Effect of "Anxiety to Itch" in Adult Atopic Dermatitis Patients : by use of Structural Equation Modeling

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  • Himachi Mika
    Faculty of Human Cultures and Sciences, Fukuyama University
  • Okajima Isa
    Japan Somnology Center, Neuropsychiatric Research Institute:Department of Somnology, Tokyo Medical University
  • Hashiro Makoto
    Department of Dermatology, Osaka Police Hospital
  • Sakano Yuji
    School of Psychological Science, Health Sciences University of Hokkaido

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Other Title
  • 成人型アトピー性皮膚炎患者の痒みに対する不安の研究 : 構造方程式モデリングを用いて
  • セイジンガタ アトピーセイ ヒフエン カンジャ ノ カユミ ニ タイスル フアン ノ ケンキュウ コウゾウ ホウテイシキ モデリング オ モチイテ

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Abstract

Objective: It has been indicated that atopic dermatitis (AD) has association with health related quality of life (HRQOL) because it can have an impact on work, sleep and social relations (Kiebert et al., 2002). Anxiety in the adult AD patient has an influence on the itch related to deterioration of the symptom and particularly, scratching behavior and it is suggested that anxiety reduced HRQOL. In the previous study, it was made clear that the adult AD patient also holds "anxiety to itch". However, it remains still unclear how "anxiety to itch" relates to the "itch" and "scratching behavior", which influence the HRQOL. The purpose of this study is to investigate the causal relationship among "anxiety to itch", "itch", "scratching behavior", and the "disease specific HRQOL" for adult AD patients by using Structural Equation Modeling (SEM). Method: Subjects were 50 adult AD patients. The "anxiety to itch" was measured by using the Itch Anxiety Scale for Atopic Dermatitis (IAS-AD: Himachi et al., 2007). Itch was measured using the Numerical Rating Scale (NRS), scratching behavior was measured using the scratching checklist (Tsutsui, 1999), and the disease specific HRQOL was measured using the skindex29 (Fukuhara, 2004). Results: Mean score on the IAS-AD was 51.07 (SD=12.73), an itch was 73.19 (SD=34.31), strength of scratching behavior was 20.20 (SD=10.54), length of scratching behavior was 19.40 (SD=11.78), and Skindex29 was 38.41 (SD=25.05). Two causal models were hypothesized referring to the previous studies and were compared by using the structural equation modeling (SEM). The result of comparison between two causal models showed that the model that "anxiety of itch" influences "itch" (r=0.84), "itch" influences "scratching behavior" (r=0.91), and "scratching behavior" influences "HRQOL" (r=0.73) is more suitable (χ^2=14.78, df=13, p=0.32, AIC=44.784, BIC=73.465, GFI=0.925, AGFI=0.835, CFI=0.995, RMSEA=0.053). Conclusion: It is concluded that the high level of "itch to anxiety" increases in itch and itch increases scratching behavior, and scratching behavior adversely effects "itch to anxiety" on HRQOL in adult AD patients. In order to improve the HRQOL of adult AD patients, it is necessary to develop the treatment method which focuses on "itch to anxiety".

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