lastname: Bachar
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology; D003876:Dermatitis, Atopic / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011565:Psoriasis / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D057566:Self Report