The Mediating Role of Insomnia in the Relationship Between Disease Severity and Mental Health Quality of Life and Productivity in Atopic Dermatitis
Author(s)
Garyfallia Stefanou, MSc1, Dimitrios Ioannides, PhD2, Katerina Lioliou, MSc1, George Gounelas, MSc1, Soultana Koukopoulou, PhD3, Eirinaios Vamvakousis, MSc3, Georgia Kourlaba, PhD4.
1ECONCARE LP, Athens, Greece, 2Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, 3Panhellenic Society of Patients with Psoriasis and Psoriatic Arthritis ‘EPIDERMIA’, Thessaloniki, Greece, 4Department of Nursing, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
1ECONCARE LP, Athens, Greece, 2Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, 3Panhellenic Society of Patients with Psoriasis and Psoriatic Arthritis ‘EPIDERMIA’, Thessaloniki, Greece, 4Department of Nursing, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
OBJECTIVES: Atopic dermatitis (AD) is a chronic inflammatory skin condition that not only impairs physical health but also significantly affects psychological well-being and socio-economic productivity. Emerging evidence suggests that sleep disturbances may play a key mediating role in the development of mental health symptoms in individuals with AD. Building on this, we hypothesized that sleep disturbances also mediate the relationship between AD severity and quality of life (QoL), work productivity, and daily activities. We conducted a mediation analysis to explore these pathways in adults with AD.
METHODS: A cross-sectional study was conducted in Greece during January-September 2023. Study participants were adult members of the patients’ association EPIDERMIA, diagnosed with AD. Self-perceived disease severity, insomnia, depression, anxiety, QoL, and work/activity impairment were assessed using validated tools: the Patient-Oriented Eczema Measure (POEM), Athens Insomnia Scale (AIS-8), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Dermatology Life Quality Index (DLQI), and Work Productivity and Activity Impairment (WPAI) questionnaire. Mediation analysis followed Imai et al.'s framework, using STATA 17.0 and adjusting for age, sex, and BMI.
RESULTS: The analysis included 147 patients (mean ± SD age 37.8 ± 12.7 years; 56% female; mean ± SD BMI 25.6 ± 4.7 kg/m2). Insomnia mediated 115%, 108%, 55%, 78%, and 65% of the effect of AD severity on depression, anxiety, QoL, work productivity, and activity impairment, respectively. Sensitivity analyses showed that a moderate-to-strong unmeasured confounder (ρ > 0.46-0.68) would be required to nullify the observed indirect effects. These findings support a robust mediating role of insomnia, although the cross-sectional design limits causal inference.
CONCLUSIONS: Our findings suggest that insomnia is a key mediator in the pathway from AD severity to adverse psychological, functional, and socio-economic outcomes. Targeting sleep disturbances may offer a promising strategy to improve the overall well-being of individuals with AD.
METHODS: A cross-sectional study was conducted in Greece during January-September 2023. Study participants were adult members of the patients’ association EPIDERMIA, diagnosed with AD. Self-perceived disease severity, insomnia, depression, anxiety, QoL, and work/activity impairment were assessed using validated tools: the Patient-Oriented Eczema Measure (POEM), Athens Insomnia Scale (AIS-8), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Dermatology Life Quality Index (DLQI), and Work Productivity and Activity Impairment (WPAI) questionnaire. Mediation analysis followed Imai et al.'s framework, using STATA 17.0 and adjusting for age, sex, and BMI.
RESULTS: The analysis included 147 patients (mean ± SD age 37.8 ± 12.7 years; 56% female; mean ± SD BMI 25.6 ± 4.7 kg/m2). Insomnia mediated 115%, 108%, 55%, 78%, and 65% of the effect of AD severity on depression, anxiety, QoL, work productivity, and activity impairment, respectively. Sensitivity analyses showed that a moderate-to-strong unmeasured confounder (ρ > 0.46-0.68) would be required to nullify the observed indirect effects. These findings support a robust mediating role of insomnia, although the cross-sectional design limits causal inference.
CONCLUSIONS: Our findings suggest that insomnia is a key mediator in the pathway from AD severity to adverse psychological, functional, and socio-economic outcomes. Targeting sleep disturbances may offer a promising strategy to improve the overall well-being of individuals with AD.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR236
Topic
Methodological & Statistical Research, Patient-Centered Research, Real World Data & Information Systems
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)