To what extent do disease severity and illness perceptions explain depression, anxiety and quality of life in Hidradenitis Suppurativa Alicia Pavon Blanco,1 Mark Turner1,2, Gabriela Petrof2, John Weinman1 1King’s College London 2St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust British Journal of Dermatology. DOI: 10.111/bjd.17123

Lead Researcher Professor John Weinman Professor of Psychology as Applied to Medicine

Introduction What’s already known? Hidradenitis Suppurativa (HS) is known to be a highly distressing and debilitating skin condition which has a profound effect on quality of life (QoL), mood, and anxiety. It has been assumed that these effects are directly related to disease severity. No previous studies have investigated patients’ perceptions of their HS, and whether these are related to disease severity and/or their QoL and mood.

Objective To examine the relationships between disease severity, illness perceptions and depression, anxiety and QoL in HS. To investigate whether patient outcomes are more strongly related to clinicians’ ratings of disease severity or to the patient’s perception of their condition.

Methods Design Sample Data collection Exploratory and cross-sectional 211 consecutive patients from Guy’s HS tertiary clinic Sample Jul 2014 – Jan 2015 IMPARTS used to collect data on: Brief Illness Perception Questionnaire (BIPQ; Broadbent et al., 2006) Patient Health Questionnaire – 2 (PHQ-2; Kroenke, et al., 2003) Generalised Anxiety Disorder – 2 (GAD-2; Kroenke et al., 2007) Dermatology Life Quality Index (DLQI; Finlay & Khan, 1994) Patients records used to collect data on: HS Hurley Stage and demographics Data collection An exploratory cross-sectional study in design, including 211 consecutive patients attending the HS tertiary service at Guy’s hospital completing validated questionnaires as part of the IMPARTS initiative evaluating their illness perceptions and reported depression, anxiety and QoL. IMPARTS stands for “Integrating Mental and Physical Healthcare: Research Training and Services”. It’s a project funded by King’s Health Partners to integrate mental and physical healthcare in research, training and clinical services at Guy’s, St Thomas’s and King’s College Hospitals.

Methods Statistical analyses SPSS package Spearman’s Rho correlations Jonckheere Terpstra trend test Hierarchical multiple regressions 1st step: demographics 2nd step: HS Hurley severity 3rd step: Illness Perceptions Statistical analyses

Results – Median BIPQ scores are independent of disease severity The illness perceptions shown in the graph correspond to the following: BIPQ1= consequences, BIPQ2= timeline, BIPQ3= personal control, BIPQ4= treatment control, BIPQ5= identity, BIPQ6= concern, BIPQ7= understanding, and BIPQ8= emotional response. High median illness perceptions (BIPQ) scores suggest that people with HS find their illness threatening. Jonckheere Terpstra trend tests showed no significant differences in illness perceptions by disease severity except for only 1 item (understanding-BIPQ7). This indicates that illness perceptions were independent of disease severity and highlight discrepancy between clinicians assessments and patients beliefs of HS. Note. Higher scores represent stronger endorsement of that dimension.

Results – Spearman’s correlations More negative illness perceptions are associated with higher depression, anxiety and impaired QoL. Examination of the scatterplots and line graphs showed that, overall, the more negative illness perceptions the individual held, the more negative psychological outcomes and QoL. Note. Statistical significance: * p < .05 (2-tailed); **p < .01 (2-tailed)

Results – hierarchical multiple regressions The inclusion of illness perceptions into the regression models showed the greatest significant increase in the explained variance for depression, anxiety and QoL. When controlling for other variables such as disease severity, results showed that illness perceptions had the greatest unique contribution to the variability in depression, anxiety and QoL, after controlling for demographic and disease severity variables. This shows the stronger and independent association between illness perceptions and health outcomes.

Discussion This is the first study to show that: People with HS find their illness threatening independent of disease severity. Illness perceptions may be a stronger indicator of HS patients’ depression, anxiety and impaired QoL relative to Hurley stage of disease.

Conclusions What does this study add? This study examines the illness perceptions of patients with HS, and the extent to which these are related to clinician-rated disease severity, mood and QoL. Given that illness perceptions may be a stronger indicator of which patients are most likely to be depressed, anxious and impaired in their QoL, we suggest that HS clinics should consider routinely screening for illness perceptions early on.

Research Team Alicia Pavon Blanco Dr Mark Turner Dr Gabriela Petrof Professor John Weinman

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