In psoriasis, levels of hope and quality of life are linked

Psoriasis is a multifactorial skin disease, with a prevalence of 1.5–3 % in Western countries [7, 14]. The chronic and relapsing course of psoriasis, its resistance to therapy, the discomfort of therapy and the presence of skin lesions in exposed areas resulting in stigmatization all lead to significant quality of life (QoL) impairment. The impact of psoriasis on QoL was reported to be comparable to that of systemic life-threatening diseases such as arthritis, cancer, diabetes and cardiovascular disorders [20]. Recently, it was postulated that psychological factors and resources such as hope may play an important, moderating role on QoL impairment in patients with psoriasis [3, 12]. Hope is held to be an important protective factor in situations of threat and challenge [16]. According to Erikson, hope is an individual belief, that the world is orderly organized, rational and friendly to people, which appears in early childhood [4]. Hope has also been postulated to play a role in the adaptation to new situations and in the face of collapse of an existing order [28]. In other words, hope is thought to stimulate and maintain individuals’ constructive ways of coping with problems. In the face of personal loss, it helps to redefine aims and to search for new opportunities, thereby increasing chances to overcome crisis by finding an optimal solution.

It was shown that hope is positively correlated with QoL in the general population [2, 32], and hope has also been shown to have a positive role in chronic internal diseases, in terminally ill patients and their families [8, 11, 21]. Very recently, the relation of hope and QoL was first investigated in patients with psoriasis [27], and some domains of general QoL were suggested to benefit from high levels of hope. As of now, however, the link of hope and disease-specific QoL remains to be investigated and characterized in detail. We addressed this question and assessed and compared the levels of hope, of disease-specific as well as general QoL, and disease severity in hospitalized patients with psoriasis.

Here, we show—to our knowledge for the first time—that hope in psoriasis patients is linked to health-related, skin disease-specific QoL. In addition, our results confirm recent evidence showing that hope is correlated to general QoL in patients with this disease [27]. Surprisingly, we also found that younger age is associated with higher hope levels in psoriasis, whereas disease severity or duration was not.

Our demonstration of an association of hope and health-related and skin disease-specific QoL raises two interesting questions: (1) Is the association of quality of life and hope specific for psoriasis? We believe it is not: recent studies have demonstrated that hope also correlates with a higher satisfaction with life in patients with serious mental illness as well as with lower levels of depression in cancer patients [19, 29]. (2) Are high hope levels in psoriasis the reason or the consequence of better health-related QoL? We believe that it is patients’ QoL that benefits from high hope, for three main reasons: (a) The hope instrument we used (BHI-12) is designed to assess basic hope, a belief about the world formed in early childhood. Hope according to the data of longitudinal studies remains stable at least over the follow-up period of up to 3 years [15, 17, 24, 25, 28]. (b) Hope as assessed employing a longitudinal approach and path analysis was shown to improve mood and anxiety, but mood and anxiety had no influence on hope [1]. (c) Basic hope levels have been shown to be similar in patients (including psoriasis patients) as compared to healthy controls [27]. Taken together, this argues that higher QoL in psoriasis patients is, at least in part, a consequence of high levels of basic hope. This view is supported by the notion that hope is regarded as a “stress buffer”, i.e., one of the psychological resources that help to cope with stress [8]. In line with this, psychological resources have previously been claimed to function as positive modulators of QoL in psoriasis [18]. Also, higher hope is known to correlate with more adaptive coping strategies, as shown for example, in blind US-American veterans [9]. Our results on hope and general QoL complement recently published observations [27]. These authors also used a general QoL tool (the Flanagan QoL Scale) and reported a correlation between basic hope in the physical and social domains of general QoL and a lack of any association with the remaining domains (personal development and fulfillment, recreation) and with overall QoL. In contrast, we found a positive correlation of hope levels with general QoL in all domains as well as with global QoL. Interestingly, the mean hope levels found by Szramka-Pawlak and co-workers (28.86) and by us (28.95) are very similar. Therefore, the differences in the results on correlation between hope and general QoL from the Szramka-Pawlak study and from our study are not due to differences in the hope levels, but rather due to differences of the two patient populations including the higher number of patients in our study as well as the use of different QoL instruments.

As of now, we cannot explain why higher levels of hope are associated with lower age in psoriasis. This phenomenon cannot simply be explained by the cumulative influence of the disease over time as hope did not correlate with psoriasis duration. Previously, increased QoL impairment and higher psychological distress were seen in a group of older psoriasis patients as compared to younger ones [22]. Available data on the stability of hope do not allow for conclusions on the stability of this construct over longer than 3 years. The correlation between hope and age detected in our study suggests that levels of hope may decrease over decades. Further studies on hope and other resources in larger numbers of patients with psoriasis are required to confirm and understand this finding.