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Classifies into 4 phases&#58; alert &#40;contact with aggressive stimulus&#41;&#59; resistance &#40;adaptation of the body&#41;&#59; near exhaustion &#40;depletion&#41; and exhaustion &#40;physical and&#47;or psychological impairment&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Dermatology life quality index &#40;DLQI-BRA&#41;&#46;</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">The analyzed variables were&#58; age&#59; gender&#59; the visual scale of daytime and nighttime pruritus&#44; the severity of AD &#40;SCORAD - atopic dermatitis score&#41; using Pearson&#39;s correlation with indexes of depression&#44; stress and quality of life&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the Adans Statistics Company &#40;CONRE 8250-A&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Thirty-one patients were included&#44; of which 18 were women&#44; 13 men&#44; with a mean age of 29 years&#44; and a standard deviation of 12&#46;2 &#40;minimum 15&#59; maximum 54 years&#41;&#46; Of the 31 patients&#44; 7 &#40;22&#46;6&#37;&#41; had mild depressive symptoms&#44; while 5 &#40;16&#46;1&#37;&#41; had mild to moderate&#59; 18 &#40;38&#46;7&#37;&#41; had moderate to severe and 7 &#40;22&#46;6&#37;&#41; had severe symptoms &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Sleep pattern disorders had the highest score &#40;1&#46;74&#41;&#44; followed by indecision &#40;1&#46;58&#41;&#44; low self-esteem &#40;1&#46;42&#41;&#44; and self-criticism &#40;1&#46;39&#41;&#46; Suicidal thoughts or ideation had the lowest score &#40;0&#46;26&#41;&#44; followed by pessimism &#40;0&#46;55&#41; and loss of sexual interest &#40;0&#46;55&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Of the 30 patients with symptoms of physical stress&#44; 18 &#40;60&#37;&#41; were in the resistance phase&#44; while 11 &#40;36&#46;7&#37;&#41; were in the near-exhaustion phase and only 1 &#40;3&#46;3&#37;&#41; was in the alert phase &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Symptoms of psychological stress were manifested by 22 patients &#40;73&#46;3&#37;&#41;&#44; while 4 &#40;13&#46;3&#37;&#41; also reported physical symptoms and another 4 &#40;13&#46;3&#37;&#41; manifested both&#46; There was no association between stress&#44; depression and impaired quality of life with gender or age&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The DLQI-BRA classification showed patients with significant quality of life impairment as follows&#58; 7 &#40;22&#46;6&#37;&#41; showing mild impact&#44; 6 &#40;19&#46;4&#37;&#41; moderate&#44; 14 &#40;45&#46;2&#37;&#41; severe and 4 &#40;12&#46;9&#37;&#41; very severe impact &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The correlation coefficient between daytime pruritus and physical stress was 0&#46;385&#59; with psychological stress&#44; 0&#46;369&#59; with both&#44; 0&#46;412&#59; with depression&#44; 0&#46;311&#59; with quality of life&#44; 0&#46;127&#46; A moderate correlation was observed with stress and depression&#44; and a weak correlation with quality of life&#46; The correlation between depression and anxiety was 0&#46;608&#44; considered moderate to strong&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The correlation coefficients of SCORAD with physical&#47;psychological stress and depression were non-significant &#40;-0&#46;02 and -0&#46;06 respectively&#44; p-value 0&#46;911 and 0&#46;739&#41;&#46; There was a weak positive correlation between the degree of severity and impaired quality of life &#40;0&#46;268&#44; p-value&#160;&#61;&#160;0&#46;145&#41;&#44; which is in accordance with Carvalho et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Because it is a reference for the health network for dermatological diseases&#44; most patients had moderate to severe disease&#59; thus&#44; it was concluded that the stress&#44; depression and impaired quality of life indexes do not depend on AD severity&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Psychosocial and emotional factors affect the course of the disease&#44; as well as the response to therapeutic interventions&#46; Other authors have obtained similar indexes of depression &#40;around 15&#37; for severe cases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Silverberg et al&#46; stated that dermatologists should consider these associations when evaluating AD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Unlike other authors&#44; the present study found no association with suicidal thoughts or ideation &#40;0&#46;26&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The present study found a high prevalence of stress &#40;96&#46;8&#37; of participants&#41;&#44; with the majority &#40;60&#46;0&#37;&#41; in the resistance phase and a significant predominance of psychological symptoms &#40;73&#46;3&#37;&#41;&#44; which was more relevant than in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The most common psychological symptoms were&#58; sudden increase in motivation&#59; enthusiasm&#59; insecurity&#59; feeling of incompetence&#59; constant thinking on a single subject&#59; excessive irritability&#59; nightmares and fatigue&#46; Classically&#44; these findings are observed when living with greater vulnerability to psychological stress&#44; as it occurs in AD crises&#46; On the other hand&#44; in our experience with atopic dermatitis patients we observe anticipatory distress and self demand&#44; which in turn can lead to crises&#44; creating a vicious circle &#40;personal opinion of the authors&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The authors conclude that individuals affected with atopic dermatitis often show symptoms of depression&#44; stress and impaired quality of life&#46; Itching is among the symptoms that were most often related to psychological distress and reduced quality of life&#46; Thus&#44; it is recommended that dermatologists&#44; when treating patients with AD&#44; also analyze aspects such as stress&#44; depression and quality of life&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">Cleide Rodrigues de Castro&#58; Design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Maria Elisa Bertocco Andrade&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Renata Marli Gon&#231;alves Pires&#58; Critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Mario Cezar Pires&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Research Letter
Evaluation of depression, stress and quality of life indexes in patients with atopic dermatitis
Cleide Rodrigues de Castroa,
Corresponding author
, Maria Elisa Bertocco Andradea, Renata Marli Gonçalves Piresb, Mario Cezar Piresa
a Complexo Hospitalar Padre Bento de Guarulhos, Guarulhos, SP, Brazil
b Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atopic Dermatitis &#40;AD&#41; is a recurrent chronic inflammatory dermatosis&#44; characterized by pruritus&#44; sleep disorders and multiple comorbidities&#44; with significant psychological alterations and impact on mental health&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In many cases&#44; there is loss of quality of life&#44; with deep psychosocial and economic impact&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Some authors have described different degrees of depression and stress in patients with AD&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> In this study&#44; the authors evaluated depression&#44; stress and quality of life indexes in adults with AD using&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Beck depression inventory &#40;Beck-BDI-II depression inventory - validated as of 15 years old&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Inventory of stress symptoms for adults &#40;ISSL - validated as of 15 years old&#41; Classifies into 4 phases&#58; alert &#40;contact with aggressive stimulus&#41;&#59; resistance &#40;adaptation of the body&#41;&#59; near exhaustion &#40;depletion&#41; and exhaustion &#40;physical and&#47;or psychological impairment&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Dermatology life quality index &#40;DLQI-BRA&#41;&#46;</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">The analyzed variables were&#58; age&#59; gender&#59; the visual scale of daytime and nighttime pruritus&#44; the severity of AD &#40;SCORAD - atopic dermatitis score&#41; using Pearson&#39;s correlation with indexes of depression&#44; stress and quality of life&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the Adans Statistics Company &#40;CONRE 8250-A&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Thirty-one patients were included&#44; of which 18 were women&#44; 13 men&#44; with a mean age of 29 years&#44; and a standard deviation of 12&#46;2 &#40;minimum 15&#59; maximum 54 years&#41;&#46; Of the 31 patients&#44; 7 &#40;22&#46;6&#37;&#41; had mild depressive symptoms&#44; while 5 &#40;16&#46;1&#37;&#41; had mild to moderate&#59; 18 &#40;38&#46;7&#37;&#41; had moderate to severe and 7 &#40;22&#46;6&#37;&#41; had severe symptoms &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Sleep pattern disorders had the highest score &#40;1&#46;74&#41;&#44; followed by indecision &#40;1&#46;58&#41;&#44; low self-esteem &#40;1&#46;42&#41;&#44; and self-criticism &#40;1&#46;39&#41;&#46; Suicidal thoughts or ideation had the lowest score &#40;0&#46;26&#41;&#44; followed by pessimism &#40;0&#46;55&#41; and loss of sexual interest &#40;0&#46;55&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Of the 30 patients with symptoms of physical stress&#44; 18 &#40;60&#37;&#41; were in the resistance phase&#44; while 11 &#40;36&#46;7&#37;&#41; were in the near-exhaustion phase and only 1 &#40;3&#46;3&#37;&#41; was in the alert phase &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Symptoms of psychological stress were manifested by 22 patients &#40;73&#46;3&#37;&#41;&#44; while 4 &#40;13&#46;3&#37;&#41; also reported physical symptoms and another 4 &#40;13&#46;3&#37;&#41; manifested both&#46; There was no association between stress&#44; depression and impaired quality of life with gender or age&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The DLQI-BRA classification showed patients with significant quality of life impairment as follows&#58; 7 &#40;22&#46;6&#37;&#41; showing mild impact&#44; 6 &#40;19&#46;4&#37;&#41; moderate&#44; 14 &#40;45&#46;2&#37;&#41; severe and 4 &#40;12&#46;9&#37;&#41; very severe impact &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The correlation coefficient between daytime pruritus and physical stress was 0&#46;385&#59; with psychological stress&#44; 0&#46;369&#59; with both&#44; 0&#46;412&#59; with depression&#44; 0&#46;311&#59; with quality of life&#44; 0&#46;127&#46; A moderate correlation was observed with stress and depression&#44; and a weak correlation with quality of life&#46; The correlation between depression and anxiety was 0&#46;608&#44; considered moderate to strong&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The correlation coefficients of SCORAD with physical&#47;psychological stress and depression were non-significant &#40;-0&#46;02 and -0&#46;06 respectively&#44; p-value 0&#46;911 and 0&#46;739&#41;&#46; There was a weak positive correlation between the degree of severity and impaired quality of life &#40;0&#46;268&#44; p-value&#160;&#61;&#160;0&#46;145&#41;&#44; which is in accordance with Carvalho et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Because it is a reference for the health network for dermatological diseases&#44; most patients had moderate to severe disease&#59; thus&#44; it was concluded that the stress&#44; depression and impaired quality of life indexes do not depend on AD severity&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Psychosocial and emotional factors affect the course of the disease&#44; as well as the response to therapeutic interventions&#46; Other authors have obtained similar indexes of depression &#40;around 15&#37; for severe cases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Silverberg et al&#46; stated that dermatologists should consider these associations when evaluating AD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Unlike other authors&#44; the present study found no association with suicidal thoughts or ideation &#40;0&#46;26&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The present study found a high prevalence of stress &#40;96&#46;8&#37; of participants&#41;&#44; with the majority &#40;60&#46;0&#37;&#41; in the resistance phase and a significant predominance of psychological symptoms &#40;73&#46;3&#37;&#41;&#44; which was more relevant than in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The most common psychological symptoms were&#58; sudden increase in motivation&#59; enthusiasm&#59; insecurity&#59; feeling of incompetence&#59; constant thinking on a single subject&#59; excessive irritability&#59; nightmares and fatigue&#46; Classically&#44; these findings are observed when living with greater vulnerability to psychological stress&#44; as it occurs in AD crises&#46; On the other hand&#44; in our experience with atopic dermatitis patients we observe anticipatory distress and self demand&#44; which in turn can lead to crises&#44; creating a vicious circle &#40;personal opinion of the authors&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The authors conclude that individuals affected with atopic dermatitis often show symptoms of depression&#44; stress and impaired quality of life&#46; Itching is among the symptoms that were most often related to psychological distress and reduced quality of life&#46; Thus&#44; it is recommended that dermatologists&#44; when treating patients with AD&#44; also analyze aspects such as stress&#44; depression and quality of life&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0085" class="elsevierStylePara elsevierViewall">Cleide Rodrigues de Castro&#58; Design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Maria Elisa Bertocco Andrade&#58; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Renata Marli Gon&#231;alves Pires&#58; Critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Mario Cezar Pires&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Article information
ISSN: 03650596
Original language: English
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