title: Sociodemographic and disease correlates of body image distress among patients with systemic sclerosis.
abstract: BACKGROUND
  Body image concerns are infrequently studied in systemic sclerosis (SSc), even though significant visible disfigurement is common. The objective of this study was to identify sociodemographic and disease-related correlates of dissatisfaction with appearance and social discomfort among people with SSc.
  
  
  METHODS
  SSc patients came from the 15-center Canadian Scleroderma Research Group Registry. Sociodemographic information was based on patient self-report. Disease characteristics were obtained via physician examinations. The Brief-SWAP was used to assess dissatisfaction with appearance and social discomfort. Structural equation models were conducted with MPlus to determine the relationship of dissatisfaction with appearance and social discomfort with age, sex, education, marital status, race/ethnicity, disease duration, skin involvement, telangiectasias, skin pigmentation changes, and hand contractures.
  
  
  RESULTS
  A total of 489 SSc patients (432 female, 57 male) were included. Extent of skin involvement was significantly associated with both dissatisfaction with appearance and social discomfort (standardized regression coefficients = 0.02, p = 0.001; 0.02, p = 0.020, respectively), as was skin involvement in the face (0.18, p = 0.016; 0.23, p = 0.006, respectively). Greater social discomfort was robustly associated with younger age (-0.017, p<0.001) and upper-body telangiectasias (0.32, p = 0.021). Dissatisfaction with appearance was associated with hand contractures (0.07, p = 0.036).
  
  
  CONCLUSIONS
  This study found that dissatisfaction with appearance and social discomfort were associated with numerous disfiguring characteristics of SSc, in addition to age. These results underline that there are multiple factors contributing to body image distress in SSc, as well as the need to attend to both disease and social contexts in understanding the impact of disfigurement among patients.
authors.affiliation: Department of Psychiatry, McGill University, Montréal, Québec, Canada.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Jewett
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Malcarne
authors.forename: Murray
authors.initials: M
authors.lastname: Baron
authors.forename: Brett D
authors.initials: BD
authors.lastname: Thombs
mesh_terms: D000368:Aged; D001828:Body Image; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012595:Scleroderma, Systemic / Q000523:psychology*; D012959:Socioeconomic Factors; D013315:Stress, Psychological