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Table of Contents
Year : 2021  |  Volume : 25  |  Issue : 1  |  Page : 22-25

Psychiatric morbidity among dermatology patients: A hospital-based cross-sectional study

1 Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
2 Department of Mental Health/Neuropsychiatry, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Date of Submission04-Sep-2020
Date of Acceptance30-Sep-2020
Date of Web Publication04-May-2021

Correspondence Address:
Dr. Chukwuma U Okeafor
Department of Mental Health/Neuropsychiatry, University of Port Harcourt Teaching Hospital, P M B 6173, Port Harcourt, Rivers State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdds.jdds_41_20

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Background: Increased frequency of psychiatric and emotional health problems has been reported among patients with dermatological lesions. These problems could negatively affect the quality of life of these patients. Purpose: The aim of the study was to evaluate the psychiatric morbidity among dermatology patients. It also sought to determine the relationship between sociodemographic factors and psychiatric morbidity. Methods: This was a cross-sectional study consisting of 90 consenting patients attending the dermatological clinic of University of Port Harcourt Teaching Hospital. These patients filled the study questionnaire which comprised of a sociodemographic questionnaire, general health questionnaire (GHQ-12), and a perceived stigma scale. A GHQ score of ≥ 3 was considered as having psychiatric morbidity. Statistical analysis was performed at the 0.05 significance level. Results: The mean age of the patients was 32 ± 13 years and a male to female ratio of 1:2; 34 of the 90 patients (38%) had psychiatric morbidity. Forty-three (48%) patients had perceived stigma, with mild perceived stigma as the most common category (40%) of perceived stigma. There was no significant relationship between sociodemographic characteristics of the patients and psychiatric morbidity (P > 0.05). Conclusion: Psychiatric morbidity is common among patients with dermatological lesions irrespective of their sociodemographic characteristics. Addressing the psychosocial care of patients who attend the dermatologic outpatient clinic may be helpful.

Keywords: Dermatology, mental health, perceived stigma, psychiatric disorders

How to cite this article:
Altraide DD, Okeafor CU, Otike-Odibi BI. Psychiatric morbidity among dermatology patients: A hospital-based cross-sectional study. J Dermatol Dermatol Surg 2021;25:22-5

How to cite this URL:
Altraide DD, Okeafor CU, Otike-Odibi BI. Psychiatric morbidity among dermatology patients: A hospital-based cross-sectional study. J Dermatol Dermatol Surg [serial online] 2021 [cited 2022 Dec 8];25:22-5. Available from: https://www.jddsjournal.org/text.asp?2021/25/1/22/315328

  Introduction Top

The physical and mental well-being of individuals are affected to a large extent by their skin appearance.[1] The brain and the skin are not only of the same ectodermal origin, but are also influenced by the same neurotransmitters.[2] Consequently, a relationship between dermatological disorders and psychiatric problems have long been hypothesized.[2] At least 30% of dermatologic disorders have background psychiatric problems.[3] Thus, some dermatology patients may require psychotherapeutic interventions, in addition to the standard dermatologic therapies for the management of psychiatric comorbidity.[4] Therefore, in the management of patients with dermatological disorders, psychiatric evaluation is important.

However, in many parts of the globe, the relationship between psychiatric and dermatological disorders has been scarcely investigated. Thus, psychodermatology, a clinical specialty that combines dermatology and psychiatry is seldom recognized.[5] Nevertheless, psychiatric problems can occur among patients diagnosed with dermatological disorders in low resource settings.[6] These problems have a negative impact on the quality of life of patients, and also forestall holistic well-being of the sufferers of skin disorders.

Although the burden of psychiatric disorders are on the increase, they could be overlooked among dermatology patients.[7] Thus, the burden of such disorders in dermatology clinic settings may be under-reported. Therefore, the index study sought to determine the prevalence of psychiatric morbidity among patients with dermatological disorders; and determine the relationship between sociodemographic findings and psychiatric morbidity.

  Methods Top

Study area

The study was conducted in the University of Port Harcourt Teaching Hospital (UPTH), a tertiary health facility located in Rivers State, South-South geopolitical zone of Nigeria. Dermatological services are among the various subspecialties offered in the hospital. The outpatient clinic runs once a week (on Thursdays), with an average of 30 patients.

Study design and study population

This was a descriptive cross-sectional study involving patients diagnosed with dermatological disorders by the dermatologist.

Sample size calculation and sampling

The formula for cross-sectional study was employed in this study.[8] A minimum sample size of 86 was obtained based on an alpha level of 0.05, beta of 0.20, 12.5% prevalence of psychiatric illness among dermatology patients from a Nigerian study,[6] and precision level of 5%. This was rounded off to 90. Hence, 90 patients with dermatological disorders were involved in the study. Patients were selected consecutively from the dermatology outpatient clinic.

Ethical considerations

The UPTH Research and Ethics board, a human subject research committee granted approval for the study with reference UPTH/ADM/90/S. II/VOL. XI/944. The principles of ethics involving human research were upheld in this study. Informed consent was obtained from patients prior to their inclusion in the study. Confidentiality and anonymity were maintained in the course of the study. Patients identified with psychiatric morbidity were counselled and referred to the neuropsychiatry clinic for further evaluation and expert care.

Data collection

Data were collected using an interviewer-based study tool comprising of sociodemographic questionnaire (age, sex, and duration of dermatology disorder), general health questionnaire (GHQ-12), and perceived stigma scale. The GHQ-12 is a widely used validated and reliable screening tool for assessing psychiatric morbidity in outpatient settings; a score of ≥3 was considered as having psychiatric morbidity.[9],[10],[11] A validated perceived stigma scale was used to ascertain the occurrence of stigma among the patients in the study.[12],[13]

Statistical analysis

Data collected were entered into Microsoft Excel and exported to IBM Statistical Package of Social Sciences (SPSS) IBM, Chicago, Illinois, United States of America version 20 for statistical analysis. Frequencies, proportions, means ± standard deviation (SD), median and range were used to summarize data. Data were tested for normality using Kolmogorov–Smirnov statistics. Normally distributed data were analysed using independent t-test, a parametric test. Data on duration of dermatological disorders were not normally distributed, thus Mann–Whitney U, a nonparametric test was used to compare significant difference across psychiatric morbidity in the study. Chi-square test was used to determine significant differences in proportions. Statistical significance was set at P < 0.05.

  Results Top

A total of 90 patients with dermatological disorders were involved in the study. They comprised of 28 (31%) males and 62 (69%) females, yielding a male to female ratio of 1:2. The mean age (±SD) of the participants was 32 ± 13 years. The mean duration (±SD) of dermatological disorder was 4 ± 8 years; the median duration of skin disorder was 8 months with minimum and maximum duration of 1 week and 50 years, respectively.

Psychiatric morbidity was reported in 34 patients giving a prevalence rate of 38%. Forty-three (48%) patients had perceived stigma [Figure 1]. Psychiatric morbidity had the highest frequency among patients with Tinea infection (21%), followed by acne [14%, [Figure 2]. There was no significant difference between mean age of dermatology patients with psychiatric morbidities and those without (P = 0.840). Psychiatric morbidity was higher among females (40%) in comparison to males (32%) but was not statistically significantly different (P = 0.459). Although not statistically significant (P = 0.211), the median duration of dermatological disorders was lower among those with psychiatric morbidity in comparison to those without psychiatric morbidities [Table 1].
Figure 1: Perceived stigma status of dermatology patients in the study

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Figure 2: Frequency of psychiatric morbidities across dermatological diagnoses

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Table 1: Sociodemographic findings by psychiatric morbidity among patients with dermatological disorders

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  Discussion Top

The occurrence of psychiatric morbidity among dermatology patients forms the basis of psychodermatology. Psychiatric morbidity is not uncommon among patients suffering from skin disorders. Psychiatric morbidity prevalence of 35% reported in this study is consistent with that of Korabel et al.,[14] who noted that 30%–60% of dermatology patients have psychiatric morbidity. However, the finding reported in the present study is much higher than that reported in a Nigerian study by Aina and Owoeye.[6] Unlike the index study, the study population in the research by Aina and Owoeye[6] comprised of only patients with more than 6 months' duration of dermatological disorders, which limits the external validity of their study. Notably, the patients in the index study had a wide range of duration of dermatological disorders, which was from 1 week to 50 years. Thus, the present study could be described as having a wider external validity in comparison to that of Aina and Owoeye,[6] nonetheless, the presence of a control group in the study by Aina and Owoeye is commendable; as these authors noted a significantly higher proportion of psychiatric morbidity among dermatology patients in comparison to the control group.

Patients with Tinea infection and acne had the highest proportion of psychiatric morbidity in comparison to other dermatological disorders in the index study, possibly highlighting the potential need for mental health screening among dermatology patients. Mental health screening for patients at dermatology outpatient clinics is further supported by the apparently high prevalence of 35%; as this invariably implies that about 3 in 10 patients with dermatological disorders suffer from psychiatric morbidity.

Closely related to psychiatric morbidity is perceived stigma. The present study notes that in addition to psychiatric morbidity, these patients struggle with perceived stigma. The finding of almost half of the patients with dermatology disorders experiencing perceived stigma in this study possibly exposes the need to institute stigma prevention strategies among patients receiving care at dermatology outpatient clinics. Although the present study did not investigate quality of life of the patients, the finding of high prevalence of both psychiatric morbidity and perceived stigma have negative effects on quality of life of the patients.[4],[14] These mental health issues facing patients with skin problems need to be adequately addressed to ensure their holistic care.

The study being a descriptive cross-sectional study did not have a control group, however, the authors advocate for further studies involving comparison groups. Furthermore, psychiatric diagnoses were not assessed in the index study, rather the broad psychiatric morbidity was determined. The authors recommend more research on common psychiatric illnesses such as depression and anxiety among dermatology patients.

Based on the age and sex characteristics of patients, the index study showed no significant relationship between these demographic findings and occurrence of psychiatric morbidity. Thus, the study highlights the need to institute interventions targeted at promoting optimal mental health among dermatology patients irrespective of their age and sex characteristics.

  Conclusion Top

About 3 in 10 dermatology patients have psychiatric morbidity. The occurrence of psychiatric morbidity has no significant relationship with age and sex of the patients. Psychiatric morbidity screening at the dermatology outpatient clinic could help identify dermatology patients that require psychiatric intervention.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Aktan S, Ozmen E, Sanli B. Psychiatric disorders in patients attending a dermatology outpatient clinic. Dermatology 1998;197:230-4.  Back to cited text no. 1
Koblenzer CS. Psychosomatic concepts in dermatology. A dermatologist-psychoanalyst's viewpoint. Arch Dermatol 1983;119:501-12.  Back to cited text no. 2
Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: Epidemiology and management. Am J Clin Dermatol 2003;4:833-42.  Back to cited text no. 3
Basavaraj KH, Navya MA, Rashmi R. Relevance of psychiatry in dermatology: Present concepts. Indian J Psychiatry 2010;52:270-5.  Back to cited text no. 4
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Shenoi SD, Prabhu S, Nirmal B, Petrolwala S. Our experience in a psychodermatology liaison clinic at manipal, India. Indian J Dermatol 2013;58:53-5.  Back to cited text no. 5
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Aina OF, Owoeye AO. Psychological distress among attendees of a dermatology clinic in Lagos, Nigeria. J Chinese Clin Med 2010;5:216-20.  Back to cited text no. 6
Aslam R, Qadir A, Asad F. Psychiatric morbidity in dermatological outpatients: An issue to be recognized. J Pak Assoc Dermatol 2016;17:235-9.  Back to cited text no. 7
Kirkwood BR Sterne JA. Calculation of required sampe size. In: Essentials Medical Statistics. 2nd ed.. UK: Blackwell Science; 2003. p. 40-1.  Back to cited text no. 8
Picardi A, Abeni D, Pasquini P. Assessing psychological distress in patients with skin diseases: Reliability, validity and factor structure of the GHQ-12. J Eur Acad Dermatol Venereol 2001;15:410-7.  Back to cited text no. 9
Picardi A, Amerio P, Baliva G, Barbieri C, Teofoli P, Bolli S, et al. Recognition of depressive and anxiety disorders in dermatological outpatients. Acta Derm Venereol 2004;84:213-7.  Back to cited text no. 10
Bashir K, Dar NR, Rao SU. Depression in adult dermatology outpatients. J Coll Physicians Surg Pak 2010;20:811-3.  Back to cited text no. 11
Birbeck G, Chomba E, Atadzhanov M, Mbewe E, Haworth A. The social and economic impact of epilepsy in Zambia: A cross-sectional study. Lancet Neurol 2007;6:39-44.  Back to cited text no. 12
Jacoby A. Felt versus enacted stigma: A concept revisited. Evidence from a study of people with epilepsy in remission. Soc Sci Med 1994;38:269-74.  Back to cited text no. 13
Korabel H, Dudek D, Jaworek A, Wojas-Pelc A. Psychodermatology: Psychological and psychiatrical aspects of dermatology. Przegl Lek 2008;65:244-8.  Back to cited text no. 14


  [Figure 1], [Figure 2]

  [Table 1]


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