Department of Dermatology and Venereology, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Eur Acad Dermatol Venereol. 2024 Nov;38(11):2167-2174. doi: 10.1111/jdv.20069. Epub 2024 May 20.
Although stress is considered to be a negative factor for psoriasis, no convincing scientific evidence of this association exists, largely because of difficulties in measuring stress. Stress resilience is the ability to cope with and adapt to stressful events. Stress resilience can be measured in a standardized way and used as a marker for chronic stress.
The objective of this study is to investigate whether low stress resilience in adolescence increases the risk for onset of psoriasis and psoriatic arthritis later in life.
A cohort of Swedish men (mean age 18.3 years), enrolled in compulsory military service between 1968 and 2005, was created using data from the Swedish Military Service Conscription Register (n = 1,669,422). Stress resilience at conscription was estimated using standardized semi-structured interviews, and was divided into three categories: low, medium and high. The men were followed from conscription until new-onset psoriasis or psoriatic arthritis, death or emigration or at the latest until 31 December 2019. Cox regression models adjusted for confounders at conscription were used to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for incident psoriasis and psoriatic arthritis.
Men in the lowest stress resilience category had an increased risk of psoriasis and psoriatic arthritis (HR 1.31 (95% CI 1.26-1.36) and 1.23 (95% CI 1.15-1.32), respectively), compared with those in the highest stress resilience category. When including only hospitalized patients the HRs for psoriasis and psoriatic arthritis in the lowest stress resilience group were 1.79 (1.63-1.98) and 1.53 (1.32-1.77), respectively.
This large, prospective register study suggests that low stress resilience in adolescence is associated with an increased risk of incident psoriasis among men. The results indicate that patients with psoriasis have an inherent psychological vulnerability, and highlight the importance of addressing psychological well-being in the management of psoriasis.
尽管压力被认为是银屑病的一个负面因素，但目前还没有令人信服的科学证据证明这种关联的存在，主要是因为测量压力存在困难。压力弹性是指应对和适应压力事件的能力。压力弹性可以通过标准化的方式进行测量，并用作慢性压力的标志物。
本研究旨在探讨青少年时期压力弹性低是否会增加日后患银屑病和银屑病关节炎的风险。
利用瑞典兵役登记处（1968 年至 2005 年入伍）的数据，创建了一个由瑞典男性组成的队列（平均年龄 18.3 岁）。入伍时采用标准化半结构式访谈评估压力弹性，并分为低、中、高三类。从入伍开始，对这些男性进行随访，直到新发银屑病或银屑病关节炎、死亡、移民或最晚至 2019 年 12 月 31 日。采用调整入伍时混杂因素的 Cox 回归模型，计算新发银屑病和银屑病关节炎的风险比（HR）及其 95%置信区间（CI）。
与压力弹性最高组相比，压力弹性最低组的男性患银屑病和银屑病关节炎的风险增加（HR 1.31（95%CI 1.26-1.36）和 1.23（95%CI 1.15-1.32））。当仅纳入住院患者时，压力弹性最低组新发银屑病和银屑病关节炎的 HR 分别为 1.79（1.63-1.98）和 1.53（1.32-1.77）。
这项大型前瞻性登记研究表明，青少年时期压力弹性低与男性银屑病的发病风险增加相关。结果表明，银屑病患者存在内在的心理脆弱性，这突显了在银屑病管理中关注心理健康的重要性。
