Comparative study of life satisfaction among patients with psoriasis versus healthy comparison group: the explanatory role of body image and resource profiles

Abstract

Purpose:
The aim of the study was first to examine the heterogeneity of body image and resources, as described by the conservation of resources theory (COR), in a sample of psoriatic patients and explore whether heterogeneity within these variables explains the possible differences in levels of life satisfaction among the participants. Second, we aimed to investigate if life satisfaction level among the observed profiles of psoriatic patients, extracted on the basis of their body image and resources, differed from that of the healthy comparison group.

Methods:
The sample consisted of 735 participants, including 355 adults with a medical diagnosis of psoriasis and 380 healthy adults recruited from a non-clinical general population. Participants filled the Satisfaction with Life Scale, the Multidimensional Body-Self Relations Questionnaire and the COR evaluation questionnaire.

Results:
Latent profile analysis revealed four classes of psoriatic patients with different levels of resources and body image. The group with the highest level of resources and the most positive body image did not differ from the healthy comparison group regarding satisfaction with life. The group with the lowest level of resources and the most negative body image was characterized by the lowest satisfaction with life.

Conclusions:
The results of our study may change the simplifying trend that highlights the traditionally very poor well-being of psoriatic patients. Moreover, the discovery of specific profiles of these patients, which differ with regard to psychological variables, can lead to rethinking contemporary forms of psychological counselling in psoriatic patients.

Full text

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Quality of Life Research (2021) 30:181–191
https://doi.org/10.1007/s11136-020-02621-3
Comparative study oflife satisfaction amongpatients withpsoriasis
versushealthy comparison group: theexplanatory role ofbody image
andresource profiles
MarcinRzeszutek1 · KatarzynaPodkowa1· MałgorzataPięta1· DanielPankowski2 · SylwiaCyran‑Stemplewska3
Accepted: 19 August 2020 / Published online: 4 September 2020
© The Author(s) 2020
Abstract
Purpose The aim of the study was first to examine the heterogeneity of body image and resources, as described by the conser-
vation of resources theory (COR), in a sample of psoriatic patients and explore whether heterogeneity within these variables
explains the possible differences in levels of life satisfaction among the participants. Second, we aimed to investigate if life
satisfaction level among the observed profiles of psoriatic patients, extracted on the basis of their body image and resources,
differed from that of the healthy comparison group.
Methods The sample consisted of 735 participants, including 355 adults with a medical diagnosis of psoriasis and 380
healthy adults recruited from a non-clinical general population. Participants filled the Satisfaction with Life Scale, the Mul-
tidimensional Body-Self Relations Questionnaire and the COR evaluation questionnaire.
Results Latent profile analysis revealed four classes of psoriatic patients with different levels of resources and body image.
The group with the highest level of resources and the most positive body image did not differ from the healthy comparison
group regarding satisfaction with life. The group with the lowest level of resources and the most negative body image was
characterized by the lowest satisfaction with life.
Conclusions The results of our study may change the simplifying trend that highlights the traditionally very poor well-being
of psoriatic patients. Moreover, the discovery of specific profiles of these patients, which differ with regard to psychological
variables, can lead to rethinking contemporary forms of psychological counselling in psoriatic patients.
Keywords Psoriasis· Life satisfaction· Body image· Resources· Latent profile analysis
Psoriasis is a chronic, inflammatory and incurable derma-
tological disease associated with visible and painful skin
lesions and disfigurements, which may involve all parts of
the body and significantly decrease patients’ well-being [2,
34]. Psoriasis affects men and women regardless of age or
ethnicity and its worldwide prevalence varies between 0.91%
in the United States to 8.5% in Norway [14]. Individuals
suffering from psoriasis are at great risk of developing other
chronic medical conditions such as cardiovascular diseases,
hypertension, stroke or Crohn’s disease [1]. Moreover, this
disease poses a major psychological burden related with
experiences of constant embarrassment, stigma, social iso-
lation and very poor self-esteem (see review, e.g. [24]). In
particular, psoriatic patients display profound distortions
in their body perception and negative body image impacts
not only their psychological well-being, but also treatment
adherence and treatment outcomes [15, 30, 36, 49]. The
aforementioned factors can be related with mental health
* Marcin Rzeszutek
marcin.rzeszutek@psych.uw.edu.pl
Katarzyna Podkowa
k.podkowa@student.uw.edu.pl
Małgorzata Pięta
mjpieta@gmail.com
Daniel Pankowski
d.pankowski87@gmail.com
Sylwia Cyran-Stemplewska
cyransyl@gmail.com
1 Faculty ofPsychology, University ofWarsaw, Stawki 5/7,
00-183Warsaw, Poland
2 Faculty ofPsychology, University ofEconomics andHuman
Sciences inWarsaw, Okopowa 59, 01-043Warsaw, Poland
3 The Jan Kochanowski University, Żeromskiego 5,
25-369Kielce, Poland
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182 Quality of Life Research (2021) 30:181–191
1 3
problems. For example, compared to the general population
psoriatic patients are 40–90% more in danger of depression
[25, 50] and anxiety [10, 12]. Thus, it is not a surprise that
their subjective well-being is one of the worst compared to
that of patients with other chronic or even life-threatening
illnesses [34, 38]. Some authors found that the major issue
associated with well-being among this patient group is the
subjective perception of the severity of their illness, which
is greatly shaped by psychosocial resources [44]. Further-
more, an increasing number of authors have underlined that
psychological factors outweigh the role of medical variables
illustrating the objective severity of the psoriasis as predic-
tors of well-being in this patient group [26, 36]. Thus, in
our study we focused on the role of subjectively assessed
resources from the conservation of resources theory (COR;
[17]), and their link to body image and life satisfaction in
psoriatic patients. The first novelty of our study relates to
the application of COR theory to illustrate the process of
coping with psoriasis, as until now only the transactional
model of stress and coping [27] has been used in this regard
(e.g. [11, 12, 44]).
COR theory describes the sociocultural aspects of stress
and coping and focuses on resources defined as things that
the individual currently possesses and values (e.g. objects,
states or conditions) or aims to achieve, maintain and protect
in the future [17]. More specifically, this theory emphasizes
the objective nature of stress simultaneously positing that
although most resources are universally valued, their rela-
tive worth is likely to vary between people. Thus, the COR
model proposes an important role for appraisal, but states
that resources have both objective and subjective compo-
nents. Until now, the majority of studies on Hobfoll’s theory
have been carried out in non-clinical settings (e.g. [19, 20,
22, 48]) and much less is known about the application of
this theory to the clinical environment, especially in patients
struggling with chronic illness [8, 43]. For example, Dirik
and Karanci [8] showed that loss of resources as described
by COR can be an important predictor of illness-related
distress (see depression and anxiety) among rheumatoid
arthritis patients. In addition, Rzeszutek etal. [43] observed
the role of family resources from the COR theory for bet-
ter psychological functioning among females suffering from
rheumatoid arthritis and females with breast cancer.
As far as psoriatic patients are concerned there are two
particular reasons why COR theory is useful for illustrat-
ing how well or poorly they are coping with this disease.
First, medical variables are very weakly related with the
subjective well-being of psoriatic patients, i.e. the way
these patients perceive their skin is much more impor-
tant for their well-being than the objective severity of
the psoriasis as assessed by clinical biomarkers [35, 39,
47]. In the constructive perception of skin symptoms,
family resources are crucial [21]. Second, psoriasis has
substantial repercussions on multiple aspects of the func-
tioning of these patients ranging from family or intimate
relationships to patients’ body image [16, 31, 33, 41].
Especially this latter variable, which is a multidimen-
sional construct describing individual’s thoughts, beliefs,
emotions and behaviours associated with one’s physical
appearance, is shaped greatly by social and cultural fac-
tors [4]. COR theory illustrates the sociocultural aspects
of stress and coping and resources as described by COR
confer a symbolic value as they are essential to one’s self-
image and identity [19]. However, till now the relationship
between COR resources and body image in the clinical set-
tings was noticed only among rheumatoid arthritis patients
[37], so examining this relationship in case of psoriasis is
an interesting research gap to fill.
There is an ongoing dispute on the process of the adap-
tation of subjective well-being (SWB) as consequence of
experiencing stressful life events [7, 28], including also the
case of coping with chronic illness [3, 42, 45]. A major-
ity of authors showed the large empirical evidence for the
“hedonic treadmill” model [29], i.e. “stability despite loss”,
of well-being in reaction to life stress and adversity [9]. This
latter pattern refers especially to the tripartite model of sub-
jective well-being by Diener etal. [6, 7], and its cognitive
component, i.e. life satisfaction, which was found to be a
relatively stable, global evaluation of a person’s life [7]. The
“stability despite loss” of life satisfaction was found also in
aforementioned research on chronically ill patients [3, 45].
In our study, we conducted a comparative analysis of the life
satisfaction level between the sample of psoriatic patients
and healthy comparison group to indirectly check whether
the aforementioned pattern may be present also in this par-
ticular, clinical sample. Comparative studies on this topic
are very scarce and have provided mixed results, especially
with regard to the variable of life satisfaction. While Solovan
etal. [46] observed intuitively obvious, poorer life satisfac-
tion among psoriatic patients, Reimus etal. [40] found no
differences in life satisfaction level between these patients
and healthy comparison group. The latter authors concluded
that when individuals suffering from psoriasis are able to
continue their usual daily activities and maintain an aver-
age day schedule thanks to family or partner support their
painful skin symptoms do not diminish their life satisfaction.
Finally, to the best of our knowledge, contemporary stud-
ies on the psychological aspects of struggling with psoriasis
have been based only on a variable-centred approach, which
disregards the problem of the heterogeneity of participants
within the studied variables (see reviews, e.g. [2, 24, 34]).
In other words, those studies focused on identifying single
sociomedical and/or psychological variables that were inde-
pendently related to various aspects of well-being, coping
or general functioning among these patients. Therefore, the
application of a person-centred perspective, exploring the
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183Quality of Life Research (2021) 30:181–191
1 3
unique profiles of participants within the study variables, is
the third novelty of our research.
Current study
Taking the above-mentioned research gaps into consider-
ation, the main aim of our study was two-fold. First, we
wanted to examine the heterogeneity of body image and
resources in the sample of psoriatic patients and explore
whether heterogeneity within these variables could explain
the possible differences in levels of life satisfaction among
participants, while controlling for their sociomedical data.
Second, we aimed to investigate if the observed profiles of
psoriatic patients, extracted on the basis of their body image
and resources, differed from the healthy comparison group
with regard to the level of life satisfaction. To the best of
our knowledge, there are no studies conducted among pso-
riatic patients that may be useful for us as a direct source of
research hypotheses in the case of this special study design.
Thus, we mainly employed an exploratory approach in our
study. However, based on some existing studies within a
different methodological framework (see above, e.g. [2, 10,
24, 34]), we expected that our clinical sample would be het-
erogeneous in terms of body image and resources and that
the observed profiles of these psychological variables would
be differently related to levels of life satisfaction within the
group of psoriatic patients, while controlling for sociomedi-
cal covariates. Moreover, we assumed that psoriatic patients
would declare, on average, lower levels of life satisfaction
and a more negative body image and would assess their
psychosocial resources as worse compared to the healthy
comparison group. We also hypothesized that participants
from various profiles, extracted on the basis of their body
image and resources, would declare different levels of life
satisfaction compared with the healthy comparison group.
Method
Participants andprocedure
The sample was comprised of 355 adults with a medical
diagnosis of psoriasis and 380 healthy adults (without any
chronic illnesses) recruited from a non-clinical population.
The psoriatic patients were recruited both from among
patients hospitalized in two dermatology clinics in Poland,
where they filled out traditional, paper-and-pencil ques-
tionnaires, and from members of the Union of Associa-
tions of Patients with Psoriasis in Poland, who filled out
an online inventory distributed via social media. Specifi-
cally, the online part of the study was conducted because
of the possibility of reaching patients all over Poland; in
our study we did not want to limit ourselves only to clinics
in large cities. Working online allowed us to recruit peo-
ple from small towns, as well as individuals who do not
have an active disease at the moment and do not require
hospitalization. Importantly, in order to be a member of
the Union of Associations of Patients with Psoriasis in
Poland the patient should submit a medically confirmed
diagnosis of psoriasis.
As far as the first mode of recruitment is concerned,
105 of the participants with psoriasis were patients of the
Dermatology Clinic at the Military Institute of Medicine
in Warsaw or the Dermatology Clinic of the Provincial
Integrated Hospital in Kielce. Specifically, out of 180
patients eligible for the study in these two clinics, 105
were recruited and agreed to filled out questionnaires
(58%), 36 declined (20%), and 39 (22%) completed the
inventories with a very high level of missing data, which
precluded including them in the statistical analysis. In the
online mode, 250 psoriatic patients agreed to fill out the
study questionnaires. In both modes of the participants’
recruitment the eligibility criteria included being 18years
of age or older and having a medical diagnosis of psoriasis
for at least 1year. The exclusion criteria included a recent
outbreak of psoriasis, i.e. having had psoriasis for <1year.
In both modes of participant recruitment the study subjects
were given informed consent and participated in the study
voluntarily, as there was no remuneration in exchange for
participation.
The healthy comparison group was recruited among stu-
dents from various Warsaw universities and this group filled
out the study questionnaires online via social media. The
both inclusion and exclusion criteria encompassed being
18years of age or older, no history or presence of chronic
medial illnesses and willingness to take part of this study.
In particular, this comparison sample was recruited after
psoriatic patient cohort was collected, because we tried to
maintain purposeful sampling in order to obtain comparison
group with demographic characteristics similar to those of
our clinical sample. The study was approved by the local
ethics commission.
Table1 summarizes the sociomedical variables in both
groups of participants with values of statistical test. Cat-
egorical variables were tested with the use of Pearson’s chi-
squared test of independence. Participants’ age was tested
with the use of Student’s t test for independent samples.
The percentages of males, married participants, par-
ticipants with higher education, and participants with full
employment were higher in the clinical sample. The percent-
age of participants living in cities with over 500 thousand
residents was higher in the healthy control group. Socio-
medical variables that differed between the two groups and
were significantly related to the explained variable were
controlled for in the subsequent analysis.
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184 Quality of Life Research (2021) 30:181–191
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Measures
Life satisfaction was assessed with the Satisfaction with Life
Scale (SWLS; [6]) in a Polish adaptation. SWLS consists of
five items, respondents assess each item on a seven-point
scale ranging from one (strongly disagree) to seven (strongly
agree). For example: I am satisfied with my life; So far I have
gotten the important things I want in life. Thus, a higher total
score on this scale indicates a higher level of life satisfac-
tion. McDonald’s omega [32] coefficient for the SWLS in
the sample of psoriatic patients was .87 and in the healthy
comparison group was .90.
Participants’ body image was evaluated with the
Multidimensional Body-Self Relations Questionnaire
(MBSRQ) created by Cash [4] and adapted to Polish.
The MBSRQ consists of ten scales describing several
aspects of body image: the appearance evaluation scale,
the appearance orientation scale, the fitness evaluation
scale, the fitness orientation scale, the health evaluation
scale, the health orientation scale, the illness orientation
scale, the body-areas satisfaction scale, the overweight
preoccupation scale and the self-classified weight scale.
The particular items of this inventory are as following:
I always pay attention to what I look like before leaving
the house, I am careful to buy clothes that will allow me
to look my best. The higher the results in each subscale,
the more positive the particular body image aspect. In
the clinical sample, subjects were instructed to focus on
Table 1 Sociomedical variables
in the studied sample of
psoriatic patients (N = 355)
and healthy comparison group
(N = 380)
M mean, SD standard deviation, χ2 Pearson’s Chi-squared test of independence, t Student’s t test for inde-
pendent samples
p, statistical significance
Variable N (%)
Psoriasis
N (%)
Healthy com-
parison group
Significance test
Gender
Male 83 (23.4%) 58 (15.3%) χ2(1) = 7.80, p < .001
Female 272 (76.6%) 322 (84.7%)
Age in years (M ± SD) 23.42 ± 12.42 29.52 ± 7.07 t(553.12) = −16.79, p < .001
Marital status
Married 260 (73.2%) 204 (53.7%) χ2(1) = 30.15, p < .001
Single 95 (26.8%) 176 (46.3%)
Education
Elementary 8 (2.3%) 6 (1.6%) χ2(3) = 89.99, p < .001
Vocational 22 (6.2%) 3 (.8%)
Secondary 141 (39.7%) 279 (73.4%)
Higher education 184 (51.8%) 92 (24.2%)
Employment
Full employment 237 (66.8%) 171 (45.0%) χ2(3) = 77.77, p < .001
Unemployed 86 (24.2%) 199 (52.4%)
Illness allowance 9 (2.5%) 10 (2.6%)
Retired 23 (6.5%) 0 (0%)
Village, small town up to 20 thousand
residents
103 (29.0%) 62 (16.3%) χ2(4) = 88.31, p < .001
City 21 to 100 thousand residents 69 (19.4%) 45 (11.8%)
City 101 to 500 thousand residents 71 (20.0%) 25 (6.6%)
City over 500 thousand residents 109 (30.7%) 244 (64.2%)
Lack of permanent residence 3 (0.8%) 4 (1.1%)
Type of psoriasis
Ordinary 256 (72.1%) –
Pustular 38 (10.7%) –
General 3 (0.8%) –
Psoriatic arthritis 36 (10.1%) –
Other 17 (4.8%) –
Missing data 5 (1.4%) –
Years of diagnosis (M ± SD) 16.66 ± 12.27 –
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185Quality of Life Research (2021) 30:181–191
1 3
possible changes in their body image as a results of their
disease experiences. McDonald’s omega coefficients for
the MBSRQ subscales varied between .67 to .76 in the
clinical sample and .76 to .88 in the healthy comparison
group.
To assess the level of COR resources, we used the
COR evaluation questionnaire (COR-E; [18]) in a Pol-
ish adaptation. The COR-E rated the extent to which the
patients possessed several resources, such as hedonistic
and vital resources, spiritual resources, family resources,
economic and political resources, and power and prestige
resources. Particular items of this inventory relate to e.g.
Having material security in old age; Employment assur-
ance; Family support. In the clinical sample, subjects
were instructed to focus on their level of resources in the
context of their disease experiences. McDonald’s omega
coefficients for the COR subscales varied between .84
to .94 in the clinical sample and .78 to .93 in the healthy
comparison group.
Finally, only among the psoriatic patients the disease-
specific quality of life was assessed using the Physical
Symptoms Scale included in Skindex-29 [5] in the Pol-
ish adaptation. This scale assesses seven dermatological
symptoms on a 5-point rating scale ranging from never to
all the time; higher scores mean more severe symptoms.
McDonald’s omega coefficient for Skindex-29 in the sam-
ple of psoriatic patients was .90.
Data analysis
Table2 presents descriptive statistics for the analysed vari-
ables, i.e. the mean values, standard deviations, skewness
and kurtosis measures and McDonald’s omega coefficients
of reliability. None of the measures of skewness or kurtosis
exceeded the value of 1 or −1; therefore normal distribution
of the analysed variables was assumed, which is the neces-
sary condition for the analysis of variance.
The data analysis consisted of three consecutive steps.
First, we examined the associations between the sociomedi-
cal data and the dependent variable, i.e. satisfaction with
life. Second, we extracted four classes of respondents from
the clinical group that differed regarding their conjoint pro-
file of resources and body image. Finally, we examined the
differences between the extracted classes and the compari-
son group in terms of satisfaction with life. Power analysis
proved that with four classes extracted the sample size of
355 patients with psoriasis let us detect statistically signifi-
cant differences regarding satisfaction with life of effect size
equal to .18 in terms of Cohen’s f effect size measure. We
assumed statistical power of .80 and conventional .05 point
of statistical significance.
Associations between the sociomedical data and satisfac-
tion with life were examined with the use of independent
samples, t test and Pearson’s correlation coefficient. There
was no statistical difference between men and women,
t(733) = .07, p > .05. Satisfaction with life did not correlate
Table 2 Descriptive statistics
for analysed variables (N = 735)
M mean value, SD standard deviation, Sp Skewness in the clinical group, Kp Kurtosis in the clinical group,
Sc Skewness in the comparison group, Kc Kurtosis in the comparison group, ω McDonald’s ω reliability
coefficient
Variables MSD SpKpScKcω
1. Hedonistic and vital resources 34.82 10.83 −.35 −.09 −.49 −.26 .91
2. Spiritual resources 23.09 5.83 −.07 −.43 −.35 −.03 .83
3. Family resources 27.56 10.24 .34 −.62 −.54 −.51 .95
4. Economic and political resources 21.56 7.68 .09 −.59 −.28 −.18 .87
5. Power and prestige 11.73 5.50 .19 −.54 −.07 −.39 .82
6. Appearance evaluation 3.19 .87 −.33 −.83 −.25 .41 .88
7. Appearance orientation 3.20 .55 −.18 −.18 .22 .63 .77
8. Fitness evaluation 3.25 .93 −.28 −.70 −.14 −.24 .66
9. Fitness orientation 3.12 .74 −.04 −.71 .38 .96 .86
10. Health evaluation 3.23 .73 −.31 −.55 −.12 .42 .77
11. Health orientation 3.04 .67 −.07 .13 −.01 −.19 .78
12. Illness orientation 3.24 .75 .01 −.40 −.05 −.32 .71
13. Overweight preoccupation 2.63 .90 .30 −.68 .09 .04 .69
14. Body-Areas Satisfaction 3.12 .71 −.27 −.33 .05 .12 .82
15. Self-classified Weight Scale 3.22 .84 .45 .79 −.25 −.10 68
16. Satisfaction with Life 18.06 6.26 −.09 −.59 .24 −.01 .89
17. Skindex Physical Symptoms Scale 21.30 5.13 – – −.12 .23 .90
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186 Quality of Life Research (2021) 30:181–191
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with participants’ age, r(733) = −.01, p > .05. However,
satisfaction with life was significantly higher in the group
of married participants compared to singles, t(733) = 3.29,
p < .01. The mean value of satisfaction with life was equal
to 18.63 (SD = 6.13) in the group of married participants
and to 17.07 (SD = 6.37) in the group of single partici-
pants. The mean value of satisfaction with life was equal to
18.79 (SD = 6.22) in the group of participants with higher
education and was higher than mean and equal to 17.62
(SD = 6.25) in the group of participants without higher edu-
cation t(733) = −2.46, p < .05. Participants with full employ-
ment did not differ from participants unemployed or retired,
t(733) = −1.44, p > .05. The mean value of satisfaction with
life was equal to 18.68 (SD = 6.46) in the group of partici-
pants living in cities with over 500,000 residents and was
higher than mean and equal to 17.48 (SD = 6.01) in the group
of participants living in minor localities, t(733) = −2.61,
p < .01. Satisfaction with life did not correlate with years
of diagnosis, r(353) = .014, p > .05; however it correlated
negatively with the Skindex score, r(355) = −.170, p < .01.
In the next step, latent profile analysis was executed
in order to estimate distinct profiles and extract different
subgroups of respondents differing in regard to resources
and body image. We analysed five types of resources and
ten indicators of body image. According to the values of
Aikake information criterion (AIC) and Bayesian infor-
mation criterion (BIC), the model with the best fit was the
model with equal variances and covariances fixed to zero
and with four extracted classes with four distinctive profiles.
The values of fit statistics were equal to AIC = 13,933.15
and BIC = 14,235.18 with entropy value equal to .82 where
values > .07 mean acceptable classification accuracy [23].
Values of fit indices for all models tested are provided in
Table3.
Figure1 presents the mean values of the standardized
variables in the acquired classes.
According to results of MANOVA the four classes
differed in terms of resources and body image,
F(45,1017) = 21.84, p < .001, η2 = .49. This applies to
Hedonistic and Vital Resources, F(3,351) = 213.40,
p < .001, η2 = .65, Spir itual Resources, F(3,351) = 94.43,
p < .001, η2 = .45, Family Resources, F(3,351) = 70.86,
p < .001, η2 = .38, Economic and Political Resources,
F(3,351) = 131.59, p < .001, η2 = .53, Power and Prestige,
Table 3 Fit indices and entropy values for models tested in latent pro-
file analysis
Classes AIC BIC Entropy
1 15,156.67 15,272.84 1
2 14,346.98 14,525.1 .87
3 14,058.64 14,298.71 .85
4 13,933.15 14,235.18 .82
5 13,933.74 14,297.72 .83
6 13,978.41 14,304.34 .84
Fig. 1 Profiles of resources and body image acquired in the group of psoriatic patients
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187Quality of Life Research (2021) 30:181–191
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F(3,351) = 138.23, p < .001, η2 = .54, Appearance Evalua-
tion, F(3,351) = 11.66, p < .001, η2 = .09, Appearance Or i-
entation, F(3,351) = 4.77, p < .01, η2 = .04, Fitness Evalua-
tion, F(3,351) = 7.51, p < .001, η2 = .06, Fitness Orientation,
F(3,351) = 57.87, p < .001, η2 = .33, Health Evaluation,
F(3,351) = 28.15, p < .001, η2 = .19, Health Or ientation,
F(3,351) = 57.87, p < .001, η2 = .33, Illness Or ientation,
F(3,351) = 49.26, p < .001, η2 = .30, Overweight Preoc-
cupation, F(3,351) = 56.13, p < .001, η2 = .32, Body-Areas
Satisfaction, F(3,351) = 32.70, p < .001, η2 = .22, and Self-
classified Weight Scale, F(3,351) = 42.76, p < .001, η2 = .27.
According to Gabriel post-hoc test all classes differed in
terms of Hedonistic and Vital Resources, p < .001, Fam-
ily Resources, p < .001, Economic and Political Resources,
p < .001, and also in terms of Power and Prestige, p < .001.
All classes with the exception of the difference between pro-
file 1 and profile 2 differed in terms of Spiritual Resources,
p < .001, and Body-Areas Satisfaction, p < .001. All classes
with the exception of the difference between profile 1 and
profile 3 and the difference between profile 2 and profile 4
differed in terms of Health Orientation, p < .001, Illness Ori-
entation, p < .001, Overweight Preoccupation, p < .001, and
Self-classified Weight Scale, p < .001. There were statisti-
cally significant differences in terms of Appearance Evalua-
tion between profile 2 and profiles 1 and 4, p < .001, and also
between profiles 3 and 4, p < .05. There were statistically
significant differences in terms of Appearance Orientation
between profile 2 and profiles 1, p < .01 and 3, p < .05. Pro-
file 4 differed in terms of Fitness Evaluation from profile
1, profile 2, and profile 3, p < .01. Profile 4 also differed in
terms of Fitness Orientation from profile 1, profile 2, and
profile 3, p < .01, but there was also statistically significant
difference in terms of Fitness Orientation between profiles
1 and 3, p < .01. Profile 2 differed in terms of Fitness Evalu-
ation from profile 1, profile 3, and profile 4, p < .001.
In the first class the acquired profile was character-
ized by an average level of resources and an average body
image assessment (profile 1). In the second class the
acquired profile was characterized by an average level of
resources and a higher-than-average evaluation of specific
body image subscales (orientation on appearance, health,
disease and absorption of weight; profile 2). In the second
class the acquired profile was characterized by a low level
of resources and poor body image assessment (profile 3);
finally, the fourth class revealed a high resources evalua-
tion and the most favourable outlook on body image (pro-
file 4).
The extracted classes of psoriatic patients were com-
pared to each other and to the comparison group. Taking
into account the sociomedical data correlating with satis-
faction of life, analysis of covariance was performed. Mari-
tal status, education, place of residence and Skindex score
were included in the statistical model as covariates. Dif-
ferences between the groups were statistically significant:
F(4,726) = 18.65, p < .001, η2 = .09. According to the value
of contrast test, the clinical sample significantly differed
from the comparison group: t(636.96) = −6.45, p < .001.
The mean value of satisfaction with life was lower in the
group of psoriatic patients (M = 16.90; SD = 5.29) than in the
comparison group (M = 19.13; SD = 6.26). However, a post-
hoc comparison based on the Games-Howell test revealed
this difference to be spurious. Figure2 presents the mean
values of satisfaction with life in the extracted classes and
in the comparison group.
According to the post-hoc test, satisfaction with life in the
comparison group differed from the classes with profile 1,
p < .001; profile 2, p < .01; and profile 3, p < .001. However
it did not differ from profile 4, p > .05. Satisfaction with life
in the comparison group and in the class with the high level
of resources and positive body image was similar. Satisfac-
tion of life in the class with profile 1 did not differ from the
class with profile 2, p > .05, even though body image in the
class with profile 2 was slightly better. The class with profile
3 significantly differed from all of the other classes and from
the comparison group (all p < .001). The most negative body
image and the lowest level of resources was associated with
the least satisfaction with life.
Fig. 2 Mean values of satisfac-
tion with life in the extracted
classess of psoriatic patients
compared to the healthy com-
parison group
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188 Quality of Life Research (2021) 30:181–191
1 3
Discussion
The results of our study were consistent with the first
research hypothesis, as our clinical sample of psoriatic
patients were heterogenous with regard to their body
image assessments and resources evaluation, which were
differently related to their levels of life satisfaction. More
specifically, we observed four profiles of participants with
an average level of resources and an average body image
assessment (profile 1), an average level of resources and
a higher-than-average evaluation of specific body image
subscales (orientation on appearance, health, disease and
absorption of weight; profile 2), a low level of resources
and poor body image assessment (profile 3), and finally, a
high level of resources and the most favourable outlook on
body image (profile 4). When comparing these four pro-
files with each other we found the biggest discrepancy in
life satisfaction between two extreme profiles with respect
to resources and body image assessment. Specifically, the
highest level of satisfaction with life was observed in the
fourth profile, while the lowest level of life satisfaction
was seen in the third profile. Significantly, medical vari-
ables such as the type of psoriasis, the duration of struggle
with the disease and the intensity of physical symptoms
were unrelated to life satisfaction among our participants.
This result can be interpreted in light of the above-men-
tioned studies pointing to the fact that psychosocial vari-
ables, including especially positive self-and body image,
outweighed the role of clinical biomarkers illustrating the
objective severity of psoriasis as predictors of well-being
in this patient group [15, 26, 36]. For example, the most
popular and widely used tool to assess the severity of pso-
riasis, the Psoriasis Area and Severity Index (PASI), has
been found to be very weakly associated with the well-
being of these patients in many studies (see review [2,
24]).
Moreover, we observed one more interesting issue.
Namely, we noticed that life satisfaction level in pro-
files 1 and 2, which consisted of participants with vari-
ous attitudes to their body image (see focus on appear-
ance, health, illness and preoccupation with weight) and a
similar, average level of resources, was the same. Several
studies showed the vicious circle mechanism of negative
body image on psychological functioning among psori-
atic patients, i.e. negative body perception fosters nega-
tive mood and further distorts illness severity perception,
which subsequently makes the body image even worse etc.
[16, 33, 41]. Conversely, many authors found that posi-
tive body image may facilitate more effective coping with
physical symptoms of psoriasis and enhance well-being
in these patients [15, 36]. However, our above-mentioned
finding may suggest that a positive outlook on body image
alone is not enough to sustain a high level of life satis-
faction when a patient does not perceive an availability
of resources in his or her close environment. Although
until now no research on COR theory has been conducted
among psoriatic patients, our results may be in line with
other studies highlighting the need to assess the multidi-
mensional influence of psoriasis on different aspects of the
functioning of these patients [12, 30, 31].
Our second, most intuitive hypothesis was also con-
firmed, as we observed that psoriatic patients declared, on
average, lower levels of life satisfaction, more negative body
image and lower levels of psychosocial resources compared
to the healthy comparison group. Dozens of studies have
shown that psoriasis significantly diminishes patients’ well-
being and is related to mental health problems not only to
the general population, but also to other chronic diseases
(see e.g. reviews [10, 25]). However, these studies focused
only on a variable-centred approach, i.e. the identifica-
tion of single sociomedical and/or psychological variables
that were independently related to various aspects of well-
being in these patients. Perhaps this unitary methodological
approach was responsible for the traditional, gloomy and
probably simplifying trend pointing to the almost always
worse well-being of psoriatic patients compared to the gen-
eral population [34]. In our study we believed that the appli-
cation of a person-centred perspective would provide a more
accurate picture of life satisfaction and its determinants in
these patients.
In accordance with these expectations we observed that
while comparing four profiles of psoriatic patients to the
comparison group, individuals from profiles 1, 2 and 3
declared lower life satisfaction than subjects from the com-
parison group. However, patients from the fourth profile did
not differ from the comparison group in the level of life
satisfaction and had even higher levels of resources and a
better body image assessment than the healthy comparison
group. Our findings may shed new light on the determinants
of well-being [2, 49] and life satisfaction [40, 46] among
psoriatic patients. Particularly, despite the great psychologi-
cal and physical burden of this disease, patients with pso-
riasis may sustain the same life satisfaction as people from
the general population, but this requires a higher perceived
availability of psychosocial resources and better outlook on
body image than that of the healthy comparison group. This
finding will obviously require replication in a larger sam-
ple of psoriatic patients, but may indicate on two important
issues. First, the traditional methodological approach (see
variable-centred) to assessing various aspects of the psycho-
logical well-being of psoriatic patients precludes obtaining
a true and comprehensive picture of this phenomena in this
disease [34]. Second, psychological interventions for pso-
riatic patients should concentrate less on patient education
and self-management in coping with psoriatic symptoms
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189Quality of Life Research (2021) 30:181–191
1 3
only (see [51]), and could be more grounded in counselling
focusing on building psychosocial resources in the patient’s
closest community and working on a more positive body
image in particular. This is in line with the most recent inter-
ventions for chronically ill patients proposed by authors rep-
resented the positive psychology, highlighting the need for
building patients’ positive resources, especially related to
their positive self-image [13].
Strengths andlimitations
This study has several strengths, including the large sample
of psoriatic patients and the comparative analysis with a
healthy comparison group using an innovative methodo-
logical design. Nevertheless, it is vital to point out some
limitations of our research. First of all, the cross-sectional
framework of this study does not allow for causal interpre-
tations of the obtained findings. Second, the clinical group
was heterogonous with regard to the diagnosis of psoria-
sis, as well as its duration and the severity of its symptoms.
Future studies should focus on a more homogenic sample
of psoriatic patients with regard to the medical variables. In
addition, although we tried to recruit the comparison group
with high similarity in socio-demographic characteristics
to the clinical sample, we did not entirely succeed in this
task. Finally, it should be underscored that in this study we
focused only the one side of resources, i.e. their subjective
appraisal, and we did not attempt to parallelly assess also the
objective level of the participants’ resources.
Conclusions
Despite its limitations, our study addressed significant
research gaps in the literature on psychological well-being
among psoriatic patients. Specifically, from the theoretical
point of view, the person-centred framework may provide
insight much above that which can be gained using variable-
centred methods and thus change the simplifying trend high-
lighting the traditionally very poor well-being of this patient
group. In addition, from practical perspective, approaching
psychological counselling based on the discovery of spe-
cific profiles of psoriatic patients, which differ with regard to
sociomedical and psychological variables, may address the
unique needs of these patients. In other words, one should
remember that beyond the clinical label, known as psoria-
sis, there is always an individual human who should not be
treated as a homogenic representative of the disease.
Acknowledgements This work was supported by the Faculty of Psy-
chology, University of Warsaw, from the funds awarded by the Min-
istry of Science and Higher Education in the form of a subsidy for
the maintenance and development of research potential in 2020 (501-
D125-01-1250000, number 5011000220) and the internal funds of the
Jan Kochanowski University under the programme of the Minister of
Science and Higher Education called “Regional Initiative of Excel-
lence” in the years 2019–2022, Project No. 024/RID/2018/19 and the
internal funds of the University of Economics and Human Sciences.
Compliance with ethical standards
Conflict of interest The corresponding author declares that he has no
conflict of interest. The second author declares that she has no conflict
of interest. The third author also declares that she has no conflict of
interest. The fourth author also declares that he has no conflict of inter-
est. The fifth author also declares that she has no conflict of interest.
Ethical approval All procedures performed in studies involving human
participants were in accordance with the ethical standards of the insti-
tutional and/or national research committee and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards.
Open Access This article is licensed under a Creative Commons Attri-
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