Self-Management Ability and Its Associations with Pruritus Severity, Self-Perceived Burden, and Psychological Resilience in Adults with Atopic Dermatitis: A Cross-Sectional Study.

OBJECTIVE

To evaluate self-management ability among adults with atopic dermatitis (AD) and examine its associations with pruritus severity, self-perceived burden, and psychological resilience.

METHODS

This cross-sectional study included 585 adults with AD. Self-management, pruritus, self-perceived burden, and psychological resilience were assessed using the Chronic Disease Self-Management Study Measures (CDSMS), pruritus Numerical Rating Scale (NRS), Self-Perceived Burden Scale (SPBS), and Connor-Davidson Resilience Scale (CD-RISC), respectively. The CDSMS total score was the primary outcome; its two subscale scores were secondary outcomes, and the three behavioral domain scores were exploratory outcomes. Univariable and multivariable linear regression analyses were used to estimate associations.

RESULTS

The mean CDSMS total score was 62.53 ± 9.55. In the primary multivariable model, older age (β=-0.06, 95% CI -0.11 to -0.02; P=0.003) and greater self-perceived burden (β=-0.23, 95% CI -0.35 to -0.11; P<0.001) were associated with lower CDSMS scores, whereas greater psychological resilience was associated with higher scores (β=0.30, 95% CI 0.21 to 0.39; P<0.001). Pruritus showed a borderline inverse association (β=-0.44, 95% CI -0.87 to 0.00; P=0.050). Alcohol use, pruritus, and physical and emotional burden were associated with lower self-efficacy, whereas optimism and tenacity were associated with higher self-efficacy. Older age and being single were associated with poorer self-management behaviors; estimates for divorced and widowed participants were based on very small subgroups and were considered exploratory. Associations varied across the cognitive symptom management, physician communication, and exercise domains.

CONCLUSION

Among adults with AD, poorer overall self-management was associated with older age and greater self-perceived burden, whereas greater psychological resilience was associated with better self-management. Associations differed across self-efficacy, overall self-management behaviors, cognitive symptom management, communication with physicians, and exercise. Assessment of pruritus, perceived burden, coping resources, communication difficulties, and age-related barriers may help tailor self-management support; longitudinal and intervention studies are needed to determine whether such support improves outcomes.