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Original Investigation
November 8, 2017

Association of Resilience With Depression and Health-Related Quality of Life for Patients With Hidradenitis Suppurativa

Author Affiliations
  • 1Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
  • 2Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
  • 3Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
JAMA Dermatol. Published online November 8, 2017. doi:10.1001/jamadermatol.2017.3596
Key Points

Question  What is the association of resilience with depression and quality of life for patients with hidradenitis suppurativa?

Findings  In this cross-sectional, multicenter survey study involving 154 patients with hidradenitis suppurativa, higher levels of resilience statistically significantly modified the association of depression with quality of life.

Meaning  In the management and treatment of patients with hidradenitis suppurativa, methods to increase resilience may improve health-related quality of life.


Importance  Hidradenitis suppurativa (HS) places a significant burden on the health-related quality of life (HRQOL) of patients, many of whom have depression. Resilience can play a role in mitigating the negative stressors, such as the symptoms of HS, on patients’ mental health.

Objective  To investigate the correlation among resilience, depression, and HRQOL for patients with HS.

Design, Setting, and Participants  This cross-sectional survey study of 154 patients from 2 referral centers in the United States and in Denmark was conducted from June 1, 2016, to March 31, 2017. Patients were considered eligible if they were 18 years or older and had a visit for HS at 1 of the 2 referral centers in the past 2 years (from January 1, 2014, through December 31, 2016). Patients were excluded if they declined to participate, could not read or write in English or Danish, or had a cognitive disability that would preclude their understanding of the survey questions.

Main Outcomes and Measures  The survey instrument included 4 questionnaires: (1) a sociodemographic and clinical characteristics questionnaire, (2) the Brief Resilient Coping Scale, (3) the Hospital Anxiety and Depression Scale, and (4) the Dermatology Life Quality Index. The main outcome of interest was the HRQOL as measured by the Dermatology Life Quality Index.

Results  All 154 patients submitted a completed survey. The mean (SD) age of the participants was 40.93 (13.5) years; most participants were women (130 [84.4%]), and most participants self-identified as white (139 [90.2%]). The rate of depression among the patients in this study was comparable to those reported in previous studies; 55 patients (35.7%) were classified as having depression, and 32 patients (20.8%) had borderline depressive symptoms. Patient-rated HS severity and the depression score each independently estimated 27% and 10% of variation in HRQOL, respectively. The interaction term for resilience and depression was significant, indicating that resilience moderates depression. Analysis of the mediation effects of resilience was not significant, indicating that resilience did not mediate the association between depressive symptoms and HRQOL. The resilience score was significantly associated with depressive symptoms (regression coefficient a = −0.21; P < .001), and the depressive symptoms score (c = 0.637; P < .001) was significantly associated with lower HRQOL (c′ = 0.644; P < .001). However, both the direct association (b = 0.033; P = .86) and the indirect association (a × b = 0.007; P = .87) of resilience with HRQOL were not significant.

Conclusions and Relevance  Patients with higher resilience levels experienced a smaller decrease in HRQOL as depressive symptoms increased. Because the findings suggest that resilience can be taught, there is an opportunity to develop a resiliency training program and investigate its role in stress levels and depressive symptoms, as well as in HRQOL and disease activity.