Hidden Wounds: Exploring the Psychosocial Impact of Hidradenitis Suppurativa

Background: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disorder that has been demonstrated to have a profound impact on psychosocial functioning. Furthermore, those with HS have been shown to have significantly higher rates of mental health difficulties than those with other dermatoses, due to its high symptom burden and the stigma associated with the condition. Despite the breadth and magnitude of the deleterious effects of HS on psychological, physical, and social well-being, limited research has been conducted with the population exploring the impacts of HS on psychosocial well-being and functioning. There also appears to be a particular dearth of evidence that examines the psychological processes that predict these impairments in quality of life. Aims: This thesis aims to further understand and explore the psychosocial burden of HS. Specifically, this thesis looks to understand the impact of stigma and its relationship with psychosocial outcomes that have been identified as central to the lived experience of HS. This thesis also aims to identify modifiable psychological factors that may be implicated in the maintenance of psychological distress and impaired quality of life in those suffering with HS. Methods: Regarding these aims, a systematic narrative review was conducted to explore the extant literature related to experiences of stigma in HS. Second, an empirical investigation into the mediating roles of stigma, shame, and self-compassion, between depression, anxiety, and quality of life was conducted. Results: The systematic review revealed that enacted, perceived, and self-stigma are central to the experience of living with HS. The review also highlighted the profound impact stigma plays in disruptions to psychological, social, and physical well-being, and perhaps most importantly, the role it plays in impeding care seeking and health-care engagement. With regard to the empirical study, significant positive associations were found between depression, anxiety, quality of life, stigma, and shame, with self-compassion being significantly negatively associated with these psychosocial factors. Results partially confirmed the model, with depression, anxiety, stigma, shame, and self-compassion contributing to a considerable amount of variance (41%) in QoL. Depression was a positive predictor of impaired quality of life, while stigma, shame, and self-compassion were joint and unique mediators of this relationship. However, anxiety was not found to be a significant direct or indirect predictor of quality of life in the proposed model. Conclusion: Findings support that living with HS involves a substantial psychosocial burden, shaped by the complex interplay between disease-related factors, psychological distress, stigma, and impaired quality of life. Underscoring the importance of addressing the psychological and social dimensions of HS as core components of effective treatment and support.