gms | German Medical Science

Background: Plaque-type psoriasis or intertriginous psoriasis affects the anogenital area in 29–40% of cases, resulting in significant quality of life (QoL) impairments and higher rates of depression. Patients with anogenital psoriasis also reported impaired sexual experiences because of both physical (e.g., pain) and psychosocial effects (e.g., feelings of stigmatization). However, the psychological mechanisms through which the interpersonal experiences might influence the health outcomes are still unclear.

Objective:

1.

To compare the interpersonal experiences of stigmatization and sexual impairments, social avoidance coping, QoL and depression between patients with psoriasis with and without anogenital involvement.

2.

To test the mediating role of social avoidance coping on the links between interpersonal experiences and health outcomes.

Method: Preliminary data from the cross-sectional multicentric PsoGen study were analysed. German patients aged ≥18 years with plaque-type or intertriginous psoriasis completed self-report questionnaires on quality of life impairments, depression, stigmatization, sexual impairments and social avoidance coping. Comparative analyses were performed with t-tests and mediation models were tested with the PROCESS macro for SPSS (model 4; 5,000 bootstrap samples).

Results: The sample included 81 patients with psoriasis (43.8±13.1 years, 56.8% male), 63 of which presented current lesions in the anal or genital area. Patients with anogenital psoriasis reported more QoL impairments (t=2.7, p<0.01), more depression symptoms (t=2.5, p=0.01), more frequent use of social avoidance coping (t=2.4, p=0.02), and higher levels of sexual impairments (t=3.0, p<0.01), compared to those without anogenital involvement. No significant differences were found for perceived stigmatization (t=0.2, p=0.84). Higher levels of sexual impairments and stigmatization were associated with increased use of social avoidance. In turn, social avoidance was linked to higher levels of depression and more QoL impairments. The direct effects of sexual impairments and stigmatization on QoL impairments and depression symptoms were non-significant, but there were significant indirectly via more frequent use of avoidance coping.

Discussion: Patients with anogenital psoriasis are at increased risk for poor health outcomes. These are not only a direct function of clinical characteristics but they also reflect the patients’ interpersonal experiences and coping processes. Specifically, social avoidance is a non-adaptive coping strategy with clear adverse effects on health outcomes.

Practical implications: Although interpersonal experiences (e.g., external stigma), might be difficult to target in clinical practice, the psychological coping mechanisms are modifiable variables that can be targeted in multidisciplinary care. Alternative coping strategies can be promoted as a way of decreasing the impact of interpersonal experiences on health outcomes.

Appeal for practice: The routine assessment of patient-reported outcomes, such as perceived stigma, sexual impairments, and coping mechanisms, might pave the way to support clinical decisions for optimized patient-centred care.