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How Does Anxiety Affect Adults with Skin Disease? Examining the Indirect Effect of Anxiety Symptoms on Impairment Through Anxiety Sensitivity

  • Laura J. Dixon
  • Sara M. Witcraft
  • Megan M. Perry
Original Article
  • 28 Downloads

Abstract

Emerging research suggests social anxiety, health anxiety, and generalized anxiety disorder symptoms are particularly relevant for dermatology patients. Unfortunately, very few studies have investigated how these anxieties affect quality of life among individuals with skin disease. The aims of the present study were to characterize the rates of these anxiety syndromes among adults with active skin disease symptoms, examine correlations between anxiety and skin disease symptoms, and test the mediating role of anxiety sensitivity in skin-related impairment. A considerable number of participants (N = 237) screened positive for social anxiety disorder (62.9%), health anxiety (18.1%), and generalized anxiety disorder (32.5%). Consistent with hypothesis, each anxiety syndrome was indirectly related to skin-related impairment through anxiety sensitivity. Overall, the findings emphasize the importance of anxiety symptoms in dermatological outcomes.

Keywords

Social anxiety disorder Generalized anxiety disorder Health anxiety Anxiety sensitivity Dermatology Impairment 

Notes

Funding

Laura J. Dixon was supported by the University of Mississippi College of Liberal Arts Research Grant for Faculty Research and Creative Achievement.

Compliance with Ethical Standards

Conflict of Interest

Laura J. Dixon, Sara M. Witcraft, and Megan M. Perry declare that they have no conflict of interest.

Human and Animal Rights

Study procedures were in accordance with the ethical standards of the institutional review board of the University of Mississippi and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individuals included in this study.

References

  1. Abramowitz, J. S., Deacon, B. J., & Valentiner, D. P. (2007). The short health anxiety inventory: Psychometric properties and construct validity in a non-clinical sample. Cognitive Therapy and Research, 31(6), 871–883.CrossRefGoogle Scholar
  2. Alberts, N. M., Hadjistavropoulos, H. D., Jones, S. L., & Sharpe, D. (2013). The Short Health Anxiety Inventory: A systematic review and meta-analysis. Journal of Anxiety Disorders, 27(1), 68–78.  https://doi.org/10.1016/j.janxdis.2012.10.009.CrossRefPubMedGoogle Scholar
  3. Allan, N. P., Korte, K. J., Capron, D. W., Raines, A. M., & Schmidt, N. B. (2014a). Factor mixture modeling of anxiety sensitivity: A three-class structure. Psychological Assessment, 26(4), 1184–1195.  https://doi.org/10.1037/a0037436.CrossRefPubMedGoogle Scholar
  4. Allan, N. P., Raines, A. M., Capron, D. W., Norr, A. M., Zvolensky, M. J., & Schmidt, N. B. (2014b). Identification of anxiety sensitivity classes and clinical cut-scores in a sample of adult smokers: Results from a factor mixture model. Journal of Anxiety Disorders, 28(7), 696–703.  https://doi.org/10.1016/j.janxdis.2014.07.006.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176.CrossRefGoogle Scholar
  6. Arditte, K. A., Cek, D., Shaw, A. M., & Timpano, K. R. (2016). The importance of assessing clinical phenomena in Mechanical Turk research. Psychological Assessment, 28(6), 684–691.  https://doi.org/10.1037/pas0000217.CrossRefPubMedGoogle Scholar
  7. Asmundson, G. J. G., Wright, K. D., & Hadjistavropoulos, H. D. (2000). Anxiety sensitivity and disabling chronic health conditions: State of the art and future directions. Scandanvian Journal of Behaviour Therapy, 29(3–4), 100–117.  https://doi.org/10.1080/028457100300049719.Google Scholar
  8. Avallone, K. M., McLeish, A. C., Luberto, C. M., & Bernstein, J. A. (2012). Anxiety sensitivity, asthma control, and quality of life in adults with asthma. Journal of Asthma, 49(1), 57–62.  https://doi.org/10.3109/02770903.2011.641048.CrossRefPubMedGoogle Scholar
  9. Bakhshaie, J., Paulus, D. J., Medvedeva, A., Otal, T., Lemaire, C., Garza, M., … Viana, A. G. (2017). The differential role of anxiety sensitivity and its components in the relation between emotional nonacceptance and anxiety and depressive symptoms and disorders among latinos in primary care. Journal of Psychopathology and Behavioral Assessment, 39(3), 563–574.CrossRefGoogle Scholar
  10. Baptista, C. A., Loureiro, S. R., de Lima Osório, F., Zuardi, A. W., Magalhães, P. V., Kapczinski, F., … Crippa, J. A. S. (2012). Social phobia in Brazilian university students: Prevalence, under-recognition and academic impairment in women. Journal of Affective Disorders, 136(3), 857–861.CrossRefPubMedGoogle Scholar
  11. Basra, M. K., & Shahrukh, M. (2009). Burden of skin diseases. Expert Review of Pharmacoeconomics & Outcomes research, 9(3), 271–283.CrossRefGoogle Scholar
  12. Bez, Y., Yesilova, Y., Kaya, M. C., & Sir, A. (2011). High social phobia frequency and related disability in patients with acne vulgaris. European Journal of Dermatology, 21(5), 756–760.  https://doi.org/10.1684/ejd.2011.1418.PubMedGoogle Scholar
  13. Bhate, K., & Williams, H. (2013). Epidemiology of acne vulgaris. British Journal of Dermatology, 168(3), 474–485.CrossRefPubMedGoogle Scholar
  14. Bohm, D., Schwanitz, P., Stock Gissendanner, S., Schmid-Ott, G., & Schulz, W. (2014). Symptom severity and psychological sequelae in rosacea: Results of a survey. Psychology, Health & Medicine, 19(5), 586–591.  https://doi.org/10.1080/13548506.2013.841968.CrossRefGoogle Scholar
  15. Böhm, D., Stock Gissendanner, S., Bangemann, K., Snitjer, I., Werfel, T., Weyergraf, A., … Schmid-Ott, G. (2013). Perceived relationships between severity of psoriasis symptoms, gender, stigmatization and quality of life. Journal of the European Academy of Dermatology and Venereology, 27(2), 220–226.CrossRefPubMedGoogle Scholar
  16. Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon’s Mechanical Turk a new source of inexpensive, yet high-quality, data? Perspectives on Psychological Science, 6(1), 3–5.CrossRefPubMedGoogle Scholar
  17. Capron, D. W., & Schmidt, N. B. (2016). Development and randomized trial evaluation of a novel computer-delivered anxiety sensitivity intervention. Behaviour Research and Therapy, 81, 47–55.CrossRefPubMedGoogle Scholar
  18. Chren, M.-M., Lasek, R. J., Sahay, A. P., & Sands, L. P. (2001). Measurement properties of Skindex-16: A brief quality-of-life measure for patients with skin diseases. Journal of Cutaneous Medicine and Surgery, 5(2), 105–110.CrossRefPubMedGoogle Scholar
  19. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.  https://doi.org/10.1037/0033-2909.112.1.155.CrossRefPubMedGoogle Scholar
  20. Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000). Psychometric properties of the social phobia inventory (SPIN). The British Journal of Psychiatry, 176(4), 379–386.CrossRefPubMedGoogle Scholar
  21. Dalgard, F. J., Gieler, U., Tomas-Aragones, L., Lien, L., Poot, F., Jemec, G. B., … Kupfer, J. (2015). The psychological burden of skin diseases: A cross-sectional multicenter study among dermatological out-patients in 13 European countries. Journal of Investigative Dermatology, 135(4), 984–991.  https://doi.org/10.1038/jid.2014.530.CrossRefPubMedGoogle Scholar
  22. Dixon, L., Witcraft, S., McCowan, N., & Brodell, R. (2018). Stress and skin disease quality of life: The moderating role of anxiety sensitivity social concerns. British Journal of Dermatology.  https://doi.org/10.1111/bjd.16082.PubMedGoogle Scholar
  23. Dixon, L. J., Lee, A. A., Viana, A. G., McCowan, N. K., Brodell, R. T., & Tull, M. T. (2016). Anxiety sensitivity in dermatological patients. Psychosomatics, 57(5), 498–504.  https://doi.org/10.1016/j.psym.2016.03.001.CrossRefPubMedGoogle Scholar
  24. Fergus, T. A., & Bardeen, J. R. (2013). Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety. Personality and Individual Differences, 55(6), 640–644.CrossRefGoogle Scholar
  25. Fortune, D., Main, C., O’sullivan, T., & Griffiths, C. (1997). Quality of life in patients with psoriasis: The contribution of clinical variables and psoriasis-specific stress. British Journal of Dermatology, 137(5), 755–760.CrossRefPubMedGoogle Scholar
  26. Fortune, D. G., Richards, H. L., & Griffiths, C. E. (2005). Psychologic factors in psoriasis: Consequences, mechanisms, and interventions. Dermatologic Clinics, 23(4), 681–694.  https://doi.org/10.1016/j.det.2005.05.022.CrossRefPubMedGoogle Scholar
  27. Fortune, D. G., Richards, H. L., Main, C. J., & Griffiths, C. E. (2000). Pathological worrying, illness perceptions and disease severity in patients with psoriasis. British Journal of Health Psychology, 5(1), 71–82.CrossRefGoogle Scholar
  28. Gascón, M. R. P., Ribeiro, C. M., Bueno, L. M. d. A., Benute, G. R. G., Lucia, M. C. S. d., Rivitti, E. A., & Festa Neto, C. (2012). Prevalence of depression and anxiety disorders in hospitalized patients at the dermatology clinical ward of a university hospital. Anais Brasileiros de Dermatologia, 87(3), 403–407.CrossRefPubMedGoogle Scholar
  29. Ghajarzadeh, M., Ghiasi, M., & Kheirkhah, S. (2012). Associations between skin diseases and quality of life: A comparison of psoriasis, vitiligo, and alopecia areata. Acta Medica Iranica, 50(7), 511–515.PubMedGoogle Scholar
  30. Gupta, M. A., & Gupta, A. K. (2003). Psychiatric and psychological co-morbidity in patients with dermatologic disorders. American Journal of Clinical Dermatology, 4(12), 833–842.CrossRefPubMedGoogle Scholar
  31. Hay, R. J., Johns, N. E., Williams, H. C., Bolliger, I. W., Dellavalle, R. P., Margolis, D. J., … Wulf, S. K. (2014). The global burden of skin disease in 2010: An analysis of the prevalence and impact of skin conditions. Journal of Investigative Dermatology, 134(6), 1527–1534.CrossRefPubMedGoogle Scholar
  32. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
  33. Hayes, J., & Koo, J. (2010). Psoriasis: Depression, anxiety, smoking, and drinking habits. Dermatologic Therapy, 23(2), 174–180.  https://doi.org/10.1111/j.1529-8019.2010.01312.x.CrossRefPubMedGoogle Scholar
  34. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239.CrossRefPubMedGoogle Scholar
  35. Hesser, H., & Andersson, G. (2009). The role of anxiety sensitivity and behavioral avoidance in tinnitus disability. International Journal of Audiology, 48(5), 295–299.CrossRefPubMedGoogle Scholar
  36. Hon, K. L., Pong, N. H., Poon, T. C., Chan, D. F., Leung, T. F., Lai, K. Y., … Luk, N. M. (2015). Quality of life and psychosocial issues are important outcome measures in eczema treatment. Journal of Dermatological Treatment, 26(1), 83–89.  https://doi.org/10.3109/09546634.2013.873762.CrossRefPubMedGoogle Scholar
  37. Hong, J., Koo, B., & Koo, J. (2008). The psychosocial and occupational impact of chronic skin disease. Dermatologic Therapy, 21(1), 54–59.CrossRefPubMedGoogle Scholar
  38. Horton, J. J., & Chilton, L. B. (2010). The labor economics of paid crowdsourcing. Paper presented at the proceedings of the 11th ACM conference on electronic commerce.Google Scholar
  39. Joinson, A. (1999). Social desirability, anonymity, and Internet-based questionnaires. Behavior Research Methods, Instruments, & Computers, 31(3), 433–438.CrossRefGoogle Scholar
  40. Joshi, S. S., Ortiz, S., Witherspoon, J. N., Rademaker, A., West, D. P., Anderson, R., … Lacouture, M. E. (2010). Effects of epidermal growth factor receptor inhibitor-induced dermatologic toxicities on quality of life. Cancer, 116(16), 3916–3923.CrossRefPubMedGoogle Scholar
  41. Kent, G., & Keohane, S. (2001). Social anxiety and disfigurement: The moderating effects of fear of negative evaluation and past experience. British Journal of Clinical Psychology, 40(1), 23.CrossRefPubMedGoogle Scholar
  42. Keough, M. E., & Schmidt, N. B. (2012). Refinement of a brief anxiety sensitivity reduction intervention. Journal of Consulting and Clinical Psychology, 80(5), 766–772.  https://doi.org/10.1037/a0027961.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184.  https://doi.org/10.1002/mpr.1359.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Linnet, J., & Jemec, G. B. (1999). An assessment of anxiety and dermatology life quality in patients with atopic dermatitis. The British Journal of Dermatology, 140(2), 268–272.CrossRefPubMedGoogle Scholar
  45. Litman, L., Robinson, J., & Abberbock, T. (2017). TurkPrime.com: A versatile crowdsourcing data acquisition platform for the behavioral sciences. Behavior Research Methods, 49(2), 433–442.  https://doi.org/10.3758/s13428-016-0727-z.CrossRefPubMedGoogle Scholar
  46. Livermore, N., Sharpe, L., & McKenzie, D. (2012). Catastrophic interpretations and anxiety sensitivity as predictors of panic-spectrum psychopathology in chronic obstructive pulmonary disease. Journal of Psychosomatic Research, 72(5), 388–392.CrossRefPubMedGoogle Scholar
  47. Loney, T., Standage, M., & Lewis, S. (2008). Not just ‘skin deep’: Psychosocial effects of dermatological-related social anxiety in a sample of acne patients. Journal of Health Psychology, 13(1), 47–54.  https://doi.org/10.1177/1359105307084311.CrossRefPubMedGoogle Scholar
  48. Long, V., & Elpern, D. J. (2017). Health anxiety in dermatology. International Journal of Dermatology, 56(9), 968–971.  https://doi.org/10.1111/ijd.13692.CrossRefPubMedGoogle Scholar
  49. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343.CrossRefPubMedGoogle Scholar
  50. Meade, A. W., & Craig, S. B. (2012). Identifying careless responses in survey data. Psychological Methods, 17(3), 437.CrossRefPubMedGoogle Scholar
  51. Mizawa, M., Yamaguchi, M., Ueda, C., Makino, T., & Shimizu, T. (2013). Stress evaluation in adult patients with atopic dermatitis using salivary cortisol. Biomed Research International, 2013, 138027.  https://doi.org/10.1155/2013/138027.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Montgomery, K., Norman, P., Messenger, A. G., & Thompson, A. R. (2016). The importance of mindfulness in psychosocial distress and quality of life in dermatology patients. British Journal of Dermatology, 175(5), 930–936.  https://doi.org/10.1111/bjd.14719.CrossRefPubMedGoogle Scholar
  53. Nguyen, C. M., Beroukhim, K., Danesh, M. J., Babikian, A., & Koo, J. (2016). The psychosocial impact of acne, vitiligo, and psoriasis: A review. Clinical, Cosmetic and Investigational Dermatology, 9, 383.CrossRefPubMedPubMedCentralGoogle Scholar
  54. Norman, S. B., & Lang, A. J. (2005). The functional impact of anxiety sensitivity in the chronically physically ill. Depression and Anxiety, 21(4), 154–160.CrossRefPubMedGoogle Scholar
  55. Ocañez, K. L., Kathryn McHugh, R., & Otto, M. W. (2010). A meta-analytic review of the association between anxiety sensitivity and pain. Depression and Anxiety, 27(8), 760–767.PubMedGoogle Scholar
  56. Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychological Bulletin, 135(6), 974–999.  https://doi.org/10.1037/a0017428.CrossRefPubMedGoogle Scholar
  57. Olthuis, J. V., Watt, M. C., Mackinnon, S. P., & Stewart, S. H. (2014). Telephone-delivered cognitive behavioral therapy for high anxiety sensitivity: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 82(6), 1005–1022.  https://doi.org/10.1037/a0037027.CrossRefPubMedGoogle Scholar
  58. Olthuis, J. V., Watt, M. C., & Stewart, S. H. (2014). Anxiety Sensitivity Index (ASI-3) subscales predict unique variance in anxiety and depressive symptoms. Journal of Anxiety Disorders, 28(2), 115–124.  https://doi.org/10.1016/j.janxdis.2013.04.009.CrossRefPubMedGoogle Scholar
  59. Osinubi, O., Grainge, M. J., Hong, L., Ahmed, A., Batchelor, J., Grindlay, D., … Ratib, S. (2017). The prevalence of psychological co-morbidity in people with vitiligo: A systematic review and meta-analysis. British Journal of Dermatology, 178, 863–878.CrossRefGoogle Scholar
  60. Pärna, E., Aluoja, A., & Kingo, K. (2015). Quality of life and emotional state in chronic skin disease. Acta Dermato-Venereologica, 95(3), 312–316.  https://doi.org/10.2340/00015555-1920.CrossRefPubMedGoogle Scholar
  61. Picardi, A., Abeni, D., Mazzotti, E., Fassone, G., Lega, I., Ramieri, L., … Pasquini, P. (2004a). Screening for psychiatric disorders in patients with skin diseases. Journal of Psychosomatic Research, 57(3), 219–223.  https://doi.org/10.1016/s0022-3999(03)00619-6.CrossRefPubMedGoogle Scholar
  62. Picardi, A., Amerio, P., Baliva, G., Barbieri, C., Teofoli, P., Bolli, S., … Abeni, D. (2004b). Recognition of depressive and anxiety disorders in dermatological outpatients. Acta Dermato-Venereologica, 84(3), 213–217.CrossRefPubMedGoogle Scholar
  63. Picardi, A., Porcelli, P., Pasquini, P., Fassone, G., Mazzotti, E., Lega, I., … Fava, G. A. (2006). Integration of multiple criteria for psychosomatic assessment of dermatological patients. Psychosomatics, 47(2), 122–128.  https://doi.org/10.1176/appi.psy.47.2.122.CrossRefPubMedGoogle Scholar
  64. Rapp, S. R., Feldman, S. R., Exum, M. L., Fleischer, A. B., & Reboussin, D. M. (1999). Psoriasis causes as much disability as other major medical diseases. Journal of the American Academy of Dermatology, 41(3), 401–407.CrossRefPubMedGoogle Scholar
  65. Rasoulian, M., Ebrahimi, A. A., Zare, M., & Taherifar, Z. (2010). Psychiatric morbidity in dermatological conditions. International Journal of Psychiatry in Clinical Practice, 14(1), 18–22.  https://doi.org/10.3109/13651500903262370.CrossRefPubMedGoogle Scholar
  66. Reiss, S., & McNally, R. J. (1985). Expectancy model of fear. In S. Reiss & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107–121). New York: Academic Press.Google Scholar
  67. Salkovskis, P. M., Rimes, K. A., Warwick, H., & Clark, D. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(5), 843–853.CrossRefPubMedGoogle Scholar
  68. Salman, A., Kurt, E., Topcuoglu, V., & Demircay, Z. (2016). Social anxiety and quality of life in vitiligo and acne patients with facial involvement: A cross-sectional controlled study. American Journal of Clinical Dermatology, 17(3), 305–311.  https://doi.org/10.1007/s40257-016-0172-x.CrossRefPubMedGoogle Scholar
  69. Schmitt, J., & Ford, D. E. (2007). Understanding the relationship between objective disease severity, psoriatic symptoms, illness-related stress, health-related quality of life and depressive symptoms in patients with psoriasis—A structural equations modeling approach. General Hospital Psychiatry, 29(2), 134–140.  https://doi.org/10.1016/j.genhosppsych.2006.12.004.CrossRefPubMedGoogle Scholar
  70. Shapiro, D. N., Chandler, J., & Mueller, P. A. (2013). Using mechanical turk to study clinical populations. Clinical Psychological Science, 1(2), 213–220.  https://doi.org/10.1177/2167702612469015.CrossRefGoogle Scholar
  71. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.CrossRefPubMedGoogle Scholar
  72. Stern, R. S. (2004). Dermatologists and office-based care of dermatologic disease in the 21st century. Paper presented at the journal of investigative dermatology symposium proceedings.Google Scholar
  73. Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., … Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19(2), 176–188.  https://doi.org/10.1037/1040-3590.19.2.176.CrossRefPubMedGoogle Scholar
  74. Wheaton, M. G., Berman, N. C., & Abramowitz, J. S. (2010). The contribution of experiential avoidance and anxiety sensitivity in the prediction of health anxiety. Journal of Cognitive Psychotherapy, 24(3), 229.CrossRefGoogle Scholar
  75. Wheaton, M. G., Deacon, B. J., McGrath, P. B., Berman, N. C., & Abramowitz, J. S. (2012). Dimensions of anxiety sensitivity in the anxiety disorders: Evaluation of the ASI-3. Journal of Anxiety Disorders, 26(3), 401–408.  https://doi.org/10.1016/j.janxdis.2012.01.002.CrossRefPubMedGoogle Scholar
  76. Wittkowski, A., Richards, H. L., Griffiths, C. E. M., & Main, C. J. (2004). The impact of psychological and clinical factors on quality of life in individuals with atopic dermatitis. Journal of Psychosomatic Research, 57(2), 195–200.  https://doi.org/10.1016/S0022-3999(03)00572-5.CrossRefPubMedGoogle Scholar
  77. Woodruff, P., Higgins, E., Du Vivier, A., & Wessely, S. (1997). Psychiatric illness in patients referred to a dermatology-psychiatry clinic. General Hospital Psychiatry, 19(1), 29–35.CrossRefPubMedGoogle Scholar
  78. World Health Organization (WHO). (2016). International statistical classification of diseases and related health problems (10th ed.). Geneva: WHO.Google Scholar
  79. Yazici, K., Baz, K., Yazici, A., Köktürk, A., Tot, S., Demirseren, D., & Buturak, V. (2004). Disease-specific quality of life is associated with anxiety and depression in patients with acne. Journal of the European Academy of Dermatology and Venereology, 18(4), 435–439.CrossRefPubMedGoogle Scholar

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Authors and Affiliations

  1. 1.Department of PsychologyUniversity of MississippiUniversityUSA

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