Stigma Underlies the Mental Health Burden of Pediatric Atopic Dermatitis: A Cohort Study

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Background: The role of stigma in childhood atopic dermatitis (AD) has received little attention. Objective: To validate a new self-reported tool to measure pediatric stigma and correlate stigma with physical, mental, and social domains of health in pediatric patients with AD. Methods: In a cohort study, 180 children with AD 8-17 years old and a parent enrolled and completed the PROMIS Pediatric Stigma (PPS)-Skin questionnaire and other patient- and proxy-reported measures. Results: PPS-Skin showed strong construct and convergent validity, as well as responsiveness to changes 6-12 months after enrollment. Stigma scores were strongly correlated with scores for itch and moderately with several other physical and psychosocial markers of health, especially sleep-related impairment, depression, and psychological stress. Almost 30% had at least moderately increased scores for depression and anxiety. Proxy reports correlated moderately to strongly with all corresponding child measures, but parents tended to overestimate the burden of itch. Correlations between PPS-Skin and other measures of psychosocial health persisted from initial visit to month 12, demonstrating responsiveness to change. Limitations: Single-center study Conclusion: PPS-Skin and its associated PPS-Skin-Proxy tool are valid for use in children with AD and valuable additions to studying childhood mental health.

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