1. Predictors of Quality of Life for Adults with Acne: The Contribution of Perceived Stigma
Johanna K. Liasidesa, M.Sc., Fotini-Sonia Apergia, Psy.D.,
aThe American College of Greece
The Annual International Conference on Cognitive - Social, and Behavioural Sciences icCSBs January

2. Introduction: Appearance Based Prejudice and Visible Differences
Social psychological research studies have shown that individuals with visible differences are subject to appearance based prejudice and discrimination (Borah & Rankin, 2003; Houston & Bull, 1994)
The most commonly reported stigmatizing behavior directed towards people with visible differences is (Spence, 2008):
Negative attention
Avoidance
Experimental studies have further shown participants’ preferential attitude towards clear skin (Del Rosso et al., 2011)
Negative attitudes towards blemished skin may translate to stigmatizing behavior and discriminatory practices (Adams et al., 2008)
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3. Introduction: The Effect of Perceived Stigma on Well-being
Dermatological stigma has been associated with psychological distress and disability in patients with psoriasis, eczema, vitiligo and atopic dermatitis (Griffiths et al., 2007; Fortune et al., 2012), i.e.:
Low self-esteem
Depressive feelings and loneliness
Guilt and shame
Appearance anxiety
There is a marked lack of studies which investigate the effects of perceived stigma among individuals with acne
The Feelings of Stigmatization Questionnaire (FSQ; Ginsburg & Link, 1989) has yet to be modified for patients with acne
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4. Introduction: Psychosocial Impact of Skin Conditions
The emergence of skin conditions has been associated with:
Lowered quality of life (Cho et al., 2006; Finlay et al. 1999)
Quality of life measures are often used in dermatological research but not by dermatologists in clinical practice to guide treatment planning (Finlay, 2005)
Patients with acne report similar levels of social and emotional problems compared to other chronic physical conditions (Finlay et al., 1999)
Concerns about body image (Benrud-Larson et al., 2003)
Lowered self-esteem (Harcourt & Rumsey, 2005; Kent & Thompson, 2001)
Interpersonal difficulties (Harcourt & Rumsey, 2005; Papadopoulos & Walker, 2003)
Psychological co-morbidities such as anxiety and depressive disorders (Gupta, 2005; Harcourt & Rumsey, 2005)
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5. Introduction: Predictors of Maladjustment to Visible Differences (Papadopoulos & Walker, 2005)
Having a visible blemish
Age
Adulthood
Gender
Female
Relationship Status
Single
Rating one’s skin condition as severe
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6. Introduction: Realities and Myths about Acne
Acne is considered a psychophysiological disorder which predominately affects the adolescent population but may persist or develop in adulthood (Papadopoulos & Walker, 2005)
Myths and misconceptions about acne influence how acne sufferers think and feel about themselves (Papadopoulos & Walker, 2005)
Myth 1: Acne solely occurs in adolescence
Myth 2: People with acne are not properly able to take care of themselves
Myth 3: Constantly clearing or scrubbing one’s face is helpful in improving acne
Adults with acne may feel a loss of their former identity and powerless in improving their skin condition; their behavior and feelings about themselves may be determined by the condition of their skin (Murray & Rhodes, 2005)
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7. Introduction: Research Aims
Problem Statement
As dermatology patients complain that their psychological distress is extensive and often overlooked, it is concerning that there is a paucity of research investigating factors associated with acne-related QOL
Research Aim
To compile a preliminary list of risk factors for psychosocial distress as a result of having acne in adulthood, while specifically examining the role of an under investigated variable - perceived stigma
Research Question
What is the predictive capacity of perceived stigma, self-rated severity, location and previous history of acne, gender, age, relationship status and education for the QOL of adult dermatology patients?
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8. Methodology: Participants
Ages: 18-56
(M= 26.37, SD=7.97)
Six private dermatologists were approached and asked to distribute questionnaires to their patients with acne
Convenience sampling
Inclusion criteria: current acne sufferers aged 18+
Exclusion criteria: current diagnosis of mental illness
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9. Methodology: Participants
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10. Methodology: Participants
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11. Methodology: Measures
General Background Questionnaire
9-item
Socio-demographic characteristics (gender, age, education, relationship status)
Dermatological characteristics (location of acne, self and doctor rated severity of acne, history of acne)
Feelings of Stigmatization Questionnaire (FSQ; Ginsburg & Link, 1989)
Self-report questionnaire designed to measure feelings of perceived stigma in individuals with psoriasis and eczema;
Modified to measure FSQ in individuals with acne;
Consists of 32 items which reflect six factors of perceived stigma;
Good internal consistency scores ranging from α=.84 to α=.94;
After cultural adaption, Chronbach’s α=.85
Acne-related Quality of Life (Acne-QoL; Botek, Girman, Light, Lookingbill, Martin & Thiboutot, 2001)
Self-report questionnaire designed to measure QOL among individuals with facial acne;
Modified to measure QOL in individuals with multi-domain acne;
Consists 19 items which relate to four domains of Acne-QoL;
Good internal consistency scores ranging from α= .70 to α=.95;
After cultural adaptation, α=.84 to α=.94
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12. Methodology: Procedure1
Ethical Approval 2
Test Modification 3
Cultural Adaptation 4
Reliability Analysis 5
Data Collection 6
Data Analysis
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13. Results: Preliminary Analysis
Reliability of culturally adapted FSQ and Acne-QOL:
Chronbach’s α = .85 for FSQ
Chronbach’s alpha ranged from .84 to .94 for Acne-QoL
Diagnostics indicated that the assumptions of parametric and regression data were met
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14. Results
Mean Scores and Standard Deviation for Measures of Perceived Stigma and Acne-Related Quality of Life
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15. Results

16. Results
Note. B: unstandardized coefficient; SE B: Std. Error; β: standardized coefficient
*p < **p < ***p <
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17. Results
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18. Implications for Policy/Practice
Although it is important to take into account the individual differences of adults with acne, the preliminary list of risk factors of psychological distress for afflicted individuals compiled in this study could be clinically useful in providing red flags for dermatologists treating adults with acne. That is, by being informed of the factors which place adults with acne more at risk of being handicapped by their skin condition, dermatologists can provide more holistic treatment by referring them to a mental health professional when needed;
The introduction of QOL measures to dermatologists in this study is also helpful in increasing their awareness of the possible uses of such instruments in clinical practice
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19. Implications for Policy/Practice
Following the footsteps of Hrehorow et al.’s (2012) recent research, other studies could attempt to discern the most prominent aspects of the stigmatization experience in individuals with skin conditions, in order to gain a better understanding and create more appropriate interventions addressing the nature of their stigmatization;
Determining the correlates of perceived stigma will also aid in identifying individuals who are at risk of encountering stigmatization as a result of their cutaneous pathology

20. Conclusion
This research study provides initial evidence that adults who feel stigmatized are at risk for developing psychological distress as a result of having acne;
According to the results, the risk factors of secondary importance may include an individual’s self-rated severity of acne (rating one’s skin condition as worse), gender (being female), age (being a younger adult) and not having a previous history of acne;
Future researchers could add other psychosocial variables to their regression model, such as self-esteem and coping styles, in order to explain the remaining variance of Acne-QOL
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21. References
Adams, J., Heading, G., Magin, P., Pond, D., & Smith, W. (2008). Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelaue:
Results of a qualitative study. Scand J Caring Sci, 22,
Benrud-Larson, L., Boling, C., Heinberg, L., Reed, J., White, B. & Wigley, E. (2003). Body image dissatisfaction among women with scleroderma: extent and relationship to
psychosocial functions. Health Psychology, 22,
Borah, G., & Rankin, M. (2003). Perceived functional impact of abnormal facial appearance. Plastic and Reconstructive Surgery, 111(7),
Botek, A., Girman, A., Light, J., Lookingbill, D., Martin, A., & Thiboutot, D. (2001). Health-related quality of life among patients with facial acne- assessment of a new acne-
specific questionnaire. Clinical Dermatology, 26,
Cho,H.S. Kim, K., Kim, J., Lee, S., Jung, S., & Seung, N. Quality of life of acne patients. (2006). Korean J Dermatol, 44(6),
Del Rosso, J., La Riche, C., Ritvo, E., & Stillman, M. (2011). Psychosocial judgments and perceptions of adolescents with acne vulgaris: a blinded controlled comparison of
adult and peer evaluations. BioPsychoSocial Medicine, 5(11), 1-14.
Feldman, S., Kerchner, K., Krejci-Manwaring, J., Rapp, D., & Rapp, S. (2006). Social sensitivity and acne: the role of personality in negative social consequences and quality
of life. International J. Psychiatry in Medicine, 36(1)
Finlay, A., Klassen, J., Mallon, E., Newton, I., Ryan, S., & Stewart-Brown, R. (1999). The quality of life in acne” a comparison with general medical conditions using generic
questionnaires. British Journal of Dermatology, 140 (4),
Fortune, D., Giffiths, C., Main, C., & Richards, H. (2001). The contribution of perceptions of stigmatisation to disability in patients with psoriasis. Journal of Psychosomatic
Research, 50(1),
Ginsburg I.H., & Link B.G. (1989). Feelings of stigmatization in patients with psoriasis. J Am Acad Dermatol, 20, 53–63.
Griffiths, C., Fortune, D., Main, C., Richards, H., Williams, J., & Wittowski, A. (2007). An examination of the psychometric properties and factor structure of the feelings of s
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22. Gupta, M. (2005). Psychiatric comorbidity in dermatological disorders
Gupta, M. (2005). Psychiatric comorbidity in dermatological disorders. In L. Papadopoulos & C. Walker (Eds.), Psychodermatology: the psychological impact of skin
disorders. (pp ). UK: Cambridge University Press.
Harcourt, D., & Rumsey, N. (2005). The psychology of appearance. UK: Open University Press.
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Papadopoulos, L., & Walker, C. (2003). Understanding skin problems: Acne, eczema, psoriasis and related conditions. U.K.: John Wiley & Sons Ltd.
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Spence, R. (2008). The challenge of reconstruction for severe facial burn deformity. Plastic Surgical Nursing, 28(2),
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23. Predictors of Quality of Life for Adults with Acne: The Contribution of Perceived Stigma
Johanna K. Liasides, M.Sc., The American College of Greece
Fotini-Sonia Apergi, Psy.D., The American College of Greece
The Annual International Conference on Cognitive - Social, and Behavioural Sciences icCSBs January