Psychosocial Impact of Acne Vulgaris: Evaluating the Evidence

J. K. L. Tan, MD, FRCPC


Skin Therapy Letter. 2004;9(7) 

In This Article

Cross-sectional Population Surveys

Cross-sectional studies are more rapid and less expensive to conduct than cohort studies. They are useful for controlling subject selection and controlling measurements, and can yield prevalence data. A particular limitation is the difficulty of establishing causal relationships or sequencing of events. There are a limited number of these studies in the literature evaluating the association of acne and psychological disturbances in the context of the general population (see Table 2 ).

A recent survey of 2,657 students from Turkey, aged 14-20 years, detected a prevalence of acne, anxiety and depression of 23%, 25%, and 13% respectively. In addition, the Hospital Anxiety and Depression scale (HAD), was administered to 308 acne patients whose responses were compared to responses of the same number of gender-matched controls. No differences were detected in the subscale scores for anxiety or depression in acne versus control subjects. Limitations of this scale include uncertain sensitivity and responsiveness in detecting psychological abnormalities in a relatively young outpatient population, and specificity in determining attributability of anxiety and depression to acne.[11]

In a survey of 317 students aged 14-16 from England, an age-appropriate, validated scale, i.e., the Strengths and Difficulties Questionnaire (SDQ), was used to assess psychological health. Subjects with acne were twice as likely to score in the borderline or abnormal range of the SDQ compared to unaffected students. Furthermore, the presence of acne was associated with higher levels of emotional and behavioral difficulties.[12]


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