Psychological Assessment of Anxiety and Depression in Patients with Single versus Multiple Keloids: A Cross-Sectional Study

Description

Supplementary Figure Legends Fig. S1: Patient enrollment and grouping flowchart. Fig. S2: Psychological distress comparison. Multiple keloid (MK) patients showed significantly higher HADS (p=0.015) and SDS (p=0.003) scores compared to single keloid (SK) patients. Fig. S3: Physical symptom comparison. SK patients paradoxically reported higher VSS and VAS scores than MK patients (both p<0.001). Fig. S4: Correlation analysis. No significant correlation was found between physical symptom severity and psychological distress (R<0.1,p>0.05). Supplementary material Methods Study Design & Population This cross-sectional study (Oct 2023 – Sept 2025) at the Dermatology Hospital of Southern Medical University analyzed 758 patients with keloids. Participants were grouped into Single Keloid (SK; n=274) or Multiple Keloid (MK; n=484) cohorts. The study followed Declaration of Helsinki principles and received institutional ethics approval. Assessments Upon enrollment and following the acquisition of informed consent, all participants underwent a standardized evaluation during their clinical consultation. Psychological status was evaluated using the HADS. This instrument comprises two subscales: the Self-Rating Anxiety Scale (SAS) to assess anxiety symptoms and the Self-Rating Depression Scale (SDS) to assess depressive symptoms; the sum of these subscales yielded the HADS Total score. Concurrently, physical symptoms were assessed using the VSS, which evaluates scar pigmentation, vascularity, pliability, and height, and a VAS to measure the subjective intensity of pain and pruritus. Recognizing that the VSS is primarily designed for single lesions, for patients with multiple keloids, the VSS was evaluated based on the most severe target lesion. Conversely, the VAS was utilized as a patient-reported outcome to capture the global, subjective sensation of overall itch and pain burden, regardless of the number of lesions. Statistical Analysis Statistical analysis was conducted using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables are presented as Mean ± Standard Deviation (SD). Normality was assessed using the Shapiro-Wilk test. Differences between groups (Single vs. Multiple, Male vs. Female) were analyzed using the Mann-Whitney U test due to non-normal distribution. Comparisons across age groups were performed using the Kruskal-Wallis test. Spearman’s rank correlation coefficient (R) was used to analyze associations between psychological and physical scores. To rule out potential confounding factors, a multivariable Ordinary Least Squares (OLS) linear regression analysis was performed utilizing the SDS score as the dependent variable, controlling for age, gender, disease duration, anatomical location, and previous treatment history. A p-value of <0.05 was considered statistically significant.

Institutions

• Southern Medical University

  Guangdong, Guangzhou

Categories

Licence