Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study
Aslı Bilgic, Bilge Fettahlıoğlu Karaman, Düriye Deniz Demirseren, Levent Cınar, Nida Kaçar, Aylin Türel Ermertcan, Emel Bülbül Başkan, Münevver Güven, Serkan Yazıcı, Tuğba Özkök Akbulut, Derya Uçmak, Arzu Ataseven, Selami Aykut Temiz, Burhan Engіn, Aysun Şikar Aktürk, Hayriye Sarıcaoğlu, Müge Güler Özden, Hilal özdemir, Kifayet Mammadlı, Koray Durmaz, Fatmagül Gülbaşaran, Fadime Kılınç, Hatice Kaya Özden, Melis Gönülal, Didem Didar Balcı, Bengü Çevirgen Cemil, Sezgi Sarıkaya Solak, Leyla Baykal Selçuk, Göknur Özaydın Yavuz, İbrahim Halil Yavuz, Levent Dönmez, Erkan Alpsoy
Abstract
BACKGROUND: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS. OBJECTIVES: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. METHODS: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. RESULTS: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. CONCLUSIONS: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.