Illness perceptions of adults with eczematous skin diseases: a systematic mixed studies review

Abstract

Background: Eczematous skin diseases, e.g., atopic dermatitis or contact dermatitis, are associated with a high disease burden, a significant impact on quality of life and a higher risk for anxiety and depression. Therefore, coping strategies are of interest. In order to understand coping processes, it is necessary to examine the patients' perspectives on their illness. The aim of this systematic mixed studies review is to investigate the illness perceptions of patients with eczematous skin diseases to get a better understanding of their coping processes.

Methods: We performed a systematic literature search in PubMed, The Cochrane Library, PsycInfo, PSYNDEX, CINAHL, Web of Science, and Scopus until February 20, 2019. Both qualitative and quantitative studies were included in the review. Two independent reviewers conducted data extraction and carried out a narrative synthesis. We assessed study quality with the Mixed Methods Appraisal Tool.

Results: Three qualitative and four quantitative studies were included in the systematic review. We found different methodological approaches for investigating illness perceptions: guided interviews, focus group interviews as well as standardized questionnaires, e.g., the Brief Illness Perception Questionnaire. All studies report suspected causes of the skin disease, such as endogenous and exogenous causes (namely, psychological or occupational factors). We found long timeline beliefs as well as various perceived and experienced social, economic, and psychological consequences. Our analysis reveals complex emotional representations in patients with eczematous skin diseases, in particular impairment of emotional well-being, and feelings of shame or helplessness. Qualitative and quantitative data were predominantly complementary and convergent.

Conclusion: Patients with eczematous skin diseases have complex illness representations regarding their disease. These representations interrelate with the coping behavior of patients. Therefore, medical professionals should consider them for counseling and treatment.

Systematic review registration: PROSPERO 2018 CRD42018109217 .

Keywords: Atopic dermatitis; Contact dermatitis; Eczema; Illness perceptions; Self-regulation model; Systematic review.

Fig. 1

PRISMA flow chart of search and study selection

Fig. 2

Narrative synthesis process. Modified according to Popay et al. [36] and Arai et al. [37]

Fig. 3

Leventhal’s common sense model of self-regulation (adapted from [20, 25, 38])

Fig. 4

Mean values of the Brief Illness Perception Questionnaire [51, 52]

Fig. 5

Expected and perceived consequences in terms of several dimensions. Summary of data from qualitative studies [–48] and Mollerup et al. [49]