Psychosocial impact and personality predictors of coherence feeling among girls with acne
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《美国医学杂志》
Pediatric Department, E. Wolfson Medical Center and Sackler School of Medicine in Tel Aviv University, Israel
Abstract
Objective : The extent to which acne influences the emotional life of adolescents is a matter of discussion; but people with acne are prone to emotional and psychological disturbances. Methods : 54 adolescent girls with acne were studied for their personality variables that are related to high coherence. Sense of coherence, e.g. meaningfulness of life, is crucial to copesuccessfully with stressors of living: it expreses the belief that a high probability exists that things will work out as well as can reasonably be expected. 58 adolescent girls without acne were in the control group. Results : Neuroticism (anxiety level) was the first predictor of the sense of coherence measure for girls with acne, explaining 19% of the variance. Extraversion was the next predictor, explaining an additional 2 3% of the variance, and psychoticism was the third predictor, explaining together 27% of the variance. There was a lack of difference between groups with respect to other personality variables. Conclusion : These predictors have to be taken into consideration while treating adolescents acne. Dermatologists, pediatricians and other physicians treating adolescents' acne should be familiar with emotional and psychosocial disturbances that accompany acne in order to effectively assist these patients.
Keywords: Acne; Girls; Sense of Coherence; Psychosocial impact
Acne is an inflammatiom of skin glands forming sebum; it includes: blackheads (open comedons), whiteheads (closed comedons) and localized areas of inflammation (papules and pustules); acne vulgaris may even cause visible disfigurement of the face.[1] Most authors admit the fact that acne can cause emotional and psychosocial disturbances.[2],[3],[4],[5] Baldwin pointed out acne may be associated with: anger, embarassment, frustration and depression.[1] Effective treatment of severe acne (vulgaris) had improved self-esteem, affects, obsessive compulsiveness, shame, embarrassment, body image and social assertiveness confidence.[6] A major psychological variable effecting emotional well-being is a sense of coherence (SOC). It means how a person sees the world as comprehensible and can face stress.[7] SOC, e.g. meaningfulness of life, may be considered as a central concept in the understanding of adolescents with potential psychosomatic difficulties. A strong SOC is crucial to successful coping with the ubiquitous stresses of living and hence to health maintenance.[8] SOC expresses the feeling that internal and external environments will work out as well as can reasonably be expected.[9] Antonovsky (1987) defined sense of coherence (SOC) as a global orientation that expresses the extent to which one has a pervasive, enduring and dynamic feeling of confidence that: (1) the stimuli deriving from one's internal and external environments are structured, predictable, and explicable; (2) the resources are available to meet the demands posed by these stimuli; and (3) these demands are viewed as challenges, worthy of investment and engagement.[8] The SOC may be applied as an emotional and cognitive character of a concrete situation. The strong SOC person seeks to impose structure on situations and to accept the challenges of situation, believing in his/her self-efficacy. SOC during adolescence has special meaning, pinpointing attention to the interrelations between the individual and his/her environment.
Powerful determinants of social behavior are the individual differences and the overall context in which behavior occurs.[10] Accepting the notion that individual differences are reflected in individual-environment interactions and are expressed in peer and familial interactions, a three-factorial personality structure can be expected to be related to the adolescents' competency and adjustment.[11] Study of individual differences has revealed three factors which may contribute to the prediction of the SOC: (a) extraversion-introversion (i.e., level of arousal and excitement seeking), (b) emotional stability vs instability (i.e., neuroticism), and (c) psychoticism versus impulse control.[12] The typical extrovert is a person who is sociable and craves excitement, whereas the typical introvert is quiet, introspective, and reserved in his/her interpersonal relations. The high neuroticism scorer is often described as an anxious, moody, and worrying individual. The typical youth with high psychoticism scores is often described as an insensitive, isolated, sensation seeking, aggressive, troublesome individual.[12] Cederblad et al pointed out that SOC reflect the level of anxiety, depression and self esteem.[13] Schumacher et al mentioned that high SOC was associated with lower subjective body complaints and somatoform symptoms, as well as with minor related problems in daily living.[14] Torsheim et al pointed out SOC may express adolescents school related stress, as well as healthy complaints and adaptation (15); and finally, Margalit had found low SOC among children suffering from learning disabilities.[16]
This study aims to determine if differences in SOC and various personality factors exist between adolescent girls with and without acne and, if positive, to describe predictors of SOC in patients with acne. The hypothesis was that severe acne would be associated with a lower SOC than that found in the control group without acne.
Materials and Methods
Subjects
The sample consisted of 112 female adolescents with age range from 15.0 to 17.0 years (M=16.01, SD=2.3), divided into two groups: (a) 54 girls with papulo-pustular acne (age 15.59±1.4) and (b) 58 girls without acne (age 15.97±1.7). The adolescents were students in the fifth through seventh grades of a regional academic high school in Holon (the fourth largest city in Israel).
Pupils were chosen at random from classes 9-10-11. They were examined individually by a senior pediatrician who diagnosed and confirmed the existence of acne on their face and/or their back. In addition, their medical records in school were checked for existence of acne in previous years. They were asked to fill the questionnaire anonymously in the physician's examination room during a 20-30 minute period. The control groups were girls from the same classes who were free of acne in the medical examination and according to their school medical records. There were no other differences between the two groups, as they attended the same school and the same class.
Instruments Sense of Coherence Scale (SOC)
The short validated form of the SOC[8] consisted of 10 statements on a 7-point Likert-type scale ranging from: Never[1] to Always.[7] The items for the short version were selected according to Antonovsky's suggestions. The alpha coefficient measure of internal consistency for the entire scale in its short form was 0.74.
Junior Eysenck Personality Questionnaire (J.EPQ)[12]
The Hebrew adaptation of the J.EPQ was used to reflect the personality factors of the sample. The Hebrew version of the questionnaire included 75 items divided into 3 factors: Psychoticism, Extraversion and Neuroticism. The Psychoticism factor included 19 items, such as "Do you seem to get into a lot of fights" with alpha coefficients of 0.60 for girls.
The Extraversion factor refers to the outgoing uninhibited social proclivities of a person. It included 17 items, such as "Do you like plenty of excitement going on around you" with alpha coefficients of 0.67 for girls.
The Neuroticism factor refers to the general emotional liability of a person, his over responsiveness and his liability to neurotic breakdown under stress. It included 20 items, such as "Are you moody" with alpha coefficients of .82 for girls. The intercorrelations between factors were low and insignificant. Statistical analysis was made using MANOVA test.
Results
In order to compare the Sense of Coherence and the J. EPQ scores, a one-way Multivariate Analysis of Variance (MANOVA) was performed, with Acne manifestation as the independent variable and the subscale scores (SOC, psychoticism, neuroticism and extraversion) as the dependent variables normal scores and no significant difference was found between the two groups of adolescent girls.
In order to further investigate the SOC global orientation measure for the group of females with and without acne, two-step wise multiple regressions were performed, with the J.EPQ scores as the independent measures, and the sense of coherence as the "dependent" variable. The results of the analysis are presented on table1.
Neuroticism was the first predictor of SOC measure for girls with acne, explaining 19% of the variance; extroversion was the next predictor, explaining additional 23% of the variance; psychoticism was the third predictor, explaining together 27% of the variance, and reaching a multiple regression score of 0.52.
For the girls without acne, neuroticism was also the first predictor of the sense of coherence explaining 14% of the variance; psychoticism was the second predictor, explaining additional 17% of the variance; extraversion was the third predictor, explaining together only 21% of the variance, and reaching a multiple regression score of 0.46.
Discussion
The results of the present study did not indicate significant differences between the two groups of girls with regard to their SOC, nor with their personality profile. It can be explained by their mild acne (there were no cases of acne vulgaris). However,after neurotism for the girls with acne, extraversion was a better predictor for the feeling of well being, while for the second group, psychotism was a better predictor. The coherence levels for girls with acne were related to their tendencies of being outgoing, looking for excitement and social in relations; while for the control group, their psychotism measure - their inability to control and inhibit themselves - was more important for their feelings of well-being, and negatively related to the sense of coherence.
The anxiety levels (neuroticism) of both groups of girls were the best predictors of their coherence feelings, yet the personality measures explained higher proportions of SOC variance for the girls with acne than for the control group. Bazynska et al found as well, significantly lower SOC in neurotic adolescents group.[17]
The potential individual psychosomatic component of the acne group pinpointed at an interactional model. SOC of the acne group was more related to their arousal levels and excitement seeking; while for the control group SOC was related to their attempts to avoid sensations and to obtain control over their impulses. Further studies are needed to clarify if these differences are significant.
The clinical implications of the present study are: acne is not a trivial disease[3]; it may seriously affect patients' life.[5] Dermatologists as well as other physicians treating adolescent acne should be familiar with psychological and social consequence of acne (like embarrassment, lack of enjoyment and avoidence of social activities)[18], in order to assist these patients.[1]
References
1. Baldwin HE. The interaction between acne vulgaris and psyche. Cutis 2002; 70 : 133-139.
2. Niemeier V, Kupfer J, Demmelbauer-Ebner M, Stangier U, Effendy I. Coping with acne vulgaris.Evaluation of the chronic skin disorder questionnaire in patient with acne. Dermatology 1998; 196 : 108-115.
3. Mallon E, Newton JN, Klassen A, Stewart-Brown SL, Ryan TJ, Finlay AY. The quality of life in acne:a comparison with general medical conditions using generic questionnaires. Br J Dermatol 1999; 140 : 672-676.
4. Martin AR, Lookingbill DP, Botek A, Light J, Thiboutot D, Girman CJ. Health-related quality of life among patients with facial acne-assessment of a new acne-specific questionnaire. Clin Exp Dermatol 2001; 26 : 380-385.
5. Barankin B, DeKoven J. Psychosocial effect of common skin diseases. Can Fam Physician 2002; 48 : 712-716.
6. Tan JK. Psychosocial impact of acne vulgaris: evaluating the evidence. Skin Therapy Lett. 2004; 9 : 1-3,9.
7. Geyer S. Some conceptual considerations on the sense of coherence. Soc Sci Med 1997; 44 : 1771-1779.
8. Antonovsky A. Unraveling the mystery of health. San Francisco: Jossey-Bass, 1987.
9. Antonovsky A. 1979. Health, stress, and coping: New perspectives on mental and physical well-being. San Francisco: Jossey-Bass.
10. Gaylord-Ross Z, Haring, T. Social interaction research for adolescent, with severe handicaps. Behavioral Disorder 1987; 12:264-275.
11. Eysenck HJ, Eysenck, MW. 1985. Personality and individual differences: A natural science approach. New York: Plenum.
12. Eysenck HJ, Eysenck, SBG. 1975. Manual of the Eysenck Personality Inventory. London: Hodder and Stoughton.
13. Cederblad M, Pruksachatkunakorn P, Boripunkul T. Intraprasert S, Hook B. Sense of coherence in a Thai sample. Transcult Psychiatry 2003; 40 : 585-600.
14. Schumacher J, Wilz G, Gunzelmann T, Brahler E. The Antonovsky Sense of Coherence Scale. Test statistical evaluation of a representative population sample and construction of a brief scale. Psychother Psychosom Med Psychol 2000; 50 : 472-482.
15. Torsheim T, Aaroe LE, Wold B. Sense of coherence and school-related stress as predictors of subjective health complaints in early adolescence:interactive, indirect or direct relationships Soc Sci Med 2001; 53 : 603-614.
16. Margalit M. Loneliness and coherence among preschool children with learning disabilities. J-Learn-Disabil 1998; 31 : 173-180.
17. Bazynska K, Bronowska Z, Namyslowska I, Zechowski C. Sense of coherence in patients of a psychiatric adolescent unit. Psychiatr Pol. 2002; 36 : 121-131.
18. Pearl A, Arroll B, Lello J, Birchall NM. The impact of acne: a study of adolescents' attitudes,perception and knowledge. N Z Med J. 1998; 111 : 269-271.(Brook U)
Abstract
Objective : The extent to which acne influences the emotional life of adolescents is a matter of discussion; but people with acne are prone to emotional and psychological disturbances. Methods : 54 adolescent girls with acne were studied for their personality variables that are related to high coherence. Sense of coherence, e.g. meaningfulness of life, is crucial to copesuccessfully with stressors of living: it expreses the belief that a high probability exists that things will work out as well as can reasonably be expected. 58 adolescent girls without acne were in the control group. Results : Neuroticism (anxiety level) was the first predictor of the sense of coherence measure for girls with acne, explaining 19% of the variance. Extraversion was the next predictor, explaining an additional 2 3% of the variance, and psychoticism was the third predictor, explaining together 27% of the variance. There was a lack of difference between groups with respect to other personality variables. Conclusion : These predictors have to be taken into consideration while treating adolescents acne. Dermatologists, pediatricians and other physicians treating adolescents' acne should be familiar with emotional and psychosocial disturbances that accompany acne in order to effectively assist these patients.
Keywords: Acne; Girls; Sense of Coherence; Psychosocial impact
Acne is an inflammatiom of skin glands forming sebum; it includes: blackheads (open comedons), whiteheads (closed comedons) and localized areas of inflammation (papules and pustules); acne vulgaris may even cause visible disfigurement of the face.[1] Most authors admit the fact that acne can cause emotional and psychosocial disturbances.[2],[3],[4],[5] Baldwin pointed out acne may be associated with: anger, embarassment, frustration and depression.[1] Effective treatment of severe acne (vulgaris) had improved self-esteem, affects, obsessive compulsiveness, shame, embarrassment, body image and social assertiveness confidence.[6] A major psychological variable effecting emotional well-being is a sense of coherence (SOC). It means how a person sees the world as comprehensible and can face stress.[7] SOC, e.g. meaningfulness of life, may be considered as a central concept in the understanding of adolescents with potential psychosomatic difficulties. A strong SOC is crucial to successful coping with the ubiquitous stresses of living and hence to health maintenance.[8] SOC expresses the feeling that internal and external environments will work out as well as can reasonably be expected.[9] Antonovsky (1987) defined sense of coherence (SOC) as a global orientation that expresses the extent to which one has a pervasive, enduring and dynamic feeling of confidence that: (1) the stimuli deriving from one's internal and external environments are structured, predictable, and explicable; (2) the resources are available to meet the demands posed by these stimuli; and (3) these demands are viewed as challenges, worthy of investment and engagement.[8] The SOC may be applied as an emotional and cognitive character of a concrete situation. The strong SOC person seeks to impose structure on situations and to accept the challenges of situation, believing in his/her self-efficacy. SOC during adolescence has special meaning, pinpointing attention to the interrelations between the individual and his/her environment.
Powerful determinants of social behavior are the individual differences and the overall context in which behavior occurs.[10] Accepting the notion that individual differences are reflected in individual-environment interactions and are expressed in peer and familial interactions, a three-factorial personality structure can be expected to be related to the adolescents' competency and adjustment.[11] Study of individual differences has revealed three factors which may contribute to the prediction of the SOC: (a) extraversion-introversion (i.e., level of arousal and excitement seeking), (b) emotional stability vs instability (i.e., neuroticism), and (c) psychoticism versus impulse control.[12] The typical extrovert is a person who is sociable and craves excitement, whereas the typical introvert is quiet, introspective, and reserved in his/her interpersonal relations. The high neuroticism scorer is often described as an anxious, moody, and worrying individual. The typical youth with high psychoticism scores is often described as an insensitive, isolated, sensation seeking, aggressive, troublesome individual.[12] Cederblad et al pointed out that SOC reflect the level of anxiety, depression and self esteem.[13] Schumacher et al mentioned that high SOC was associated with lower subjective body complaints and somatoform symptoms, as well as with minor related problems in daily living.[14] Torsheim et al pointed out SOC may express adolescents school related stress, as well as healthy complaints and adaptation (15); and finally, Margalit had found low SOC among children suffering from learning disabilities.[16]
This study aims to determine if differences in SOC and various personality factors exist between adolescent girls with and without acne and, if positive, to describe predictors of SOC in patients with acne. The hypothesis was that severe acne would be associated with a lower SOC than that found in the control group without acne.
Materials and Methods
Subjects
The sample consisted of 112 female adolescents with age range from 15.0 to 17.0 years (M=16.01, SD=2.3), divided into two groups: (a) 54 girls with papulo-pustular acne (age 15.59±1.4) and (b) 58 girls without acne (age 15.97±1.7). The adolescents were students in the fifth through seventh grades of a regional academic high school in Holon (the fourth largest city in Israel).
Pupils were chosen at random from classes 9-10-11. They were examined individually by a senior pediatrician who diagnosed and confirmed the existence of acne on their face and/or their back. In addition, their medical records in school were checked for existence of acne in previous years. They were asked to fill the questionnaire anonymously in the physician's examination room during a 20-30 minute period. The control groups were girls from the same classes who were free of acne in the medical examination and according to their school medical records. There were no other differences between the two groups, as they attended the same school and the same class.
Instruments Sense of Coherence Scale (SOC)
The short validated form of the SOC[8] consisted of 10 statements on a 7-point Likert-type scale ranging from: Never[1] to Always.[7] The items for the short version were selected according to Antonovsky's suggestions. The alpha coefficient measure of internal consistency for the entire scale in its short form was 0.74.
Junior Eysenck Personality Questionnaire (J.EPQ)[12]
The Hebrew adaptation of the J.EPQ was used to reflect the personality factors of the sample. The Hebrew version of the questionnaire included 75 items divided into 3 factors: Psychoticism, Extraversion and Neuroticism. The Psychoticism factor included 19 items, such as "Do you seem to get into a lot of fights" with alpha coefficients of 0.60 for girls.
The Extraversion factor refers to the outgoing uninhibited social proclivities of a person. It included 17 items, such as "Do you like plenty of excitement going on around you" with alpha coefficients of 0.67 for girls.
The Neuroticism factor refers to the general emotional liability of a person, his over responsiveness and his liability to neurotic breakdown under stress. It included 20 items, such as "Are you moody" with alpha coefficients of .82 for girls. The intercorrelations between factors were low and insignificant. Statistical analysis was made using MANOVA test.
Results
In order to compare the Sense of Coherence and the J. EPQ scores, a one-way Multivariate Analysis of Variance (MANOVA) was performed, with Acne manifestation as the independent variable and the subscale scores (SOC, psychoticism, neuroticism and extraversion) as the dependent variables normal scores and no significant difference was found between the two groups of adolescent girls.
In order to further investigate the SOC global orientation measure for the group of females with and without acne, two-step wise multiple regressions were performed, with the J.EPQ scores as the independent measures, and the sense of coherence as the "dependent" variable. The results of the analysis are presented on table1.
Neuroticism was the first predictor of SOC measure for girls with acne, explaining 19% of the variance; extroversion was the next predictor, explaining additional 23% of the variance; psychoticism was the third predictor, explaining together 27% of the variance, and reaching a multiple regression score of 0.52.
For the girls without acne, neuroticism was also the first predictor of the sense of coherence explaining 14% of the variance; psychoticism was the second predictor, explaining additional 17% of the variance; extraversion was the third predictor, explaining together only 21% of the variance, and reaching a multiple regression score of 0.46.
Discussion
The results of the present study did not indicate significant differences between the two groups of girls with regard to their SOC, nor with their personality profile. It can be explained by their mild acne (there were no cases of acne vulgaris). However,after neurotism for the girls with acne, extraversion was a better predictor for the feeling of well being, while for the second group, psychotism was a better predictor. The coherence levels for girls with acne were related to their tendencies of being outgoing, looking for excitement and social in relations; while for the control group, their psychotism measure - their inability to control and inhibit themselves - was more important for their feelings of well-being, and negatively related to the sense of coherence.
The anxiety levels (neuroticism) of both groups of girls were the best predictors of their coherence feelings, yet the personality measures explained higher proportions of SOC variance for the girls with acne than for the control group. Bazynska et al found as well, significantly lower SOC in neurotic adolescents group.[17]
The potential individual psychosomatic component of the acne group pinpointed at an interactional model. SOC of the acne group was more related to their arousal levels and excitement seeking; while for the control group SOC was related to their attempts to avoid sensations and to obtain control over their impulses. Further studies are needed to clarify if these differences are significant.
The clinical implications of the present study are: acne is not a trivial disease[3]; it may seriously affect patients' life.[5] Dermatologists as well as other physicians treating adolescent acne should be familiar with psychological and social consequence of acne (like embarrassment, lack of enjoyment and avoidence of social activities)[18], in order to assist these patients.[1]
References
1. Baldwin HE. The interaction between acne vulgaris and psyche. Cutis 2002; 70 : 133-139.
2. Niemeier V, Kupfer J, Demmelbauer-Ebner M, Stangier U, Effendy I. Coping with acne vulgaris.Evaluation of the chronic skin disorder questionnaire in patient with acne. Dermatology 1998; 196 : 108-115.
3. Mallon E, Newton JN, Klassen A, Stewart-Brown SL, Ryan TJ, Finlay AY. The quality of life in acne:a comparison with general medical conditions using generic questionnaires. Br J Dermatol 1999; 140 : 672-676.
4. Martin AR, Lookingbill DP, Botek A, Light J, Thiboutot D, Girman CJ. Health-related quality of life among patients with facial acne-assessment of a new acne-specific questionnaire. Clin Exp Dermatol 2001; 26 : 380-385.
5. Barankin B, DeKoven J. Psychosocial effect of common skin diseases. Can Fam Physician 2002; 48 : 712-716.
6. Tan JK. Psychosocial impact of acne vulgaris: evaluating the evidence. Skin Therapy Lett. 2004; 9 : 1-3,9.
7. Geyer S. Some conceptual considerations on the sense of coherence. Soc Sci Med 1997; 44 : 1771-1779.
8. Antonovsky A. Unraveling the mystery of health. San Francisco: Jossey-Bass, 1987.
9. Antonovsky A. 1979. Health, stress, and coping: New perspectives on mental and physical well-being. San Francisco: Jossey-Bass.
10. Gaylord-Ross Z, Haring, T. Social interaction research for adolescent, with severe handicaps. Behavioral Disorder 1987; 12:264-275.
11. Eysenck HJ, Eysenck, MW. 1985. Personality and individual differences: A natural science approach. New York: Plenum.
12. Eysenck HJ, Eysenck, SBG. 1975. Manual of the Eysenck Personality Inventory. London: Hodder and Stoughton.
13. Cederblad M, Pruksachatkunakorn P, Boripunkul T. Intraprasert S, Hook B. Sense of coherence in a Thai sample. Transcult Psychiatry 2003; 40 : 585-600.
14. Schumacher J, Wilz G, Gunzelmann T, Brahler E. The Antonovsky Sense of Coherence Scale. Test statistical evaluation of a representative population sample and construction of a brief scale. Psychother Psychosom Med Psychol 2000; 50 : 472-482.
15. Torsheim T, Aaroe LE, Wold B. Sense of coherence and school-related stress as predictors of subjective health complaints in early adolescence:interactive, indirect or direct relationships Soc Sci Med 2001; 53 : 603-614.
16. Margalit M. Loneliness and coherence among preschool children with learning disabilities. J-Learn-Disabil 1998; 31 : 173-180.
17. Bazynska K, Bronowska Z, Namyslowska I, Zechowski C. Sense of coherence in patients of a psychiatric adolescent unit. Psychiatr Pol. 2002; 36 : 121-131.
18. Pearl A, Arroll B, Lello J, Birchall NM. The impact of acne: a study of adolescents' attitudes,perception and knowledge. N Z Med J. 1998; 111 : 269-271.(Brook U)