Psychology, Health & Medicine, 2015 Vol. 20, No. 1, 97–102, http://dx.doi.org/10.1080/13548506.2014.894641
Assessing quality of life in Alopecia areata patients in China Sisi Qi, Feng Xu, Youyu Sheng and Qinping Yang* Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China (Received 19 August 2013; accepted 11 February 2014) Alopecia areata (AA) is a common chronic hair condition that has negative impact on both patients and their families. The aim of this article is to assess the impact of AA on patients’ quality of life (QoL) using the dermatology life quality index (DLQI) questionnaire, and assess its feasibility and internal consistency. A cross-sectional survey was conducted among 831 patients with AA between January 2010 and July 2012. The Chinese version of DLQI questionnaire was used to assess the QoL of AA patients more than 16 years old. About 698 patients (84%) completed the questionnaire. The scores ranged from 0 to 29 with a mean of 5.8 ± 5.6. Patients’ QoL was affected moderately to extremely by AA. Questions 2 (embarrassment), 5 (social or entertainment), and 3 (shopping or housework) had the most impact on patients. Mean score of younger patients was higher compared to older ones (6.2 vs. 4.8, P < .05). Patients with alopecia totalis/alopecia universalis, longer duration, local symptoms, and recurrent disease exhibited higher scores (P < .001). Among our patients with AA, Cronbach’s alpha was .881, indicating high internal reliability of DLQI questionnaire. In conclusion, AA moderately affected the QoL of the patients. These individuals had to be treated early, and required psychological support in addition to prescription drugs. Keywords: Alopecia areata; dermatology life quality index; quality of life; China; clinical study
Introduction Alopecia areata (AA) is characterized by a sudden onset hair loss in well-circumscribed round/oval patches without inflammation or scarring. In severe cases, hair loss can involve the entire scalp (AT) or body (AU) (Olsen et al., 2004). AA accounts for approximately 2% of new patient visits to dermatology clinics in the US and UK. (Safavi, Muller, Suman, Moshell, & Melton, 1995). In China, the prevalence of AA was account approximately .27% (Wang et al., 2009). Millions of patients were suffering from AA in China, but their quality of life (QoL) was not noticed as well. The dermatology life quality index (DLQI) is a dermatology-specific QoL measurement that has been used in many diseases (Basra, Fenech, Gatt, Salek, & Finlay, 2008). But there was only one study for severe AA patients in Kuwait (Al-Mutairi & Eldin, 2011). The purpose of this study is to assess QoL of AA in Chinese patients, and determine the relationship of DLQI scores to demographic and clinical variables.
*Corresponding author. Email: [email protected] © 2014 Taylor & Francis
98
S. Qi et al.
Methods Patients older than 16 years diagnosed with AA at the Department of Dermatology at Huashan Hospital, Shanghai, China, from January 2010 to July 2012 were recruited. The study was approved by the Huashan Hospital ethics committee. Demographic and clinical data were collected on each patient. The extent of hair loss was further categorized by the AA investigations assessment guidelines (Olsen et al., 2004). The DLQI questionnaire consists of 10 questions, each referring to the previous 7 days. It covers symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment as dimensions of life. Each item scored 0–3. Scores are added to yield a total DLQI of 0–30; higher scores mean greater impairment of the patient’s QoL (Finlay & Khan, 1994). The Chinese version of the DLQI was used here. “Banding” of DLQI scores allows this measure to be clinically useful (Hongbo, Thomas, Harrison, Salek, & Finlay, 2005). Grade 1 (0–1) means no effect at all on patient’s life, similarly, grade 2 (2–5) means small, grade 3 (6–10) means moderate, grade 4 (11–20) means very large, and grade 5 (21–30) means extremely large effect on patient’s life. Data were analyzed using SPSS version 13.0. The Mann–Whitney U-test was used to test the equality of distributions of quantitative outcomes. The relationships between DLQI scores and clinical and demographic factors were analyzed using ordinal multiple logistic regression. Construct validity was tested by factor analysis. Reliability was assessed by average inter-item correlation, item total correlation, and Cronbach’s alpha. P < .05 was interpreted as statistically significant. Results Of the 831 patients who had received questionnaires, 785 responded and 698 completed questionnaires were included. The reply rate was 84.0%. Patient demographics About 698 patients (349 male and 349 female) with an average age of 38.8 ± 12.0 years were enrolled. The average duration was 16.9 ± 37.3 months. Demographic and clinical characteristics are shown in Table 1. Hair pulling test consists of pulling on a tuft of hair without wishing to tear out the hair in so doing. The hairs which are left behind between the thumb and forefinger are counted. The test was performed on 654 patients and positive result was yielded in 155 (22.2%) patients. Local scalp symptoms were noted in 28.5%, including itching (25.4%), twinge (3.3%), haphalgesia (2.6%), and 3.4% patients presented with more than one symptom. DLQI scores The DLQI score ranged from 0 to 29, with a mean score of 5.8 ± 5.6. As shown in Table 2, 40.9% patients’ QoL was affected moderately to extremely by AA. The individual mean score ranged from .36 to .91. Questions 2 (embarrassment), 5 (social or entertainment), and 3 (shopping or housework) had the most impact on AA patients. The lowest was for question 6 (sport) and 1 (symptoms) (Table 3).
Psychology, Health & Medicine Table 1.
Demographic and clinical characteristics for patients with AA (n = 698).
Gender Male Female Mean age (years, mean ± SD) Age of onset (years)
Assessing quality of life in Alopecia areata patients in China Sisi Qi, Feng Xu, Youyu Sheng and Qinping Yang* Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China (Received 19 August 2013; accepted 11 February 2014) Alopecia areata (AA) is a common chronic hair condition that has negative impact on both patients and their families. The aim of this article is to assess the impact of AA on patients’ quality of life (QoL) using the dermatology life quality index (DLQI) questionnaire, and assess its feasibility and internal consistency. A cross-sectional survey was conducted among 831 patients with AA between January 2010 and July 2012. The Chinese version of DLQI questionnaire was used to assess the QoL of AA patients more than 16 years old. About 698 patients (84%) completed the questionnaire. The scores ranged from 0 to 29 with a mean of 5.8 ± 5.6. Patients’ QoL was affected moderately to extremely by AA. Questions 2 (embarrassment), 5 (social or entertainment), and 3 (shopping or housework) had the most impact on patients. Mean score of younger patients was higher compared to older ones (6.2 vs. 4.8, P < .05). Patients with alopecia totalis/alopecia universalis, longer duration, local symptoms, and recurrent disease exhibited higher scores (P < .001). Among our patients with AA, Cronbach’s alpha was .881, indicating high internal reliability of DLQI questionnaire. In conclusion, AA moderately affected the QoL of the patients. These individuals had to be treated early, and required psychological support in addition to prescription drugs. Keywords: Alopecia areata; dermatology life quality index; quality of life; China; clinical study
Introduction Alopecia areata (AA) is characterized by a sudden onset hair loss in well-circumscribed round/oval patches without inflammation or scarring. In severe cases, hair loss can involve the entire scalp (AT) or body (AU) (Olsen et al., 2004). AA accounts for approximately 2% of new patient visits to dermatology clinics in the US and UK. (Safavi, Muller, Suman, Moshell, & Melton, 1995). In China, the prevalence of AA was account approximately .27% (Wang et al., 2009). Millions of patients were suffering from AA in China, but their quality of life (QoL) was not noticed as well. The dermatology life quality index (DLQI) is a dermatology-specific QoL measurement that has been used in many diseases (Basra, Fenech, Gatt, Salek, & Finlay, 2008). But there was only one study for severe AA patients in Kuwait (Al-Mutairi & Eldin, 2011). The purpose of this study is to assess QoL of AA in Chinese patients, and determine the relationship of DLQI scores to demographic and clinical variables.
*Corresponding author. Email: [email protected] © 2014 Taylor & Francis
98
S. Qi et al.
Methods Patients older than 16 years diagnosed with AA at the Department of Dermatology at Huashan Hospital, Shanghai, China, from January 2010 to July 2012 were recruited. The study was approved by the Huashan Hospital ethics committee. Demographic and clinical data were collected on each patient. The extent of hair loss was further categorized by the AA investigations assessment guidelines (Olsen et al., 2004). The DLQI questionnaire consists of 10 questions, each referring to the previous 7 days. It covers symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment as dimensions of life. Each item scored 0–3. Scores are added to yield a total DLQI of 0–30; higher scores mean greater impairment of the patient’s QoL (Finlay & Khan, 1994). The Chinese version of the DLQI was used here. “Banding” of DLQI scores allows this measure to be clinically useful (Hongbo, Thomas, Harrison, Salek, & Finlay, 2005). Grade 1 (0–1) means no effect at all on patient’s life, similarly, grade 2 (2–5) means small, grade 3 (6–10) means moderate, grade 4 (11–20) means very large, and grade 5 (21–30) means extremely large effect on patient’s life. Data were analyzed using SPSS version 13.0. The Mann–Whitney U-test was used to test the equality of distributions of quantitative outcomes. The relationships between DLQI scores and clinical and demographic factors were analyzed using ordinal multiple logistic regression. Construct validity was tested by factor analysis. Reliability was assessed by average inter-item correlation, item total correlation, and Cronbach’s alpha. P < .05 was interpreted as statistically significant. Results Of the 831 patients who had received questionnaires, 785 responded and 698 completed questionnaires were included. The reply rate was 84.0%. Patient demographics About 698 patients (349 male and 349 female) with an average age of 38.8 ± 12.0 years were enrolled. The average duration was 16.9 ± 37.3 months. Demographic and clinical characteristics are shown in Table 1. Hair pulling test consists of pulling on a tuft of hair without wishing to tear out the hair in so doing. The hairs which are left behind between the thumb and forefinger are counted. The test was performed on 654 patients and positive result was yielded in 155 (22.2%) patients. Local scalp symptoms were noted in 28.5%, including itching (25.4%), twinge (3.3%), haphalgesia (2.6%), and 3.4% patients presented with more than one symptom. DLQI scores The DLQI score ranged from 0 to 29, with a mean score of 5.8 ± 5.6. As shown in Table 2, 40.9% patients’ QoL was affected moderately to extremely by AA. The individual mean score ranged from .36 to .91. Questions 2 (embarrassment), 5 (social or entertainment), and 3 (shopping or housework) had the most impact on AA patients. The lowest was for question 6 (sport) and 1 (symptoms) (Table 3).
Psychology, Health & Medicine Table 1.
Demographic and clinical characteristics for patients with AA (n = 698).
Gender Male Female Mean age (years, mean ± SD) Age of onset (years)
