The Psychosocial Burden of Morphea in Adults: Associations Between Disease Severity, Body Image, Mental Health, and Quality of Life
Main Article Content
Abstract
ckground: Morphea is a chronic skin disorder which can cause persistent disfigurement and impair quality of life. The relationship between disease severity, body image and mental health with quality of life has been insufficiently explored.
Objective: To evaluate the psychosocial burden of morphea in adults and examine the association of disease activity and body image with depressive symptoms, anxiety and quality of life.
Methods: This is a cross-sectional study that included 83 adults with dermatologist-established morphea conducted between 2023 and 2025 at Pegasus Med Clinic and EB Dermatology Clinic in Tirana, Albania. A consecutive sampling method was used to recruit all patients. The modified localized scleroderma skin severity index and damage index (mLoSSI, LoSDI) was used to assess disease activity and damage. The cutaneous body image scale (CBIS) was used to assess body image, depressive symptoms and quality of life. Other questionnaires included patient health questionnaire- 9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), and dermatology life quality index (DLQI). Correlations and multiple linear regression were performed to analyse all data.
Results: The mean age of the study population was 50.95±17.45 years and 88.0% of all participants were females. Mean mLoSSI, LoSDI, CBIS, PHQ-9, GAD-7 and DLQI scores were 9.35±7.96, 10.84±9.78, 6.21±1.22, 6.63±3.57,
7.90±4.03 and 3.87±3.99, respectively. There was a positive correlation of DLQI with mLoSSI (r=0.431, p<0.001), PHQ-9 (r=0.420, p<0.001) and GAD-7 (r=0.365,
p=0.001). There was a negative correlation of CBIS with DLQI (r=−0.257, p=0.019). Regression analysis showed 40.5% of DLQI variance and found that mLoSSI and CBIS were independently associated with DLQI.
Conclusion: Psychosocial burden in morphea is associated with active disease and body-image disturbance. Assessment of psychosocial outcomes alongside clinical severity may support comprehensive and patient-focused management.