QUALITY-OF-LIFE IN PATIENTS WITH PSORIASIS - THE CONTRIBUTION OF CLINICAL-VARIABLES AND PSORIASIS-SPECIFIC STRESS

The purpose of this study was: (i) to examine the impact of the clinic al severity, anatomical location and treatment of psoriasis on patient s' quality of life, and (ii) to investigate the effects of perceptions of psoriasis-related stress on patients' physical and mental health a nd on areas of disability in everyday life. All patients (n = 204) att ending a psoriasis speciality clinic were invited to complete a multid imensional quality of life assessment comprising the Psoriasis Disabil ity Index (PDI), the SF-36 Health Survey and the Psoriasis Life Stress Inventory (PLSI). Results (n = 150) indicated that overall clinical s everity of psoriasis as assessed by the Psoriasis Area and Severity In dex, and duration of psoriasis, were unrelated to impairment in any ar eas of quality of life. Anatomical location (social visibility) of pso riasis was associated with self-report of poor physical health (P = 0. 01), and there was a modest association with patients' mental health ( P = 0.04); however, anatomical location of psoriasis was not significa ntly associated with self-reported disability in everyday life, or str ess scores. Patients who were classified as more reactive to the stres s associated with psoriasis (78% of the sample) were functioning less well in terms of their mental health (P = 0.001) and also experienced significantly more disability in all areas of everyday life (P = 0.001 ). Differences in method of treatment for psoriasis did not significan tly affect scores on the psoriasis-specific (PDI; PLSI) or generic (SF -36) quality of life measures. A multiple regression analysis demonstr ated that stress resulting from anticipating other people's reactions to their psoriasis contributed more to the variance in patients' disab ility in everyday life than any other medical or health status variabl e. The results support the importance of assessing the effects of stre ss in patients' adjustment to their condition and may indicate a role for adjunctive psychological stress management training for a signific ant number of patients with psoriasis.