Association of Chronic Urticaria with Psychological Distress: A Multicentre Cross-sectional Study
DOI:
https://doi.org/10.2340/actadv.v102.2939Keywords:
chronic urticaria, quality of life, depression, psychological, correlationAbstract
Chronic urticaria is a debilitating disease that affects health-related quality of life, but few studies have evaluated its impact on psychological wellbeing. The aim of this study was to evaluate the quality of life of patients with chronic urticaria and determine its impact on their emotional and psychological wellbeing. A cross-sectional multicentre study of a cluster of 264 Lebanese patients visiting dermatology/immunology clinics was conducted between July 2018 and June 2020. The impact of chronic urticaria on quality of life was assessed using the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) and Dermatology Life Quality Index (DLQI), as well as its consequences on mood changes using the Patient Health Questionnaire-9 (PHQ-9) and Beirut Distress Score 22 (BDS-22) scores. A multivariable analysis of covariates was performed to determine the effect of the triggering factors of urticaria on both CU-Q2oL and PHQ-9. A moderate negative correlation was found between Urticaria Control Test and quality of life scores as well as PHQ-9 and BDS-22 (p < 0.001). Patients with the lowest Urticaria Control Test score had the highest impairment in quality of life and depression scores. In conclusion, chronic urticaria compromises patients’ quality of life and emotional wellbeing. This distress is more pronounced when the disease is more severe.
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Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014; 69: 868-887.
https://doi.org/10.1111/all.12313 DOI: https://doi.org/10.1111/all.12313
Ferrer M. Epidemiology, healthcare, resources, use and clinical features of different types of urticaria. Alergologica 2005. J Investig Allergol Clin Immunol 2009; 19: 21-26.
Balp MM, Khalil S, Tian H, Gabriel S, Vietri J, Zuberbier T. Burden of chronic urticaria relative to psoriasis in five European countries. J Eur Acad Dermatol Venereol 2018; 32: 128-290.
https://doi.org/10.1111/jdv.14584 DOI: https://doi.org/10.1111/jdv.14584
Murota H, Kitaba S, Tani M, Wataya-Kaneda M, Azukizawa H, Tanemura A, et al. Impact of sedative and non-sedative antihistamines on the impaired productivity and quality of life in patients with pruritic skin diseases. Allergol Int 2010; 59: 345-354.
https://doi.org/10.2332/allergolint.10-OA-0182 DOI: https://doi.org/10.2332/allergolint.10-OA-0182
Grob JJ, Revuz, J, Ortonne JP, Auquier P, Lorette G. Comparative study of the impact of chronic urticaria, psoriasis and atopic dermatitis on the quality of life. Br J Dermatol 2005; 152: 289-295.
https://doi.org/10.1111/j.1365-2133.2005.06385.x
Balp MM, Vietri J, Tian H, Isherwood G. The impact of chronic urticaria from the patient's perspective: a survey in five European countries. Patient 2015; 8: 551-558.
https://doi.org/10.1007/s40271-015-0145-9 DOI: https://doi.org/10.1007/s40271-015-0145-9
Weldon DR. Quality of life in patients with urticaria. Allergy Asthma Proc 2006; 27: 96-99.
https://doi.org/10.2500/aap.2006.27.2925 DOI: https://doi.org/10.2500/aap.2006.27.2925
Baiardini I, Giardini A, Pasquali M. Dignetti P, Guerra L, Specchia C, et al. Quality of life and patients' satisfaction in chronic urticaria and respiratory allergy. Allergy 2003; 58: 621-23.
https://doi.org/10.1034/j.1398-9995.2003.00091.x DOI: https://doi.org/10.1034/j.1398-9995.2003.00091.x
Engin B, Uguz F, Yilmaz E, Ozdemir M, Mevlitoglu I. The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria. J Eur Acad Dermatol Venereol 2008; 22: 36-40.
Staubach P, Eckhardt-Henn A, Dechene M, Vonend A, Metz M, Magerl M, et al. Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity. Br J Dermatol 2006; 154: 294-298.
https://doi.org/10.1111/j.1365-2133.2005.06976.x DOI: https://doi.org/10.1111/j.1365-2133.2005.06976.x
Papadopoulou N, Kalogeromitro SD, Staurianea NG, Tiblalexi D, Theoharides TC. Corticotropin-releasing hormone receptor-1 and histidine decarboxylase expression in chronic urticaria. J Invest Dermatol 2005; 125: 952-955.
https://doi.org/10.1111/j.0022-202X.2005.23913.x DOI: https://doi.org/10.1111/j.0022-202X.2005.23913.x
Lindsay K, Goulding J, Solomon M, Broom B. Treating chronic spontaneous urticaria using a brief 'whole person' treatment approach: a proof-of-concept study. Clin Translational Allergy 2015; 5:40.
https://doi.org/10.1186/s13601-015-0082-7 DOI: https://doi.org/10.1186/s13601-015-0082-7
Ben-Shoshan M, Clarke A, Raz A. Psychosocial factors and the pathogenesis of chronic hives: a survey of Canadian physicians. J Allergy Therapy 2012; 3:1-2.
https://doi.org/10.4172/2155-6121.1000113 DOI: https://doi.org/10.4172/2155-6121.1000113
Konstantinou GN, Konstantinou GN. Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis. Clin Translational Allergy 2019; 9:42.
https://doi.org/10.1186/s13601-019-0278-3 DOI: https://doi.org/10.1186/s13601-019-0278-3
Maurer M, Staubach P, Raap U, Richter-Huhn G, Baier-Ebert M, Chapman-Rothe N. ATTENTUS, a German online survey of patients with chronic urticaria highlighting the burden of disease, unmet needs and real-life clinical practice. Br J Dermatol 2016; 174: 892-894.
https://doi.org/10.1111/bjd.14203 DOI: https://doi.org/10.1111/bjd.14203
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-216.
https://doi.org/10.1111/j.1365-2230.1994.tb01167.x DOI: https://doi.org/10.1111/j.1365-2230.1994.tb01167.x
Lewis V, Finlay AY. 10 years' experience of the Dermatology Life Quality Index (DLQI). J Invest Dermatol Symp Proc 2004; 9: 169-180.
https://doi.org/10.1111/j.1087-0024.2004.09113.x DOI: https://doi.org/10.1111/j.1087-0024.2004.09113.x
Salek MS, Jung S, Brincat-Ruffini LA, MacFarlane L, Lewis-Jones MS, Basra MK, et al. Clinical experience and psychometric properties of the Children's Dermatology Life Quality Index (CDLQI), 1995-2012. Br J Dermatol 2013; 169: 734-759.
https://doi.org/10.1111/bjd.12437 DOI: https://doi.org/10.1111/bjd.12437
Tondury B, Muehleisen B, Ballmer-Weber BK, Hofbauer G, Schmid-Grendelmeier P, French L, et al. The Pictorial representation of Iilness and self-measure (PRISM) instrument reveals a high burden of suffering in patients with chronic urticaria. J Investig Allergol Clin Immunol 2011; 21: 93-100.
Baiardini I, Fasola S, Maurer M, Weller K, Canonica GW, Braido F. Minimal important difference of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL). Allergy 2019; 74: 2542-2544.
https://doi.org/10.1111/all.13939 DOI: https://doi.org/10.1111/all.13939
Brzoza Z, Badura-Brzoza K, Młynek, A, Magerl M, Baiardini I, Canonica GW, et al. Adaptation and initial results of the polish version of the GA²LEN chronic urticaria quality of life questionnaire (CU-Q2oL). J Dermatol Sci 2011; 62: 36-41.
https://doi.org/10.1016/j.jdermsci.2011.01.010 DOI: https://doi.org/10.1016/j.jdermsci.2011.01.010
Młynek A, Magerl M, Hanna M, Lhachimi S, Baiardini I, Canonica GW, et al. The German version of the chronic urticaria quality-of-life questionnaire (CU-Q2oL): factor analysis, validation and initial clinical findings. Allergy 2009: 64; 927-936.
https://doi.org/10.1111/j.1398-9995.2008.01920.x DOI: https://doi.org/10.1111/j.1398-9995.2008.01920.x
Baiardini I, Pasquali M, Braido F, Fumagalli F, Guerra L, Compalati E, et al. A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU-QoL). Allergy 2005; 60: 1073-1078.
https://doi.org/10.1111/j.1398-9995.2005.00833.x DOI: https://doi.org/10.1111/j.1398-9995.2005.00833.x
Alzahrani NS, Alshammari MA, Alshaer ZA, Alfouwais NM, Alhunaki RN, Albasi AA, et al. Chronic idiopathic urticaria impacts on patients' quality of life. Saudi Ar Int J Sci & Eng Res 2017; 8: 1246-1247.
Maurer M, Ortonne JP, Zuberbier T. Chronic urticaria: an internet survey of health behaviors, symptom patterns and treatment needs in European adult patients. Br J Dermatol 2009; 160: 633-641.
https://doi.org/10.1111/j.1365-2133.2008.08920.x DOI: https://doi.org/10.1111/j.1365-2133.2008.08920.x
Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria: a GA²LEN task force report. Allergy 2011; 66:317-330.
https://doi.org/10.1111/j.1398-9995.2010.02496.x DOI: https://doi.org/10.1111/j.1398-9995.2010.02496.x
Weller K, Groffik A, Church MK, Hawro T, Krause K, Metz M, et al. Development and validation of the urticarial control test: a patient-reported outcome instrument for assessing urticarial control. J Allergy and Clin Imm 2014; 133: 1365-1372.
https://doi.org/10.1016/j.jaci.2013.12.1076 DOI: https://doi.org/10.1016/j.jaci.2013.12.1076
Irani C, Hallit S, Weller K, Maurer M, El Haber C, Salameh P. Chronic urticaria in most patients is poorly controlled: Results of the development, validation, and real life application of the arabic urticaria control test. Saudi Med J 2017; 38: 1230-1236.
https://doi.org/10.15537/smj.2017.12.21206 DOI: https://doi.org/10.15537/smj.2017.12.21206
Lennox RD, Leahy MJ. Validation of the Dermatology Life Quality Index as an outcome measure for urticaria-related quality of life. Ann Allergy Asthma Immunol 2004; 93: 142-146.
https://doi.org/10.1016/S1081-1206(10)61466-4 DOI: https://doi.org/10.1016/S1081-1206(10)61466-4
Tawil S, Irani C, Kfoury R, Salameh P, Baiardini I, Weller K, et al. The Arabic Urticaria Activity Score and Chronic Urticaria Quality of Life Questionnaire: validation and correlations. Int J Dermatol 2020; 59: 893-901.
https://doi.org/10.1111/ijd.15006 DOI: https://doi.org/10.1111/ijd.15006
Lambachahab FE, Abouqqal R, Hassam B, Ismaili N. The Arabic version of the dermatology life quality index for Morocco: psychometric properties in psoriasis. J Am Ac Derm 2010; 62: 138-142.
Basra MK, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results. Br J Dermatol 2008; 159: 997-1035.
https://doi.org/10.1111/j.1365-2133.2008.08832.x DOI: https://doi.org/10.1111/j.1365-2133.2008.08832.x
Eltaher SM, Araby EM. Health related quality of life in patients with vitiligo. Egypt J Comm Medi 2015; 33: 77-83.
https://doi.org/10.21608/ejcm.2015.710 DOI: https://doi.org/10.21608/ejcm.2015.710
American Psychiatric Association, 2022. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR™). Washington, DC: American Psychiatric Press.
Kroenke K, Spitzer RL, Williams JB, Lowe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010; 32: 345-359.
https://doi.org/10.1016/j.genhosppsych.2010.03.006 DOI: https://doi.org/10.1016/j.genhosppsych.2010.03.006
Sawaya H, Atoui M, Hamadeh A, Zeinoun P, Nahas Z. Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psych Res 2016; 239: 245-252.
https://doi.org/10.1016/j.psychres.2016.03.030 DOI: https://doi.org/10.1016/j.psychres.2016.03.030
Abou Abbas L, Salameh P, Mansour Z, Nasser Z, Elias E, Godin I. Development and initial validation of a brief scale for assessing psychological distress in obese adults. Clin Epidemiol Global Health 2016; 4: 16-22.
https://doi.org/10.1016/j.cegh.2015.08.001 DOI: https://doi.org/10.1016/j.cegh.2015.08.001
Barbour B, Saadeh N, and Salameh P. Psychological distress in Lebanese young adults: constructing the screening tool "BDS-22". Int J Culture and Mental Health 2012; 5: 94-108.
https://doi.org/10.1080/17542863.2011.563043 DOI: https://doi.org/10.1080/17542863.2011.563043
Nunnaly JC, Bernstien IH. Psychometric theory. 3rd ed. NewYork: Mc Graw-Hill; 1994.
Takeuchi S, Esaki H, Furue M. Epidemiology of atopic dermatitis in Japan. J Dermatol 2014; 41: 200-204.
https://doi.org/10.1111/1346-8138.12331 DOI: https://doi.org/10.1111/1346-8138.12331
Kubota K, Kamijima Y, Sato T, Ooba N, Koide D, Iizuka H, et al. Epidemiology of psoriasis and palmoplantar pustulosis: a nationwide study using the Japanese national claims database. Br Med J Open 2015; 5: e006450.
https://doi.org/10.1136/bmjopen-2014-006450 DOI: https://doi.org/10.1136/bmjopen-2014-006450
Itakura A, Tani Y, Kaneko N, Hide, M. Impact of chronic urticaria on quality of life and work in Japan: Results of a real-world study. J Derm 2018; 45: 963-970.
https://doi.org/10.1111/1346-8138.14502 DOI: https://doi.org/10.1111/1346-8138.14502
Stull DE, McBride D, Houghton K, Finlay AY, Gnanasakthy A, Balp MM. Assessing changes in chronic spontaneous/idiopathic urticaria: comparisons of patient-reported outcomes using latent growth modeling. Adv Ther 2016; 33: 214-224.
https://doi.org/10.1007/s12325-016-0282-0 DOI: https://doi.org/10.1007/s12325-016-0282-0
Dias GC, Pires GV, Do Valle SR, Dortas SD, Levy S, França AT, et al. Impact of chronic urticaria on the quality of life of patients followed up at a university hospital. An Bras Dermatol 2016; 91: 754-759.
https://doi.org/10.1590/abd1806-4841.20165071 DOI: https://doi.org/10.1590/abd1806-4841.20165071
Yun J, Katelaris CH, Weerasinghe A, Adikari DB, Ratnayake C. Impact of chronic urticaria on the quality of life in Australian and Sri Lankan populations. Asia Pac Allergy 2011; 1: 25-29.
https://doi.org/10.5415/apallergy.2011.1.1.25 DOI: https://doi.org/10.5415/apallergy.2011.1.1.25
Heng JK, Koh LJ, Toh MP, Aw DC. A study of treatment adherence and quality of life among adults with chronic urticaria in Singapore. Asia Pac Allergy 2015; 5: 197-202.
https://doi.org/10.5415/apallergy.2015.5.4.197 DOI: https://doi.org/10.5415/apallergy.2015.5.4.197
Revuz JJ, Ortonne JP, Auquier P, Lorette G. Comparative study of the impact of chronic urticaria, psoriasis and atopic dermatitis on the quality of life. Br J Derm 2005; 152: 289-295.
https://doi.org/10.1111/j.1365-2133.2005.06385.x DOI: https://doi.org/10.1111/j.1365-2133.2005.06385.x
Sperber J, Shaw J, Bruce S. Psychological components and the role of adjunct interventions in chronic idiopathic urticaria. Psychother Psychosom 1989; 51: 135-141.
https://doi.org/10.1159/000288147 DOI: https://doi.org/10.1159/000288147
Özkan M, Oflaz SB, Kocaman N, Özşeker F, Gelincik A, Büyüköztürk S, et al. Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol 2007; 99: 29-33.
https://doi.org/10.1016/S1081-1206(10)60617-5 DOI: https://doi.org/10.1016/S1081-1206(10)60617-5
Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dermatol 2010; 35: 869-873.
https://doi.org/10.1111/j.1365-2230.2010.03840.x DOI: https://doi.org/10.1111/j.1365-2230.2010.03840.x
Niemeier V, Nippesen M, Kupfer J, Schill WB, Gieler U. Psychological factors associated with hand dermatoses: which subgroup needs additional psychological care? Br J Dermatol 2002; 146: 1031-1037
https://doi.org/10.1046/j.1365-2133.2002.04716.x DOI: https://doi.org/10.1046/j.1365-2133.2002.04716.x
Verhoeven L, Kraaimaat F, Duller P, van de Kerkhof P, Evers A. Cognitive, behavioral, and physiological reactivity to chronic itching: analogies to chronic pain. Int J Behav Med 2006; 13: 237-243
https://doi.org/10.1207/s15327558ijbm1303_7 DOI: https://doi.org/10.1207/s15327558ijbm1303_7
Baumann M, Ionescu I, Chau N. Psychological quality of life and its association with academic employability skills among newly-registered students from three European faculties. BMC Psychiatry 201; 11: 63.
https://doi.org/10.1186/1471-244X-11-63 DOI: https://doi.org/10.1186/1471-244X-11-63
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