INTRODUCTION:

Skin disease is one of the most common human illnesses. Yet despite this profound impact, skin disease continues to receive relatively little attention in the national or global health debate.¹There has been a stigma attached to diseases of the skin for centuries. Lepers were cast out from society in biblical and medieval times as they were considered 'unclean'. There is stigma attached to a wide range of skin diseases, affecting many millions of people, just as there is for mental illness. Skin diseases can be difficult to cope with and have a big psychological impact on patients. Even mild skin diseases can have an adverse effect and disrupt enjoyment of life for those who have the diseases.

Such disruption can range from embarrassment and concerns about self-image to low self-esteem and severe depression. Talk to patients and discuss the impact of their disease, how they cope and how they feel about it.² Patients with dermatological problems often present mood disorders (mainly depression), anxiety disorders and psychological conditions.³ Depression is an alteration in mood that is expressed by feelings of sadness, despair, and pessimism. There is a loss of interest in usual activities.⁴ Serious depression can destroy family life as well as the life of the ill person. people with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years.⁵The symptoms of depression can include: loss of interest or pleasure in previously enjoyable activities, major changes in appetite, sleep problems, fatigue, a feeling of worthlessness or hopelessness, problems with concentration and making decisions, and thoughts of suicide.⁶

BACKGROUND OF THE STUDY:

The skin is the most exposed organ of the body and is most vulnerable to the assault of external agents. The spectrum of dermatoses varies from genetic, infection, immunological, inflammatory, and cosmetics disorders to tumors and diseases of the appendages. The vicious cycle of ignorance, poverty and diseases plays and a prominent role in the prevalence of many skin diseases. According to WHO prevalence studies of the general population in developing countries reported high prevalence figures for skin diseases (21-87%).⁷

Psychiatric disorders are frequent in dermatology patients, and many studies pointed out complex, mutual relationships between psyche and skin. Our aim was to provide a systematic psychosocial evaluation of a large and heterogeneous population of patients with skin diseases, including assessments of quality of life, psychiatric status according to the DSM-IV and psychological conditions with psychosomatic relevance according to established criteria.⁸

NEED OF THE STUDY:

Dermatological problems account for 15% to 20% of visits family practices. With advances in generic and specific instruments measuring quality of life, there is now a greater appreciation how skin diseases affect children and adults. Patients with real and perceived imperfections in important body image areas, such as the face, scalp, hands, and genital area, are prone to distress. Blemishes on parts of the body can cause distress and require treatment as well Patients with body dysmorphic disorder, acne, psoriasis, and particularly men and women with facial conditions are more likely to have reactive depression and be at risk of suicide.⁹

Depression is a disorder of major public health importance, in terms of its prevalence and the suffering, dysfunction, morbidity, and economic burden. Depression is more common in women than men. The report on Global Burden of Disease estimates the point prevalence of unipolar depressive episodes to be 1.9% for men and 3.2% for women, and the one-year prevalence has been estimated to be 5.8% for men and 9.5% for women. It is estimated that by the year 2020 if current trends for demographic and epidemiological transition continue, the burden of depression will increase to 5.7% of the total burden of disease and it would be the second leading cause of disability-adjusted life years (DALYs), In view of the morbidity, depression as a disorder has always been a focus of attention of researchers in India.¹⁰

STATEMENT OF THE PROBLEM:

“A descriptive study to assess the level of depression in patients visiting skin OPDs with skin problem in selected hospitals of the city”

OBJECTIVES OF THE STUDY:

The primary objective:

1. To assess the level of depression among the patients with skin problems visiting the skin OPDs in selected hospitals of the city

The secondary objectives:

1. To assess the level of depression among the patients with skin problems visiting the skin OPDs

2. To find out the association between the level of depression in patients with skin problems with selected demographic variables.

3. To find out the correlation between socio-physical and psychological problem in patient with skin problem.

OPERATIONAL DEFINITION:

Assess:

In this study assess means, “to evaluate the level of depression in patients with skin problems”

Depression:

In this study depression means, “a person who is depressed due to skin problem.”

Patients:

In this study the patients means, “a person visiting skin OPD due to specific skin problems

Skin problems:

In the study skin problems means, “acne, dermitis, leprosy, scar, burn ,tinea, impetigo, scabies

ASSUMPTION:

1. Patients with skin problems may have depression.

2. There may be an association between the level of depression in patients with selected demographic variables.

LIMITATION:

1. Study is limited to the patients visiting skin OPDs with specific skin problemsin the selected hospital of the study.

2. The study is not interventional study; only the assessment study

REVIEW OF LITERATURE:

In the present study review of literatures are arranged under the following

Heading

· Literature related to prevalence of depression

· Literature related to comorbidity of psychiatric disorder and skin disorder.

· Literature related to prevalence of depression in patient with skin disease

1. Literature related to prevalence of depression:

Hussien G., Tesfaye.M, Hiko.D, Fekadu. H (2017) conducted study on depression is a significant contributor to the global burden of disease andaffects people in all communities across the world. Previously conducted studies in Ethiopia have consistently shown that depression is common problem in the country.¹²

2. Literature related to comorbidity of psychiatric disorder and skin disorder:

Basvaraj, Navya, and Rashmi (2010) conducted a study to review different dermatological conditions under each of the three categories namely psychosomatic disorders, dermatological conditions due to primary and secondary psychiatric disorders. Dermatological conditions resulting from psychiatric conditions like stress/ depression and those caused by psychiatic disorders are discussed. This review intends to present the relationship between the ‘skin’ and the ‘mind’ specifically from the dermatology point of view. The effects on the quality of life as a result of psychodermatological conditions are highlighted.¹³

3. Literature related to prevalence of depression in patients with skin diseases:

Kumar et al (2016) conducted a study to find psychiatric depression inpatients attending dermatology out Patients department (OPD). A total of 200 patients of both Gender were consecutively taken who referred to psychiatry OPD from skin OPD after meeting inclusion and exclusion criteria.¹⁵

RESEARCH APPROACH:

In this study the descriptive quantitative research approach was adopted to assess the level of depression in patients with specific skin problem visiting skin OPDs.

RESEARCH DESIGN:

“A descriptive research design” is used to identify, describe and explore the existing phenomenon and its related fact

SETTING OF THE STUDY:

The study is conducted in skin OPDs in the selected hospitals of the city.

VARIABLES UNDER THE STUDY:

Research variable: level of depression in patients visiting skin OPDs.

POPULATION:

Population is selected for present study is patients with specific skin problems

TARGET POPULATION:

Target population of present study is all patients with skin problems visiting skin OPDs in hospitals of the city.

ACCESSIBLE POPULATION:

In this study accessible population is patients who meet the designated criteria and who are visiting skin OPDs in selected hospitals of the city.

SAMPLE AND SAMPLING TECHNIQUE:

In this study sample who were fulfilling the inclusive criteria. Sample taken from skin OPDs in the selected hospitals of the city

The sampling technique used in the study was non probability convenient sampling.

SAMPLE SIZE:

Sample size consist of 100 patients with skin problem visiting skin OPDs.

SAMPLING CRITERIA:

Inclusion criteria:

· Patients those who are available during the time of data collection period.

· Patients those who are willing to participate in the study.

· Patients those have selected skin problem

· Patients those who are able to understand in Marathi, Hindi, and English.

Exclusion criteria:

· Patients those who are not willing to participate

· Patients those who are not present at the time of study.

· Patients those who are not understand Marathi, Hindi, and English.

TOOL PREPARATION:

Development of tool:

Based on the objectives of the study, demographic data, self structured questionnaires were prepared to assess the level of depression in patient with skin problem

DESCRIPTION OF TOOLS:

Section A:

Demographic data: It includes total 10 demographic variables like Age, gender, Marital Status, Education, Occupation, Family Monthly Income, Area of Residence, Number of visits in skin OPD’s, social support, Duration of skin problem in patient with skin problem.

Section B:

Self structured depression rating scale: These Rating Scale are structured to assess the level of depression; it is forty item rating scale each with item answered on a Three Point score as never, sometimes, and always.

FEASIBILITY OF THE STUDY:

The investigator did not find some difficulty in getting the subject because accessible population and sample size was 100 which held to inclusive criteria.

DATA COLLECTION PROCEDURE:

To conduct the research study in selected hospitals of the city, formal written permission was obtained from the concerned authority and ethical committee of selected areas, before data collection. Data collection was held in the selected hospitals of the city the data collection done between 8 to23 January, 2018.T Investigator approached the patients with skin problem and explained the purpose of the study and explained how it will be beneficial for them and enquired their willingness to participate in the study. The investigator collected a group of patients with skin problem visiting skin OPD’s in selected hospital of the city, administered self-structured depression rating scale, doubt were clarified once the questionnaire was completed, investigator collected them back, each sample required mean time of 40 min to complete self structured depression rating scale.

PLAN FOR DATA ANALYSIS:

The obtained data is analysed by using descriptive and inferential statistic.

· Organizing the data in master sheet.

· Computation of frequencies and percentage

· Computation of mean and SD

· Chi- square test used to find out association between level of depression with selected demographic variable.

ORGANIZATION OF FINDINGS:

The analysis and interpretation of the observations are given in the following section:

· Section I: Distribution of patients visiting skin OPDs with regards to demographic variables.

Table 1: Percentage wise distribution of patients according to their demographic characteristics:

Demographic Variables	No of Patients	Percentage (%)
Age (yrs)
18-28 yrs	71	71%
29-39 yrs	16	16%
40-50 yrs	8	8%
51-60 yrs	4	4%
≥61 yrs	1	1%
Gender
Male	40	40%
Female	60	60%
Marital Status
Unmarried	59	59%
Married	39	39%
Divorced	1	1%
Widower/Widow	1	1%
Separated	0	0%
Education
Primary	3	3%
Secondary	24	24%
Higher Secondary	54	54%
Graduate	14	14%
Postgraduate	4	4%
Other	1	1%
Occupation
Service	9	9%
Farmers	6	6%
Labourer	12	12%
Business	6	6%
Student	50	50%
Housewife	15	15%
Unemployed	2	2%
Family monthly Income (Rs)
10000-20000 Rs	49	49%
20001-30000 Rs	32	32%
30001-40000 Rs	14	14%
>40000 Rs	5	5%
Area of Residence
Urban	62	62%
Rural	38	38%
Number of visits in Skin OPD
Once a week	15	15%
Once a month	37	37%
Twice in a month	48	48%
Social Support
Parents	53	53%
Spouse	31	31%
Siblings	2	2%
Children	10	10%
Friends	4	4%
Relatives	0	0%
Others	0	0%
Duration of skin problems
First diagnosis/just diagnosed	43	43%
Six months	38	38%
More than six months	19	19%

· Section II: Assessment of level of depression among the patients with skin problems visiting the Skin OPD.

· Section –III: Correlation between socio-physical and psychological problem of the patients with skin problems

· Section-IV: Association between the level of depression in patients with skin problems with their selected demographic variables.

SR NO	Demogrphic Variables	Df	Table Value	Inference
1	Age	4,95		S
2	Gender	98	2.09	S
3	Marrital status	3,96		NS
4	Education	4,94		S
5	Occupation	6,93		S
6	Family monthly income	3,96		S
7	Area of residence	98	2.30	S
8	No of visit in skin opd’s	2,97		S
9	Social support	4,95		NS
10	Duration of skin problem	2,97		S

CONCLUSION:

The following conclusion were drawn from the finding of the present study.

1. The present study shows that th majority 44 percent of them were moderate depression, 26 percent of them were mild depression, 19 percent of them were no depression, 11 percent of them were severe depression.

2. It is observed by the study that there is significant association of level of depression in relation to age (in years), gender, education, occupation, Family monthly income, number of visit to skin OPDs, duration of skin problem.

3. There is no significant association of depression level in relation to marital status, social support.

THE FINDING OF THE STUDY:

In my study there is significant association of level of depression relation to age (in years), gender, occupation, duration of skin problem in patients with skin problems.

The present study showed that, many of the samples 19 percent of them were no depression, 26 percent of them were mild level depression, 44 percent of them were moderate level of depression, and 11 percent of them were severe level depression.

IMPLICATION OF THE STUDY:

In this context, the health professionals especially the nurse have a major role in assessing the level of depression in patients with skin problem which is one of the most effective Weapon to assess the level of depression. The implication of the study have been discussed under identifying socio- physical problem, psychological problem, to reduce the depression in patients with skin problem treatment counseling and referral for follow up and after care services. Several Implication is drawn from the study.

Nursing practice:

· The finding of the present study emphasis assessment of level of depression which can put into nursing practice in early identification of level of depression in patients with skin problem will help to prevent psychiatric problems.

Nursing education:

· The present study emphasis that health education on prevention of management of level of depression in patients with skin problem. In order to counseling to patients with skin problem, it is essential that the nurses are competent and have sound knowledge to improve the level of understanding which can be reflected to the public through education.

Nursing administration:

· Health administration plays a pivotal role in supervision and management of nursing profession. The nurse administrator can utilize the present tool for assessing the level of depression patients with skin problem. Assessment, interview schedule can arrange for assessing the depression in patients with skin problem.

Nursing research:

· The nurse researchers can use the findings of this study as baseline data to conduct further interventional research to identify the level of depression in patients with skin problem and determine the association of other demographic variable to identify the effect on level of depression in patients with skin problem.

LIMITATION:

· Study is limited to the patients visiting skin OPDs with specific skin problems in the selected hospitals of the city.

· The study is not interventional study: only the assessment study

RECOMMENDATION:

1. A similar study can be replicated on a large scale population in the same city.

2. A similar study can be done to assess level of depression in patients with skin problem in different population in same city.

3. Interventional study can be done to assess the level of depression in patients with skin problem.

4. A comparative study can be done to assess the level of anxiety and depression of patients with skin problem admitted in skin wards in hospital of the city

REFERENCES:

1. Roderick J. Hay, Nicole E. Johns, Hywel C. Williams, Ian W. Bolliger, Robert P. Dellavalle, David J. Margolis, Robin Marks, Luigi Naldi, Martin A. Weinstock , Sarah K. Wulf, Catherine Michaud, Christopher J.L. Murray and Mohsen Naghavi, The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of SkinConditions, Availableat:http://skin.cochrane.org/sites/skin.cochrane.org/files/public/uploads/Hay%202014%20%20The%20global%20burden%20of%20skin%20disease%20in%202010.pdf

2. Dr.Knott.L, Living with Skin Disease. Authored by, 25 Nov 2014, Available at: https://patients.info/ doctor/living-with-skin-disease

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Received on 23.10.2019 Modified on 09.12.2019

Int. J. Nur. Edu. and Research. 2020; 8(4):468-473.

DOI: 10.5958/2454-2660.2020.00103.9