P082 The WHO-5 wellbeing measure as an assessment tool in inflammatory skin diseases

Abstract

Inflammatory skin diseases have significant effects on wellbeing. Patient-reported outcome measures (PROs) are important in assessing the impact of skin disease on the individual affected. The WHO-5 measure is a brief, five-item questionnaire providing a subjective measure of overall wellbeing, developed by the World Health Organization. It has been clinically validated and shows reliability across multiple populations and in multiple medical conditions (Topp CW, Ostergaard SD, Sondergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom 2015; 84: 167–76). It has been used as an endpoint in dermatology and nondermatology clinical trials. For this study we recruited 203 participants, 71% female and 29% male. Inflammatory skin conditions included 52 patients with psoriasis, 73 with hidradenitis suppurativa (HS) and 24 with atopic dermatitis (AD). We compared their WHO-5 scores to those of a control group of 55 without inflammatory skin disease. Each participant completed the WHO-5 questionnaire. Those scoring < 50 were contacted, and those who did not have a diagnosis of depression completed the Major Depression Index. Ethical approval was granted by the hospital research ethics committee. The mean WHO-5 score of controls was 70.5 (SD 20), in line with previous studies using the WHO-5 in the general population. Mean (SD) scores in the psoriasis, AD and HS groups were 66.2 (24.9), 58.3 (23.4) and 49.1 (19.4), respectively. In total, 64 participants scored < 50: 15% of controls, 25% of those with psoriasis, 29% with AD, and 49% with HS. Statistical analysis using the Kruskal–Wallis test revealed a statistically significant difference between the groups (χ2 = 35.3, df = 3, P ≤ 0.001). Post hoc analysis using DSCF correction showed significantly lower wellbeing in those with HS compared with both the control group (P ≤ 0.001) and the psoriasis group (P < 0.001). Reviewing other studies on wellbeing using WHO-5 for assessment, we found that the mean WHO-5 in patients after a stroke was 68.9, just below the 50 in diabetes, 70.5 in epilepsy, 61.6 in schizophrenia on treatment, and 52.2 in breast cancer (Topp et al.). It is notable that most participants were returning to the outpatient clinic, and therefore on treatment for their skin disease. It is possible that wellbeing scores in those with untreated skin disease may be lower again. These findings highlight the significant impact of inflammatory skin diseases on wellbeing, with all three groups having lower scores than those with epilepsy, with treated schizophrenia, or after a stroke. Furthermore, the HS group had a lower mean score than that reported in studies of patients with breast cancer or type 1 diabetes. The low scores in our HS group emphasize the devastating impact of HS, and the need for appropriate resourcing and licensed treatments for this debilitating, chronic disease.