Ahmed A, Steed L, Burden-Teh E, Shah R, Sanyal S, Tour S, Dowey S, Whitton M, Batchelor J M, Bewley A P
Department of Dermatology, King Edward VII Hospital, Windsor, UK.
Centre for Public Health and Primary Care, Queen Mary University of London, London, UK.
J Eur Acad Dermatol Venereol. 2018 Dec;32(12):2275-2283. doi: 10.1111/jdv.15168. Epub 2018 Aug 13.
Psychological interventions are recommended as part of routine management of vitiligo. However, the development and effectiveness of such interventions have been rarely addressed. This study aimed to identify key components for a psychological intervention for people with vitiligo. This is the first time perspectives of people with vitiligo, and healthcare professionals (HCPs) have been directly explored to inform intervention content and delivery.
To identify 1. which psychological difficulties are highlighted that can be targeted by an intervention; 2. what is important in terms of intervention content and delivery.
Web-based questionnaires containing both quantitative and qualitative items were completed by people with vitiligo and HCPs. Questionnaires collected data from people with vitiligo on demographics, clinical features, psychological difficulties and priority areas for psychological interventions, including ideas on delivery and content. HCPs questionnaires collected data on psychological difficulties reported, use of psychological interventions and suitability within health services. Quantitative data were analysed using descriptive statistics, and qualitative data utilized thematic framework analysis.
A total of 100 people with vitiligo (66% female, 92% Caucasian) and 39 HCPs (54% dermatologists) participated. Key areas of difficulty were the impact of vitiligo, coping, issues with appearance/body image and the sun, and medical interactions. Vitiligo on sensitive sites was associated with more psychological impact. Interventions directed at increasing acceptance, confidence and self-esteem, as well as managing embarrassment, were important. These issues could be managed through interventions such as cognitive behavioural therapy, mindfulness and acceptance and commitment therapy. Both people with vitiligo and HCPs favoured individual interventions.
Vitiligo has significant impact, requiring ongoing psychosocial support. There is a strong need for a psychoeducational intervention with focus on acceptance and managing social impact. The results of this study are the first steps to informing the development of a patient-centred psychological intervention.
心理干预被推荐作为白癜风常规管理的一部分。然而，此类干预措施的开发及其有效性很少得到探讨。本研究旨在确定针对白癜风患者的心理干预的关键组成部分。这是首次直接探讨白癜风患者和医疗保健专业人员（HCPs）的观点，以为干预内容和实施提供参考。
确定1. 哪些心理困难被凸显出来可作为干预目标；2. 干预内容和实施方面的重要因素。
白癜风患者和HCPs完成了包含定量和定性项目的网络问卷。问卷收集了白癜风患者的人口统计学、临床特征、心理困难以及心理干预的优先领域等数据，包括关于实施和内容的想法。HCPs问卷收集了所报告的心理困难、心理干预的使用情况以及在医疗服务中的适用性等数据。定量数据采用描述性统计进行分析，定性数据采用主题框架分析。
共有100名白癜风患者（66%为女性，92%为白种人）和39名HCPs（54%为皮肤科医生）参与。主要困难领域包括白癜风的影响、应对方式、外貌/身体形象和日晒问题以及医疗互动。敏感部位的白癜风与更大的心理影响相关。旨在增强接纳度、自信心和自尊以及应对尴尬情绪的干预措施很重要。这些问题可通过认知行为疗法、正念以及接纳与承诺疗法等干预措施来解决。白癜风患者和HCPs都倾向于个体化干预。
白癜风有重大影响，需要持续的社会心理支持。迫切需要一种以心理教育为重点、关注接纳和应对社会影响的干预措施。本研究结果是为以患者为中心的心理干预开发提供信息的第一步。
