Shifting the focus: Exploring happiness as a health outcome in dermatology

Happiness is under-researched in medicine. The World Happiness Report highlights the role of societal factors: income equality, social freedom and healthcare access in influencing population-level happiness.¹ The majority of dermatological research focuses on disability indices such as impairment in mental health, reduced health-related quality of life (HRQoL), economic burden and other negative measurements that impair well-being. In this issue of the JEADV, Ziehfreund, Wecker et al. present their study² in which they chose to adopt a positive perspective, exploring happiness as the key health outcome. The authors investigated happiness in 1039 patients with psoriasis and atopic dermatitis (AD).

The study employs a combination of subjective self-assessments using standardized instruments (Dermatology Life Quality Index (DLQI), Satisfaction with Life Scale (SWLS), subjective well-being with the Scale of Positive and Negative Experience (SPANE), a heuristic happiness single item scale and self-assessed disease severity) as well as objective clinical measures of disease severity (Psoriasis Area and Severity Index [PASI] and SCORing Atopic Dermatitis [SCORAD]) to integrate diverse data, which were then used to perform quantile regression. This approach offers valuable insights into the factors influencing happiness across a spectrum of experiences.

The authors selected their measurements based on prior existing publications and their own experience in the field, ensuring that results could be compared across studies and patient groups. Furthermore, the participants were recruited from eight European countries, providing insights into geographical differences in happiness levels and their relationship with dermatological health. This broad scope is a valuable contribution to cross-cultural research in dermatology.

Patients with AD reported greater impairment in HRQoL compared to patients with psoriasis. The authors attribute this difference to symptoms such as itch and fatigue. However, fatigue is more explored in psoriasis, while tiredness in AD is more likely to result from sleep loss due to severe itching.³ Another reason for lower experienced happiness in patients with AD may be due to psoriasis patients having had access to effective biological treatments, available since the early 2000s, whereas similar treatments for AD have only recently become available.⁴ The last two decades have offered psoriasis patients considerably better improvement in symptoms than for patients with AD, thus a different patient journey. In the study by Ziehfreund, Wecker et al.,² patients with AD exhibited more severe disease symptoms than patients with psoriasis, and current or previous use of systemic treatments was linked to higher happiness scores in some quantiles. These findings underscore the importance of adequate medical management in improving patient happiness.

Among the various outcomes, the disparity in happiness was most pronounced between the eight participating countries (Austria, Poland, Italy, Ukraine, Malta, Germany, Portugal and Romania). Happiness levels were highest in Austria and Italy, potentially reflecting better healthcare access or societal factors. In contrast, Poland, Romania and Ukraine exhibited lower scores, suggesting disparities in treatment availability or cultural attitudes towards visible skin conditions. However, there were significant differences in the number of patients from each country, ranging from 23 (Romania, 7 with AD) to 256 (Austria, 91 with AD), making some comparisons less robust. Nevertheless, these results align with known differences in health policies and treatment access across European countries.⁵

The study largely focuses on European populations and two chronic inflammatory skin diseases. Expanding research to include diverse global contexts and a broader range of dermatological conditions could generate knowledge to enhance well-being, satisfaction with life and happiness. This study represents a significant step forward in understanding the interplay between dermatological health and subjective well-being, shifting the focus from traditional impairment metrics to positive psychological constructs such as happiness.

None.