Psychosocial adjustment to stigma among young adults with chronic visible skin disease

Living with a stigmatizing skin disease may hinder normative development during emerging adulthood. The present study aimed to examine indirect effects of internalized stigma in the relationship between social stigma and psychosocial adjustment among young adults with visible chronic skin diseases. Indicators of psychosocial adjustment spanned several domains: mental health (depression, anxiety, quality of life), physical health (somatic symptoms), intimacy and health behaviour (physical activity).

This cross-sectional study recruited young adult patients with chronic skin disease from an outpatient dermatology clinic. Data were obtained through self-report, electronic medical records and a physical exam.

Young adults (N = 195, M_age = 28.06 years; 49% female) with psoriasis (55%), atopic dermatitis (23%) or hidradenitis suppurativa (22%) self-reported sociodemographic information and measures for social stigma (PSQ), internalized stigma (WBIS-adapted) and psychosocial adjustment (PHQ-9, GAD-7, DLQI, SSS-8, DIS, days of physical activity per week). Bootstrapped mediation analyses tested indirect effects of internalized stigma on the relationship of social stigma and each psychosocial adjustment outcome, controlling for covariates.

Indirect effects of internalized stigma on the relationship of social stigma with each outcome were significant (p's < .01, R² = .10 to .64).

Findings indicated that stigma has implications for many areas of functioning and well-being, highlighting how emerging adulthood contextualizes the experience of living with the stigma of visible skin disease. Internalized stigma was a major driving force, serving as a potential target for clinical and psychoeducational interventions to improve the well-being of young adults with chronic visible skin disease.