Stigmatization Plays Key Role in the Mental Health of Children with Skin Disease

While chronic skin disorders can be difficult for children to manage, the stigmatization of their diseases can trigger poor mental health and quality of life (QOL) outcomes. Researchers found a significant number of cases where mental health and QOL was exacerbated in children with skin disorders because of bullying and other negative sentiments toward the visibility of their ailments, according to a study published in JAMA Dermatology.

“Skin diseases affect more than a quarter of the population globally and are the fourth leading cause of nonfatal morbidity worldwide. Since chronic skin disorders often begin during childhood, early life experiences can influence long-term health… Chronic skin disorders are costly and can threaten physical, mental, and social health, impairing health-related QOL for the affected individual and family,” wrote the authors.¹

Despite the physical aspects of a skin disorder potentially stunting the overall continuity of a person’s life, its effects on mental health and QOL seem to be much more apparent, especially for children.

And while mental health itself is already stigmatized among adolescent age groups, coupling that with a visible skin disorder can create immensely negative psychosocial effects for children.

“Middle adolescence (corresponding to ages 14-18, when youth typically attend high school) is a potentially critical period for both the development of mental health conditions and targeting mental health stigma. Approximately 50% of all diagnosable mental health conditions develop in middle adolescence, and there is evidence that it is a crucial period for the crystallization of stigmatizing attitudes that can affect interactions with peers and discourage future help-seeking,” wrote DeLuca et al for Behavioral Health News.²

In Paller et al’s study, researchers examined 1671 adolescents (57.9% female; mean [SD] age, 13.7 [2.7] years) and quantified the childhood stigma of visible skin diseases. Conducting in-person visits for participants aged 8 to 17 years old, the study lasted for 3 years from November 2018 to November 2021.¹

“The primary outcome was measuring childhood stigma in relation to disease visibility. Key secondary outcomes were comparing child-assessed stigma scores with disease severity; QOL, extent of anxiety, depression, and poor peer relationships; and parental responses, each of which was expected to correlate with stigma,” wrote authors of the study.

With secondary outcomes used to quantify stigma, researchers determined T scores for each participant using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS). For the sake of this study, T scores of 44 or less were considered mild, 45 to 54 as moderate, and 55 or above as high.¹

Among the study population, 74.5% of participants reported their acne as highly visible and 75% had reported dermatomyositis or lupus as highly visible, rounding out the 2 most visible diseases among participants. Regarding severity of the disorders, children reported hyperhidrosis (55.6%), epidermolysis bullosa (33.3%), and atopic dermatitis (32.4%) as the 3 most severe disorders. “Overall, 56.4% of the children self-reported their condition as highly visible; 50.5% reported the severity as moderate, and 21.3% as severe,” they continued.

Furthermore, 27% of children reported T scores of below 40, representing minimal or less-than-mild stigma. Moderate T scores were less prominent at just over 20% for the population, while only 8.2% of all participants reported scores in the high range. Girls also reported more stigma than the boys who participated.

“Overall, stigma was experienced by 73% of children and adolescents with chronic skin disease and was at least moderate in severity in 43.8%,” explained the authors.

Despite T scores being high enough for researchers to consider a significant stigmatization in adolescents with skin disorders, one of the more notable findings was that 29.4% of participants’ parents were conscious of their child being bullied at school because of their disorder.¹

“While successfully treating the underlying skin disease is a goal, other tools to diminish stigma include discussions with teachers; educating about the child’s disorder in the classroom; active discussions with the child about handling, recognizing, and managing bullying; and managing the psychosocial impact of stigma,” continued the authors.

These study results can help individuals without skin disorders better understand that these diseases can affect both physical and mental health concurrently. While communication amongst adolescents and education on skin disorders are necessary to minimize bullying, it’s important for classrooms to preach compassion for the children experiencing these illnesses.

“The findings of this cross-sectional study suggest that stigma is central to the impact of chronic skin disease on QOL and mental health. Increased awareness and instituting medical and psychological interventions to identify and reduce stigma and disease severity are important directions for improving QOL,” they concluded.¹

READ MORE: Dermatology Resource Center

Don’t get left behind: Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips delivered straight to your inbox.

References

1. Paller AS, Rangel SM, Chamlin SL, et al. Stigmatization and mental health impact of chronic pediatric skin disorders. JAMA Dermatol. 2024;160(6):621–630. doi:10.1001/jamadermatol.2024.0594

2. DeLuca JS, Yanos PT. Addressing stigma among high school students using NAMI’s ending the silence. Behavioral Health News. April 18, 2023. Accessed July 12, 2024. https://behavioralhealthnews.org/addressing-stigma-among-high-school-students-using-namis-ending-the-silence/