The Association of Alopecia Areata-Related Emotional Symptoms with Work Productivity and Daily Activity Among Patients with Alopecia Areata

Abstract

Introduction: Patients with alopecia areata (AA) experience psychological and psychosocial symptoms including depression, anxiety, anger, social withdrawal, embarrassment, and low self-esteem. While multiple studies have measured the detrimental emotional impact of AA on patient quality of life, evidence of its effect on work productivity loss (WPL) and daily activities is limited. This study aimed to assess the extent of AA-related emotional symptom (ES) burden on work productivity and activity impairment.

Methods: A cross-sectional survey of dermatologists and their adult patients with AA was conducted in the USA in 2019. Dermatologists provided assessments of patients' clinical characteristics, while patients completed sociodemographic questionnaires along with two validated patient-reported outcome measures of the Work Productivity and Activity Impairment (WPAI) and the AA Patient Priority Outcomes (AAPPO) ES subscale. The WPAI assessed AA-related WPL (employed respondents) and activity impairment (all respondents), and the AAPPO-ES assessed AA-related frequency of feeling self-conscious, embarrassed, sad, or frustrated. Multiple linear regression models were fitted to both WPAI scores with the AAPPO ES as an independent variable.

Results: A total of 242 patients with a mean (SD) age of 39.2 (13.3) years, treated by 59 dermatologists, were evaluated. Mean (SD) ES score was 2.0 (1.1). Mean (SD) work productivity loss [n = 170] and activity impairment [n = 242] were 12.2% (17.4%) and 13.3% (18.3%), respectively. After adjusting for covariates, WPL increased by 4.1% [95% confidence interval (CI) 1.6-6.7%; p = 0.002] and activity impairment increased by 3.1% (95% CI 0.7-5.4%; p = 0.010) for every 1-point increase in ES. For an average patient, a 1-SD decrease (about 1 point) on the ES scale substantially reduced WPL and activity impairment (by at least 25%).

Conclusions: Patients with AA reported significant increases in WPL and activity impairment associated with worsening AA-related ES. These findings underscore the substantial emotional and psychosocial burden among patients with AA and a need for improved treatment options.

Keywords: Activity impairment; Alopecia areata; Alopecia areata patient priority outcomes; Emotional symptoms; Psychodermatology; Work productivity loss.

Fig. 1

Flow of Selection of Study Cohort. AAPPO Alopecia Areata Patient Priority Outcome, PSC patient self-completion questionnaire, WPAI Work Productivity and Activity Impairment

Fig. 2

WPAI Scores—Descriptive Summaries. Values on top of bars indicate mean (SD). SD standard deviation, WPAI Work Productivity and Activity Impairment

Fig. 3

WPAI by AAPPO Emotional Symptoms Score. The continuous AAPPO ES scores were grouped for presentation purposes. 95% CI 95% confidence interval, AAPPO Alopecia Areata Patient Priority Outcomes, Corr. Coeff corrected coefficient, ES emotional symptoms, WPAI Work Productivity and Activity Impairment, WPL work productivity loss