title: Health status, coping strategies, and alexithymia in subjects with androgenetic alopecia: a questionnaire study.
abstract: BACKGROUND
  Androgenic alopecia (AGA) is viewed as a relatively mild dermatologic condition; however, affected individuals feel that alopecia is a serious condition with major consequences in their life.
  
  
  OBJECTIVE
  The objective of this study was to assess the health status, the risk of anxiety/depression, the coping strategies, and alexithymia in subjects with AGA.
  
  
  METHODS
  Consecutive subjects referred to the outpatients department of the Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IDI IRCCS) dermatologic hospital with a diagnosis of AGA were enrolled. AGA was assessed using the Ludwig scale in female subjects and following Hamilton-Norwood's classification in male subjects. The questionnaires provided to the patient and collected before the visit were the Medical Outcomes Study Short Form-12 (SF-12), the 12-item General Health Questionnaire (GHQ-12), the Coping Orientations to Problems Experienced (COPE), and the Toronto Alexithymia Scale-20 (TAS-20). Multiple logistic regressions were performed to examine the relationship of sociodemographic variables and clinical characteristics with coping.
  
  
  RESULTS
  351 subjects were enrolled during the study period. Sixty percent of female subjects with AGA were GHQ-12 positive (values ≥4) compared with 32 % of male subjects with AGA. AGA male and AGA female subjects had a statistically worse score than non-AGA male subjects for the physical component summary (PCS) and the mental component summary (MCS) of the SF-12, and for the GHQ-12. Compared with male subjects, AGA female subjects were more likely to adopt an 'active emotional coping' strategy according to COPE scores, and less likely to have 'externally oriented thinking,' and more 'difficulty identifying feelings' according to the TAS-20 scores. In a logistic regression model, including sex, MCS, total TAS-20, and the COPE scores as independent variables and the AGA severity as a dependent variable, only sex had a significant odds ratio (OR) [13.32; 95 % CI 4.77-38.58, p < 0.001]. Female subjects were almost 13 times more likely to have more severe AGA than male subjects. In three other models (i.e., one for each coping category) which included sex, AGA severity, MCS, and TAS-20, the 'problem-focused coping' strategy was negatively associated with alexithymia (OR 0.48; 95 % CI 0.27-0.86, p = 0.01), the 'active emotional coping' strategy was associated with gender (women had an OR of 2.69; 95 % CI 1.5-4.8, p = 0.001), and the 'avoidant coping' strategy was associated with alexithymia (OR 4.12; 95 % CI 2.23-7.58, p < 0.001) and with lower MCS values (OR 0.37; 95 % CI 0.22-0.64, p < 0.001).
  
  
  CONCLUSIONS
  The study confirmed the high prevalence of depression/anxiety in AGA subjects, with a significantly higher prevalence in AGA female than male subjects. It is interesting to observe that patients reactions to their AGA related more to the emotional and psychological states deriving from their alopecia than to the objective clinical rating. Avoidant coping strategies were selected more frequently by AGA subjects if they were GHQ-12 positive and had alexithymia. To have alexithymia modified all coping strategies in AGA female subjects but not in AGA male subjects. Physicians should be aware that the impact of AGA is not limited to symptoms, and should help people to deal with their emotional responses to alopecia, such as anger and worry, and their beliefs about the consequences of their condition, and how it will impact on their daily life.
authors: Health Services Research Unit, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IDI IRCCS), Via Monti di Creta 104, 00167 Rome, Italy. ste.tab@idi.it
authors: Stefano
authors: S
authors: Tabolli
authors: Francesca
authors: F
authors: Sampogna
authors: Cristina
authors: C
authors: di Pietro
authors: Thomas J
authors: TJ
authors: Mannooranparampil
authors: Marcella
authors: M
authors: Ribuffo
authors: Damiano
authors: D
authors: Abeni
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D000367:Age Factors; D000505:Alopecia / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011594:Psychometrics; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult