PS71 Psychodermatological burden in military personnel: impact of stress, insomnia and night-shift work on dermatological disease flares and quality of life

Abstract

Psychological stress, sleep disturbance and occupational strain modulate inflammatory and autoimmune skin diseases through neuroendocrine, immune and behavioural pathways. Military personnel face unique occupational exposures including rotating shifts, night duties and high psychological stress, yet psychodermatological burden in military settings remains insufficiently explored. The aim of this study was to determine the prevalence of psychological distress, insomnia and perceived stress among military dermatology patients, identify stress-responsive dermatoses, and to evaluate independent predictors of quality-of-life impairment and disease flare, with particular attention to night-shift work. This was a cross-sectional study of 300 consecutive adult patients attending a military dermatology outpatient clinic over 2 months. Validated instruments were used to assessed psychological distress (General Anxiety Disorder-7, Patient Health Questionnaire-9), insomnia (Insomnia Severity Index) and perceived stress (Perceived Stress Scale-10). Dermatological assessment included clinical diagnosis, flare status, physician-rated severity and Dermatology Life Quality Index (DLQI). Multivariable linear regression was used to identify predictors of DLQI, and logistic regression was used to identify predictors of flare at presentation. Covariates included stress, insomnia, anxiety, depression, night-shift exposure and dermatological diagnosis. Approximately one-third of patients exhibited clinically significant anxiety, depression or insomnia, with moderate-to-severe quality-of-life impairment. Psoriasis and alopecia areata demonstrated the highest flare rates, supporting their classification as stress-responsive diseases. Multivariable analysis showed that disease severity, anxiety and depression were the strongest independent predictors of higher DLQI scores, while insomnia and perceived stress contributed additional effects. Higher perceived stress, insomnia severity and night-shift frequency were independently associated with flare at presentation. Psoriasis and alopecia areata demonstrated the strongest adjusted associations with flare, confirming heightened stress sensitivity. A substantial psychodermatological burden exists within military dermatology populations, with strong links between psychological factors, night-shift exposure and disease flares. The findings underscore the importance of routine psychological and sleep screening, integration of psychodermatological and occupational health approaches, and development of targeted stress- and sleep-focused interventions to reduce flare frequency and improve quality of life.