Intimate partner violence exposure, posttraumatic stress and quality of life among women with psoriasis: a cross-sectional study

Intimate partner violence exposure, posttraumatic stress and quality of life among women with psoriasis: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Intimate partner violence exposure, posttraumatic stress and quality of life among women with psoriasis: a cross-sectional study Esra Agaoglu, Imran Gokcen Yilmaz Karaman, Furkan Acıkbas, Hilal Kaya Erdogan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6975817/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Nov, 2025 Read the published version in BMC Women's Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Intimate partner violence (IPV) exposure is a chronic stressful condition that prevalently affects women's health and quality of life. As a chronic stressor factor, the presence of IPV and related posttraumatic stress have never been examined in psoriasis patients. The present study aims to evaluate the prevalence of emotional, physical and sexual IPV exposure, posttraumatic stress symptoms and quality of life among female psoriasis patients. Methods: This cross-sectional study was conducted on 134 female psoriasis patients. The disease severity was assessed with the Psoriasis Area Severity Index (PASI) by a dermatologist. Patients were asked to complete the Dermatology Life Quality Index (DLQI), the Violence Against Women Instrument (VAWI), and the Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5). Results: Sixty-two patients (46.3%) were exposed to at least one type of IPV and psychological IPV (45.5%) was the most prevalent form of IPV. Patients with lifetime IPV exposure had worse dermatological quality of life (U=1545.00, p=0.004) and higher posttraumatic stress symptoms (U=1272.00, p<0.001). Posttraumatic stress of IPV was related to higher PASI (ρ=0.184, p=0.047) and higher DLQI scores (ρ=0.654, p<0.001). Conclusions: IPV exposure is a common stressor that influences the psychological health of female psoriasis patients. Lifetime IPV exposure is associated with lower dermatological quality of life and higher posttraumatic stress. Acknowledging IPV-related chronic stress in patients with psoriasis may help increase quality of life. Healthcare providers should be aware of IPV and prevent the deleterious effects of violence on this vulnerable group of women. Psoriasis women intimate partner violence post-traumatic stress disorder quality of life Figures Figure 1 Introduction Psoriasis is a common chronic T-cell-mediated inflammatory disease affecting approximately 2–3% of the global population [ 1 , 2 ]. The etiopathogenesis of psoriasis is complex and multifactorial, including a genetic predisposition and various environmental stimuli such as psychological stress. Psychological stress can activate the interaction between the nervous system, endocrine system, and immune system leading to the development of chronic skin diseases [ 3 , 4 ]. Several studies indicate that exposure to psychological stressors might induce, aggravate, or even affect the course of psoriasis [ 1 , 2 ]. Additionally, high levels of psychological stress are associated with more extensive psoriasis. Considering the comorbid psychiatric disorders that frequently accompany patients with psoriasis, it has been hypothesized that a common psychodermatological mechanism plays a causal role in the development of psoriasis [ 5 ]. Intimate partner violence (IPV) experienced by women is a major public health concern leading to long-term physical, mental, and financial impacts. It is defined as physical or sexual violence, stalking behavior, and/or psychological aggression by an intimate partner [ 6 , 7 ]. Latest data from the World Health Organization (WHO) indicate that globally approximately 30% of women worldwide experience either physical and/or sexual IPV or non-partner sexual violence in their lifetime [ 8 ]. Beyond the acute physical health consequences, the high incidence of long-term psychosocial morbidity has been shown in women exposed to IPV. Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health conditions that occurs in more than 60% of IPV survivors [ 9 ]. Although the exact pathogenesis of how IPV-related stress response causes ill-health issues is not elucidated, one of the possible psychological explanations is the dysregulation of the hypothalamic-pituitary axis (HPA). Dysregulation of the HPA axis is the common mechanism involved in chronic stress-induced dermatological and psychiatric diseases [ 5 ]. Several studies documented that this neuroimmunological pathway may be impaired in a subgroup of psoriasis patients leading to an unappropriately response to stress [ 10 , 11 ]. Glucocorticoids, such as cortisol, as well as epinephrine and norepinephrine may enhance cutaneous immune responses at low concentrations and suppress immune responses at high concentrations. After acute stress, activation of the HPA axis results in increased cortisol secretion which decreases both inflammation and T cell-mediated immune response [ 5 , 11 ]. However, chronic stressful conditions such as IPV-related PTSD lead to dysregulation of the HPA axis resulting in decreased cortisol. Low concentration of cortisol may enhance the cutaneous T cell-mediated immune response that might eventually initiate psychodermatologic disorders such as psoriasis [ 12 , 13 ]. Considering the negative impact of chronic stress on both skin diseases and psychological health, this study primarily aims to determine the frequency of emotional, physical, and sexual IPV exposure in female psoriasis patients. The secondary aim is to determine whether traumatic stress symptoms accompany IPV exposure and to examine the relationship of these findings with psoriasis severity and quality of life. Materials and Methods Study Design and Participants The present study has a cross-sectional design. The researchers submitted the study scale to the patients who applied to the Dermatology Outpatients Clinic of [Blinded for peer review] Faculty of Medicine through October 2021 and September 2022. Inclusion criteria were female patients diagnosed with psoriasis, being 18 years of age and above who had a romantic relationship/marriage that has lasted at least one month or longer, could complete forms alone, and were willing to participate in the study. All participants provided informed written consent. The local ethics committee approved the study protocol (approval number: 33, date: 07.09.2021). Measurements Sociodemographic and Clinical Characteristics Form Researchers created a form to collect the participants' sociodemographic information (age, civil status, number of living children, occupation, and monthly income). The second part of the survey consisted of clinical features of patients, the onset age of psoriasis, psoriasis subtype, involvement areas of psoriasis, medical comorbidities, and current treatments. Disease severity was assessed by the dermatologist with Psoriasis Area Severity Index (PASI) which is the most widely used clinical indicator of psoriasis severity. The PASI measures symptoms of the disease such as erythema, desquamation, and induration (each graded on a 0–4 scale), weighted by the area of involvement [ 14 ]. Dermatology Life Quality Index (DLQI) The DLQI is a dermatology-specific quality-of-life instrument developed by Finlay and Khan (1994) [ 15 ]. The scale comprises 10 items covering the following six aspects of health-related quality of life: symptoms and feelings, daily activities, leisure, work or school, personal relationships, and treatment. Each item is answered on a 4-point scale scored as follows: "not at all" = 0, "a little" = 1, "a lot" = 2, and "very much" = 3. The highest score denotes the most impairment in life quality, while the lowest score represents the least. The Turkish version was established successfully with validity and reliability [ 16 ]. Evaluation of Psoriasis Severity Mild disease was defined as patients with PASI ≤ 10 and DLQI ≤ 10; while patients with PASI ≥ 10 and DLQI ≥ 10 were classified as moderate-severe psoriasis. Additionally, patients with PASI ≤ 10 but the involvement of specific areas such as hands, face, and genital region (DLQI ≥ 10) were evaluated as having moderate-severe psoriasis [ 17 ]. Violence Against Women Instrument (VAWI) The VAWI was used in the World Health Organization's multinational study investigating the frequency of violence against women [ 18 ]. It was utilized by Turkish researchers in wide population samples [ 19 ]. The scale consists of 4 items that primarily assess psychological violence, 6 items that assess physical violence, and 3 items that assess sexual violence. The scale, which was originally designed as a semi-structured interview, has also been used in some studies in the literature as a self-report. There are also views that its application in the form of a self-report may result in individuals feeling more comfortable in disclosing the violence they have been exposed to and that higher rates of violence against women are detected when screened with self-report [ 20 ]. Since our study aims to evaluate only lifetime IPV, the section questioning violence in the last year has been omitted and only 4 + 6 + 3 = 13 questions related to the existence and frequency of lifetime emotional, physical, and sexual IPV will be used. The output of the scale in the present study will be psychological violence present-absent, physical violence present-absent, and sexual violence present-absent. Since collecting data on violence against women has some risks of psychological deterioration or escalation of violence by the perpetrator, the research team took some precautions. The authors collaborated with the psychiatry department for psychiatric emergencies during data collection. All participants were evaluated without the presence of their relatives or partners. Participants with IPV exposure were asked if they needed the support of social services or psychiatric services. In the outpatient clinic, potential participants were asked to participate in research about their intimate relationships, to protect them from any existing IPV perpetrators and to ease their participation. Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) The PCL-5 is a 20-item measure that assesses PTSD symptomatology. Patients were asked to answer the scale by specifically considering problems in their partner relationship as questioned right before with VAWI. The Turkish validity and reliability of the PCL-5 have been demonstrated and 4 subscales were obtained [ 21 ]. These subscales were re-experiencing, avoidance, negative alterations, and hyperarousal. Participants responded to the items on 5-point Likert-type scales (0 = not at all to 4 = extremely) with total scores ranging from 0 to 80 [ 22 ]. Statistical analysis IBM SPSS version 25 was utilized for statistical analyses. Categorical data were presented as frequency and percentage. When it is distributed normally, continuous data are presented as mean and standard deviation. Continuous data were demonstrated as median and quartiles in case it is not normally distributed. A comparison of two independent groups regarding continuous variables was performed utilizing the Mann-Whitney U test. The categorical variables of the independent groups were compared with the chi-square test. Spearman correlation analysis was performed to demonstrate the associations between continuous variables. A statistically significant p-value was set at 0.05. Results Sociodemographic Data This study included 134 female patients with psoriasis vulgaris. The mean age of the patients was 46.04 ± 12.17. One hundred-eleven (82.8%) of the patients were married. Sixty-two (46.3%) of the patients had 2 children and 41 (30.6%) of the patients had 1 child. Eleven (8.2%) women stated that they were married before 18 years old. More than half of the patients (50.7%) were unpaid domestic workers and 41 (30.6%) of the patients were paid full-time employment. One hundred-thirteen (84.3%) patients stated that they have middle income and sixty-one (45.5%) of the patients were high school graduates (Table 1 ). Table 1 Sociodemographic characteristics of the participants (n = 134). Age 46.04 ± 12.17 Current marital status Married 111 (82.8%) Single/in relationship 16 (11.9%) Single/no relationship 7 (5.2%) Number of living children 0 17 (12.7%) 1 41 (30.6%) 2 62 (46.3%) 3 12 (9.0%) 4 2 (1.5%) Occupation Unpaid domestic worker 68 (50.7%) Paid full-time employment 41 (30.6%) Unemployed 24 (17.9%) Paid part-time employment 1 (0.7%) Income Middle income 113 (84.3%) Low income 19 (14.2%) High income 2 (1.5%) Educational level < High school graduate 61 (45.5%) High school graduate 33 (24.6%) Collage graduate 40 (29.8) Clinical Characteristics The mean age of psoriasis onset was 30.25 ± 15.09 and the duration of psoriasis was 15.7 ± 12.4 months. Forty (29.9%) of the patients had at least one concomitant systemic comorbid condition other than psoriasis. Plaque psoriasis was detected in 120 (89.6%) of the patients. The distribution of regional involvement and current treatments of the patients are shown in Table 2 . Table 2 Clinical characteristics of psoriasis patients (n = 134). Age at disease onset, mean ± SD 30.25 ± 15.09 Duration of psoriasis (month), mean ± SD 15.7 ± 12.4 At least one comorbidity, n (%) 40 (29.9%) Psoriasis subtype, n (%) Plaque 120 (89.6%) Palmoplantar 8 (6.0%) Guttate 3 (2.2%) Palmoplantar pustular 3 (2.2%) Psoriatic arthritis, n (%) 15 (11.2%) Nail psoriasis, n (%) 48 (35.8%) Involvement, n (%) Hand 43 (32.1%) Genital 22 (16.4%) Face 16 (11.9%) Current treatment, n (%) * Topical corticosteroid 69 (51.9%) Topical corticosteroid + calcipotriol 3 (2.3%) Methotrexate 20 (14.9%) Acitretin 11 (8.2%) Phototherapy 4 (3.0%) Biologic therapy 54 (14.2%) *: The patient receives m ore than one treatment type. The median PASI score of the patients was 2.70 (1.20–6.55). Most participants had moderate-severe psoriasis (n = 123, 91.8%), while 11 had mild psoriasis (n = 11, 8.2%). The mean DLQI score of the psoriasis patients was 17.73 ± 10.05. Intimate Partner Violence Sixty-two patients (46.3%) were exposed to at least one type of IPV. Psychological IPV was reported by 61 (45.5%) of the participants. Twenty-one (15.7%) participants reported physical IPV. Eleven (8.2%) women stated that they were exposed to sexual IPV (Figure). Psychiatric Characteristics Previously psychiatric disorders were reported by 38 (28.4%) of the patients. Among them, eleven (8.2%) were diagnosed with depression, three (2.2%) with anxiety disorder, two (1.5%) with sleep disorder, two (1.5%) with panic disorder and one (0.7%) with vaginismus. Forty (29.9%) of the patients stated that they had previously used antidepressants. Current psychiatric disorders reported by 21 (15.7%) of the patients: three (2.2%) were diagnosed with depression, two (1.5%) with sleep disorder and each one patient had anxiety disorder, panic disorder and obsessive-compulsive disorder. Among the participants, 71 of them (52.6%) were not smoking; 130 (96.3%) were not consuming alcohol. Posttraumatic stress related to IPV was measured with the PCL-5 score, the mean value was 26.82 ± 19.97. Comparison of the patients with and without IPV exposure The participants were divided into two groups regarding their IPV exposure. Groups did not differ regarding age (U = 2104.00, p = 0.765), civil status (χ²=2.944, p = 0.086), income (χ²=0.286, p = 0.593), educational level (χ²=4.462, p = 0.216), and psoriasis severity (Fisher's exact test p = 0.216). Clinical variables of the two groups, PASI, DLQI, and PCL-5 were compared. Female psoriasis patients with lifetime IPV exposure had worse dermatological quality of life (U = 1545.00, p = 0.004) and higher posttraumatic stress symptoms (U = 1272.00, p < 0.001) (Table 3 ). Table 3 Comparison of the clinical variables of the participant groups with and without IPV exposure. Variable Lifetime IPV Exposure Median (Q1-Q3) No Exposure Median (Q1-Q3) Test values PASI 2.55 (0.90–8.12) 2.70 (1.20–5.92) U = 1626.00 p = 0.765 DLQI 19.00 (14.75-24.00) 14.00 (6.75–22.25) U = 1545.00 p = 0.004 PCL-5 34.00 (18.00–51.00) 16.00 (5.75-32.00) U = 1272.00 p < 0.001 PASI: Psoriasis Area Severity Index, DLQI: Dermatology Life Quality Index, PCL-5: Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5. Spearman Correlation Analyses Higher PASI scores were associated with worse dermatological quality of life (ρ = 0.285, p = 0.002). Posttraumatic stress of IPV was related to higher PASI (ρ = 0.184, p = 0.047) and higher DLQI scores (ρ = 0.654, p < 0.001) (Table 4 ). Table 4 Median values, quartiles, and Spearman Correlation Analyses of study variables. Median (Q1-Q3), n PASI DLQI PASI 2.70 (1.20–6.55) - n = 117 DLQI 16.00 (11.75-23.00) 0.285** - n = 134 PCL-5 24.50 (9.00- 39.25) 0.184* 0.654** n = 134 PASI: Psoriasis Area Severity Index, DLQI: Dermatology Life Quality Index, PCL-5: Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5. **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). Discussion Based on the hypothesis that the impaired HPA axis might play a role in the development of both psoriasis and IPV-associated PTSD, we aimed to evaluate IPV findings and PTSD in female psoriasis patients according to the disease severity. To the best of our knowledge, this is the first study to examine the presence of IPV and related PTSD in female psoriasis patients. Concerning lifetime IPV exposure and psoriasis, the major findings of our study were almost half of the patients (46.3%) reported that they had been exposed to IPV and most frequently (45.5%) they reported psychological IPV. Patients with lifetime IPV exposure had worse quality of life (higher DLQI score) and higher levels of post-traumatic stress.Additionally, IPV-related post-traumatic stress was related to psoriasis severity, even so, the relationship was weak. Although no study to date has examined the potential role of IPV in psoriasis onset, several studies have shown that stressful life events and adulthood traumas increase the vulnerability of psoriasis [ 23 , 24 ]. Simonic et al. investigated the presence of traumatic events in psoriasis patients and found that lifespan negative experiences such as emotional abuse were significantly higher in patients than in controls. They suggested that negative life events experienced in childhood and adulthood, together with a lack of positive experiences, may have increased the vulnerability to psoriasis onset [ 23 ]. As a chronic traumatic stressor, exposure to IPV is associated with negative physical and mental health consequences. The effects of IPV can occur both during times of violence and in the long-term period following violence [ 5 , 12 ]. A meta-analysis by Golding et al. showed that suicidal ideation, substance abuse, and depression were three to five times more frequent among female victims of IPV compared with non-victimised women [ 9 ]. It is well documented that women affected by IPV are at high risk of developing chronic pain, neurologic disorders, gastrointestinal disorders, migraine, headaches, and other physical disabilities, as well as PTSD [ 25 ]. Apart from the negative psychosocial effects caused by psoriasis, poor physical functioning during the disease is comparable to those seen in patients with cancer, hypertension, and heart disease [ 26 ]. Several studies reported that regarding the gender-dependent differences in the quality of life, female psoriasis patients presented poorer quality of life compared to men [ 27 , 28 ]. It is also documented that women with emotional and physical disabilities are at higher risk of sexual assault and IPV [ 29 ]. To date, there is only one study in the field of dermatology comparing the presence of IPV and sexual assault victimization in hidradenitis suppurativa and acne. This study reported that patients with hidradenitis were more exposed to IPV compared to acne showing that those with these disabilities are at higher risk of abuse [ 30 ]. IPV is a globally prevalent issue affecting women of all ages, ethnicities, and socioeconomic levels. Several individual risk factors have been identified for IPV including childhood exposure to abuse, history of depression, low socioeconomic status, female education less than high school level, and early age of marriage [ 31 ]. In our study, as we evaluated IPV exposure in female psoriasis, more than half of the patients were unpaid domestic workers and the most common (35.1%) educational status was primary school. Additionally, a history of depression was the most common psychiatric disorder in our patients. Looking at the VAWI subscales regarding IPV, 61 (45.5%) of our psoriasis patients reported exposure to psychological violence, 21 (15.7%) to physical violence, and 11 (8.2%) to sexual violence by an intimate partner. In our study, higher IPV exposure rates were recorded in all three VAWI subscales of domestic violence compared to the population-based cross-sectional studies in China [ 32 ] and Sweden [ 33 ]. Similarly, in Sweden, Lövestad et al. reported lower physical (6.6%) and sexual (2.4%) violence rates than our participants [ 34 ]. However, in an Indian cross-sectional study, the prevalence of physical violence was found to be %31.1 which was higher than our results, while sexual violence was similar to our study [ 35 ]. Measuring IPV is challenging across different countries, regarding its cultural complexity and traumatic nature for the study participants and the interviewers [ 18 ]. Psoriasis is linked to chronic stress; IPV may deteriorate symptoms and quality of life by being a chronic stressor factor. Evidence confirms that altered HPA axis activity and hypocortisolism have been identified with stress-induced conditions such as PTSD [ 36 , 37 ]. PTSD may be considered as an underlying triggering factor for chronic, recurrent, and stress-reactive skin diseases [ 38 ]. The HPA axis maintains an optimum homeostatic state for the adaptation to environmental stimuli. Activation of the acute stress response in patients with intact HPA axes results in the secretion of glucocorticoids and catecholamines. Thus, glucocorticoids and catecholamines stimulate the differentiation of T helper (Th) cells into the Th1/Th17 phenotype, resulting in the downregulation of Th1-related cytokines. It has been shown that adequate levels of cortisol reduce the inflammation in Th1-dominant diseases such as psoriasis, moving the response towards a Th2-mediated pathway. However, in psoriasis patients who persistently experience higher levels of daily stress may lead to downregulation of the HPA axis which may result in less circulating cortisol. This dysregulation of the HPA axis results in alterations in the glucocorticoid response to stress factors thereby a decrease of the desired anti-inflammatory effect of cortisol [ 5 , 39 ]. There are a limited number of studies that have investigated the posttraumatic stress symptoms in stress-reactive dermatoses [ 39 , 40 ]. Sagaltıcı et al. evaluated the psychological status of acne vulgaris patients during the COVID-19 pandemic and higher levels of PTSD symptoms were found in acne patients compared to the control group. According to this study, acne patients had significantly higher (median: 32) PCL-5 scores than the control group (median: 29.5) [ 39 ]. Drake et al. conducted a large cross-sectional national survey on alopecia areata patients and reported that one in 3 patients met the criteria for PTSD related to their hair loss problem. In this study, the mean PCL-5 score of the patients was 48.8 ± 12.3 [ 40 ]. The lower PCL-5 scores in our study may be explained by differences in the patients' sociodemographic characteristics, as well as the possibility that they may have developed coping strategies for posttraumatic stress symptoms. The limitation of the present study is the cross-sectional and single-center design. Thus, it is not possible to reflect a causal relationship. IPV occurs with multiple disadvantages like low education, poverty, or general health issues. Selecting IPV as a main variable is challenging since diverse disadvantages overlap. On the other hand, the same reason can make IPV a usable indicator as a social determinant of health. The strengths of the study are measuring IPV with widely utilized measurements, and focusing on women with psoriasis which is an under-researched population regarding IPV. Conclusions Our findings highlighted that violence against women is a common issue in psoriasis patients, and psychological IPV is the most prevalent form of IPV. Furthermore, lifetime IPV exposure was associated with higher posttraumatic stress and lower dermatological quality of life; additionally, there is a weak relationship with disease severity. Both clinicians and healthcare providers should be aware of the risk of IPV exposure in female psoriasis patients. Interventions to reduce the causes of chronic stress in psoriasis patients may be beneficial for lowering the severity of the disease. Maintaining secure intimate relationships may be a target for psychological interventions. Abbreviations IPV Intimate partner violence WHO World Health Organization PTSD Posttraumatic stress disorder HPA Hypothalamic-pituitary axis PASI Psoriasis Area Severity Index DLQI Dermatology Life Quality Index VAWI Violence Against Women Instrument PCL-5 Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 Th T helper Declarations Ethics approval and consent to participate Institutional Ethics Committee approval was obtained from the Eskişehir Osmangazi University Faculty of Medicine Ethics Committee (approval number: 33, date: 07.09.2021). Informed consent was obtained from all participants. This research was conducted ethically in accordance with the Declaration of Helsinki. Consent for publication Consent was obtained from each participant for the publication of survey data. Availability of data and materials Datasets generated and/or analyzed in the current study are presented in the text. Competing interests The authors declare no competing interests. Funding Not applicable. Authors’ contributions E.A. conceptualization, design, analysis and preparation of the manuscript. I.G.Y.K. conceptualization, design, analysis and supervision. F.A. design and data collection. H.K.E. design and supervision. Acknowledgements Not applicable . References Picardi A, Abeni D. Stressful life events and skin diseases: Disentangling evidence from myth. Psychother Psychosom. 2001;70:118-36. Malhotra SK, Mehta V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria. Indian J Dermatol Venereol Leprol. 2008;74:594-9. Zhang H, Wang M, Zhao X, Wang Y, Chen X, Su J. Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav Immun. 2024;116:286-302. Torales J, Echeverría C, Barrios I, García O, O’Higgins M, Castaldelli-Maia JM, et al. Psychodermatological mechanisms of psoriasis. Dermatol Ther. 2020;33:e13827. Yang H, Zheng J. Influence of stress on the development of psoriasis. Clin Exp Dermatol. 2020;45:284-8. Kyle J. Intimate Partner Violence. Med Clin North Am. 2023;107:385-95. O'Doherty L, Hegarty K, Ramsay J, Davidson LL, Feder G, Taft A. Screening women for intimate partner violence in healthcare settings. Cochrane Database Syst Rev. 2015;2015: CD007007. World Health Organization, 2024. Violence Against Women. Retrieved March 25, 2024, from. https://www.who.int/news-room/fact-sheets/detail/violence-against-women. Golding JM. Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence. 1999;14;99-132. Buske-Kirschbaum A, Ebrecht M, Kern S, Hellhammer DH. Endocrine stress responses in TH1-mediated chronic inflammatory skin disease (psoriasis vulgaris)--do they parallel stress-induced endocrine changes in TH2-mediated inflammatory dermatoses (atopic dermatitis)? Psychoneuroendocrinology. 2006;31:439-46. Evers AW, Verhoeven EW, Kraaimaat FW, de Jong EM, de Brouwer SJ, et al. How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol. 2010;163:986-91. Inslicht SS, Marmar CR, Neylan TC, Metzler TJ, Hart SL, Otte C, et al. Increased cortisol in women with intimate partner violence-related posttraumatic stress disorder. Psychoneuroendocrinology. 2006;3:825-38. Alhalal E, Falatah R. Intimate partner violence and hair cortisol concentration: A biomarker for HPA axis function. Psychoneuroendocrinology. 2020;122:104897. Fredriksson T, Pettersson U. Severe psoriasis - oral therapy with a new retinoid. Dermatologica. 1978;157:238-44. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210-6. Oztürkcan S, Ermertcan AT, Eser E, Sahin MT. Cross validation of the Turkish version of dermatology life quality index. Int J Dermatol. 2006;45:1300-7. Bülbül Başkan E. Determining disease severity. Turkderm-Turk Arch Dermatol Venereol. 2022;56(Suppl 1):3-5. Ellsberg M, Heise L. Researching Violence Against Women: A Practical Guide for Researchers and Activists. Washington DC, United States: World Health Organization, PATH; 2005. Hacettepe University Institute of Population Studies. Türkiye'de Kadına Yönelik Aile İçi Şiddet Araştırması, Ankara: Elma Teknik Basım Matbaacılık, 2015. Nybergh L, Taft C, Krantz G. Psychometric properties of the WHO Violence Against Women instrument in a female population-based sample in Sweden: a cross-sectional survey. BMJ Open. 2013;3:e002053. Boysan M, Guzel Ozdemir P, Ozdemir O, Selvi Y, Yilmaz E, Kaya N. Psychometric properties of the Turkish version of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, (PCL-5). Psychiatry and Clinical Psychopharmacology. 2017;27:300-10. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. 2015;28:489-98. Simonić E, Kaštelan M, Peternel S, Pernar M, Brajac I, Rončević-Gržeta I, et al. Childhood and adulthood traumatic experiences in patients with psoriasis. J Dermatol. 2010;37:793-800. Manolache L, Petrescu-Seceleanu D, Benea V. Life events involvement in psoriasis onset/recurrence. Int J Dermatol. 2010;49:636-41. Stubbs A, Szoeke C. The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. Trauma Violence Abuse. 2022;23:1157-72. Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41:401-7. Obradors M, Blanch C, Comellas M, Figueras M, Lizan L. Health-related quality of life in patients with psoriasis: a systematic review of the European literature. Qual Life Res. 2016; 25:2739-54. Napolitano M, Mastroeni S, Fania L, Pallotta S, Fusari R, Uras C, et al. Sex and gender-associated clinical and psychosocial characteristics of patients with psoriasis. Clin Exp Dermatol. 2020;45:705-11. Brownridge DA. Partner violence against women with disabilities: prevalence, risk, and explanations. Violence Against Women. 2006;12:805-22. Sisic M, Tan J, Lafreniere KD. Hidradenitis Suppurativa, Intimate Partner Violence, and Sexual Assault. J Cutan Med Surg. 2017;21:383-87. Yakubovich AR, Stöckl H, Murray J, Melendez-Torres GJ, Steinert JI, Glavin CEY, et al. Risk and Protective Factors for Intimate Partner Violence Against Women: Systematic Review and Meta-analyses of Prospective-Longitudinal Studies. Am J Public Health. 2018; 108: e1-e11. Chang X, Yang Y, Li R. The characteristics of husbands and violence against women in Wuhan, China: a cross-sectional study. BMC Women’s Health 2022;22:73. Nybergh L, Taft C, Enander V, Krantz G. Self-reported exposure to intimate partner violence among women and men in Sweden: results from a population-based survey. BMC Public Health. 2013;13:845. Lövestad S, Löve J, Vaez M, Krantz G. Prevalence of intimate partner violence and its association with symptoms of depression; a cross-sectional study based on a female population sample in Sweden. BMC Public Health. 2017;17:335. Arumugaperumal R, Ravichandhiran G, Agadi S, Muthuchamy V, D R, S S, et al. Evaluation of Intimate Partner Violence and Its Association With Depression Among Women in Chengalpattu District, India: A Cross-Sectional Study. Cureus. 2024;16:e59825. Heim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25:1-35. Raison CL, Miller AH. When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 2003;160: 1554-65. Sagaltici E, Tas B. Mental health and psychological resilience among acne vulgaris patients during the pandemic: A cross-sectional controlled study. J Cosmet Dermatol. 2021;20: 3739-46. Kwon CW, Fried RG, Nousari Y, Ritchlin C, Tausk F. Psoriasis: Psychosomatic, somatopsychic, or both? Clin Dermatol 2018;36:698-703. Drake L, Li SJ, Reyes-Hadsall S, Lee K, Huang K, Mostaghimi A. Post-Traumatic Stress Disorder in Patients with Alopecia Areata: A Survey Study in the USA. Skin Appendage Disord. 2023;9:342-5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Nov, 2025 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Revision requested 28 Oct, 2025 Reviews received at journal 27 Oct, 2025 Reviewers agreed at journal 20 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviews received at journal 03 Jul, 2025 Reviewers agreed at journal 03 Jul, 2025 Reviewers invited by journal 03 Jul, 2025 Editor invited by journal 26 Jun, 2025 Editor assigned by journal 25 Jun, 2025 Submission checks completed at journal 25 Jun, 2025 First submitted to journal 25 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6975817","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":480286294,"identity":"68750828-8aa9-4aa5-84c3-fc765f9c89bc","order_by":0,"name":"Esra Agaoglu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYFADdgbGBwwMB0jRwszAbECyFjYJorTw8599+OHHLzs5eWces2qemjty/AzMDx/dwKNFcka6sWRvX7Kx4WEes9s8x54ZSzawGRvn4NFicIONQYK3hzlxYzNIC9vhxA0HeNik8WmxP3+M+effnnqwlmKef0RoMWBIY5Pm+XE4cT4zjxkzbxsRWiRupLFZyzYcNzZgZiuWnNt32FiymYBf+PuPMd9886daTr69eeOHN98Oy/GzNz98jE8LGDC2AV14gIGBiQfEYyakHAz+MDDINwC1/iBK9SgYBaNgFIw0AAC+Hkmng61hUAAAAABJRU5ErkJggg==","orcid":"","institution":"Eskisehir Osmangazi University, Faculty of Medicine, Department of Dermatology","correspondingAuthor":true,"prefix":"","firstName":"Esra","middleName":"","lastName":"Agaoglu","suffix":""},{"id":480286295,"identity":"fcb0e71e-b64d-4b90-b602-7ccd41bcd5d3","order_by":1,"name":"Imran Gokcen Yilmaz Karaman","email":"","orcid":"","institution":"Eskisehir Osmangazi University, Faculty of Medicine, Department of Psychiatry","correspondingAuthor":false,"prefix":"","firstName":"Imran","middleName":"Gokcen Yilmaz","lastName":"Karaman","suffix":""},{"id":480286296,"identity":"b94e1cc5-d210-4a9e-976a-1bf72d4ae8e2","order_by":2,"name":"Furkan Acıkbas","email":"","orcid":"","institution":"Eskisehir Osmangazi University, Faculty of Medicine, Department of Dermatology","correspondingAuthor":false,"prefix":"","firstName":"Furkan","middleName":"","lastName":"Acıkbas","suffix":""},{"id":480286297,"identity":"3fe5a069-fb54-4c4b-aecc-ce8770679789","order_by":3,"name":"Hilal Kaya Erdogan","email":"","orcid":"","institution":"Eskisehir Osmangazi University, Faculty of Medicine, Department of Dermatology","correspondingAuthor":false,"prefix":"","firstName":"Hilal","middleName":"Kaya","lastName":"Erdogan","suffix":""}],"badges":[],"createdAt":"2025-06-25 14:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6975817/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6975817/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-025-04170-8","type":"published","date":"2025-11-28T15:58:08+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86141228,"identity":"c5597cc0-0ae4-4ec7-b8aa-4209c22ed7f5","added_by":"auto","created_at":"2025-07-07 08:24:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44862,"visible":true,"origin":"","legend":"\u003cp\u003eLifetime IPV exposure among the participants.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6975817/v1/f9d3b7781ce143d427537cc6.png"},{"id":97178471,"identity":"b1049760-3f59-459a-acaa-5f49165a31af","added_by":"auto","created_at":"2025-12-01 16:10:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":896264,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6975817/v1/5d3b9008-bafa-4bba-bc94-a853fc563921.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intimate partner violence exposure, posttraumatic stress and quality of life among women with psoriasis: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePsoriasis is a common chronic T-cell-mediated inflammatory disease affecting approximately 2\u0026ndash;3% of the global population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The etiopathogenesis of psoriasis is complex and multifactorial, including a genetic predisposition and various environmental stimuli such as psychological stress. Psychological stress can activate the interaction between the nervous system, endocrine system, and immune system leading to the development of chronic skin diseases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies indicate that exposure to psychological stressors might induce, aggravate, or even affect the course of psoriasis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Additionally, high levels of psychological stress are associated with more extensive psoriasis. Considering the comorbid psychiatric disorders that frequently accompany patients with psoriasis, it has been hypothesized that a common psychodermatological mechanism plays a causal role in the development of psoriasis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIntimate partner violence (IPV) experienced by women is a major public health concern leading to long-term physical, mental, and financial impacts. It is defined as physical or sexual violence, stalking behavior, and/or psychological aggression by an intimate partner [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Latest data from the World Health Organization (WHO) indicate that globally approximately 30% of women worldwide experience either physical and/or sexual IPV or non-partner sexual violence in their lifetime [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Beyond the acute physical health consequences, the high incidence of long-term psychosocial morbidity has been shown in women exposed to IPV. Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health conditions that occurs in more than 60% of IPV survivors [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the exact pathogenesis of how IPV-related stress response causes ill-health issues is not elucidated, one of the possible psychological explanations is the dysregulation of the hypothalamic-pituitary axis (HPA). Dysregulation of the HPA axis is the common mechanism involved in chronic stress-induced dermatological and psychiatric diseases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Several studies documented that this neuroimmunological pathway may be impaired in a subgroup of psoriasis patients leading to an unappropriately response to stress [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlucocorticoids, such as cortisol, as well as epinephrine and norepinephrine may enhance cutaneous immune responses at low concentrations and suppress immune responses at high concentrations. After acute stress, activation of the HPA axis results in increased cortisol secretion which decreases both inflammation and T cell-mediated immune response [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, chronic stressful conditions such as IPV-related PTSD lead to dysregulation of the HPA axis resulting in decreased cortisol. Low concentration of cortisol may enhance the cutaneous T cell-mediated immune response that might eventually initiate psychodermatologic disorders such as psoriasis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsidering the negative impact of chronic stress on both skin diseases and psychological health, this study primarily aims to determine the frequency of emotional, physical, and sexual IPV exposure in female psoriasis patients. The secondary aim is to determine whether traumatic stress symptoms accompany IPV exposure and to examine the relationship of these findings with psoriasis severity and quality of life.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eThe present study has a cross-sectional design. The researchers submitted the study scale to the patients who applied to the Dermatology Outpatients Clinic of [Blinded for peer review] Faculty of Medicine through October 2021 and September 2022. Inclusion criteria were female patients diagnosed with psoriasis, being 18 years of age and above who had a romantic relationship/marriage that has lasted at least one month or longer, could complete forms alone, and were willing to participate in the study. All participants provided informed written consent. The local ethics committee approved the study protocol (approval number: 33, date: 07.09.2021).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic and Clinical Characteristics Form\u003c/h2\u003e \u003cp\u003eResearchers created a form to collect the participants' sociodemographic information (age, civil status, number of living children, occupation, and monthly income). The second part of the survey consisted of clinical features of patients, the onset age of psoriasis, psoriasis subtype, involvement areas of psoriasis, medical comorbidities, and current treatments. Disease severity was assessed by the dermatologist with Psoriasis Area Severity Index (PASI) which is the most widely used clinical indicator of psoriasis severity. The PASI measures symptoms of the disease such as erythema, desquamation, and induration (each graded on a 0\u0026ndash;4 scale), weighted by the area of involvement [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDermatology Life Quality Index (DLQI)\u003c/h3\u003e\n\u003cp\u003eThe DLQI is a dermatology-specific quality-of-life instrument developed by Finlay and Khan (1994) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The scale comprises 10 items covering the following six aspects of health-related quality of life: symptoms and feelings, daily activities, leisure, work or school, personal relationships, and treatment. Each item is answered on a 4-point scale scored as follows: \"not at all\" = 0, \"a little\" = 1, \"a lot\" = 2, and \"very much\" = 3. The highest score denotes the most impairment in life quality, while the lowest score represents the least. The Turkish version was established successfully with validity and reliability [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eEvaluation of Psoriasis Severity\u003c/h3\u003e\n\u003cp\u003eMild disease was defined as patients with PASI\u0026thinsp;\u0026le;\u0026thinsp;10 and DLQI\u0026thinsp;\u0026le;\u0026thinsp;10; while patients with PASI\u0026thinsp;\u0026ge;\u0026thinsp;10 and DLQI\u0026thinsp;\u0026ge;\u0026thinsp;10 were classified as moderate-severe psoriasis. Additionally, patients with PASI\u0026thinsp;\u0026le;\u0026thinsp;10 but the involvement of specific areas such as hands, face, and genital region (DLQI\u0026thinsp;\u0026ge;\u0026thinsp;10) were evaluated as having moderate-severe psoriasis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eViolence Against Women Instrument (VAWI)\u003c/h2\u003e \u003cp\u003eThe VAWI was used in the World Health Organization's multinational study investigating the frequency of violence against women [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It was utilized by Turkish researchers in wide population samples [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The scale consists of 4 items that primarily assess psychological violence, 6 items that assess physical violence, and 3 items that assess sexual violence. The scale, which was originally designed as a semi-structured interview, has also been used in some studies in the literature as a self-report. There are also views that its application in the form of a self-report may result in individuals feeling more comfortable in disclosing the violence they have been exposed to and that higher rates of violence against women are detected when screened with self-report [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Since our study aims to evaluate only lifetime IPV, the section questioning violence in the last year has been omitted and only 4\u0026thinsp;+\u0026thinsp;6\u0026thinsp;+\u0026thinsp;3\u0026thinsp;=\u0026thinsp;13 questions related to the existence and frequency of lifetime emotional, physical, and sexual IPV will be used. The output of the scale in the present study will be psychological violence present-absent, physical violence present-absent, and sexual violence present-absent.\u003c/p\u003e \u003cp\u003eSince collecting data on violence against women has some risks of psychological deterioration or escalation of violence by the perpetrator, the research team took some precautions. The authors collaborated with the psychiatry department for psychiatric emergencies during data collection. All participants were evaluated without the presence of their relatives or partners. Participants with IPV exposure were asked if they needed the support of social services or psychiatric services. In the outpatient clinic, potential participants were asked to participate in research about their intimate relationships, to protect them from any existing IPV perpetrators and to ease their participation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePosttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5)\u003c/h3\u003e\n\u003cp\u003eThe PCL-5 is a 20-item measure that assesses PTSD symptomatology. Patients were asked to answer the scale by specifically considering problems in their partner relationship as questioned right before with VAWI. The Turkish validity and reliability of the PCL-5 have been demonstrated and 4 subscales were obtained [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These subscales were re-experiencing, avoidance, negative alterations, and hyperarousal. Participants responded to the items on 5-point Likert-type scales (0\u0026thinsp;=\u0026thinsp;not at all to 4\u0026thinsp;=\u0026thinsp;extremely) with total scores ranging from 0 to 80 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIBM SPSS version 25 was utilized for statistical analyses. Categorical data were presented as frequency and percentage. When it is distributed normally, continuous data are presented as mean and standard deviation. Continuous data were demonstrated as median and quartiles in case it is not normally distributed. A comparison of two independent groups regarding continuous variables was performed utilizing the Mann-Whitney U test. The categorical variables of the independent groups were compared with the chi-square test. Spearman correlation analysis was performed to demonstrate the associations between continuous variables. A statistically significant p-value was set at 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographic Data\u003c/h2\u003e\n \u003cp\u003eThis study included 134 female patients with psoriasis vulgaris. The mean age of the patients was 46.04\u0026thinsp;\u0026plusmn;\u0026thinsp;12.17. One hundred-eleven (82.8%) of the patients were married. Sixty-two (46.3%) of the patients had 2 children and 41 (30.6%) of the patients had 1 child. Eleven (8.2%) women stated that they were married before 18 years old. More than half of the patients (50.7%) were unpaid domestic workers and 41 (30.6%) of the patients were paid full-time employment. One hundred-thirteen (84.3%) patients stated that they have middle income and sixty-one (45.5%) of the patients were high school graduates (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic characteristics of the participants (n\u0026thinsp;=\u0026thinsp;134).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e46.04\u0026thinsp;\u0026plusmn;\u0026thinsp;12.17\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eCurrent marital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e111 (82.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle/in relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle/no relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eNumber of living children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62 (46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnpaid domestic worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68 (50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePaid full-time employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePaid part-time employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113 (84.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; High school graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33 (24.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollage graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40 (29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eClinical Characteristics\u003c/h2\u003e\n \u003cp\u003eThe mean age of psoriasis onset was 30.25\u0026thinsp;\u0026plusmn;\u0026thinsp;15.09 and the duration of psoriasis was 15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4 months. Forty (29.9%) of the patients had at least one concomitant systemic comorbid condition other than psoriasis. Plaque psoriasis was detected in 120 (89.6%) of the patients. The distribution of regional involvement and current treatments of the patients are shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical characteristics of psoriasis patients (n\u0026thinsp;=\u0026thinsp;134).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge at disease onset, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e30.25\u0026thinsp;\u0026plusmn;\u0026thinsp;15.09\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDuration of psoriasis (month), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAt least one comorbidity, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (29.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003ePsoriasis subtype, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlaque\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120 (89.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePalmoplantar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGuttate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePalmoplantar pustular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePsoriatic arthritis, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNail psoriasis, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eInvolvement, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGenital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eCurrent treatment, n (%)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTopical corticosteroid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (51.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTopical corticosteroid\u0026thinsp;+\u0026thinsp;calcipotriol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMethotrexate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcitretin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhototherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBiologic therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e*:\u0026nbsp;\u003c/strong\u003e\u003cem\u003eThe patient receives m\u003c/em\u003e\u003cem\u003eore than one treatment type.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe median PASI score of the patients was 2.70 (1.20\u0026ndash;6.55). Most participants had moderate-severe psoriasis (n\u0026thinsp;=\u0026thinsp;123, 91.8%), while 11 had mild psoriasis (n\u0026thinsp;=\u0026thinsp;11, 8.2%). The mean DLQI score of the psoriasis patients was 17.73\u0026thinsp;\u0026plusmn;\u0026thinsp;10.05.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eIntimate Partner Violence\u003c/h2\u003e\n \u003cp\u003eSixty-two patients (46.3%) were exposed to at least one type of IPV. Psychological IPV was reported by 61 (45.5%) of the participants. Twenty-one (15.7%) participants reported physical IPV. Eleven (8.2%) women stated that they were exposed to sexual IPV (Figure).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003ePsychiatric Characteristics\u003c/h2\u003e\n \u003cp\u003ePreviously psychiatric disorders were reported by 38 (28.4%) of the patients. Among them, eleven (8.2%) were diagnosed with depression, three (2.2%) with anxiety disorder, two (1.5%) with sleep disorder, two (1.5%) with panic disorder and one (0.7%) with vaginismus. Forty (29.9%) of the patients stated that they had previously used antidepressants.\u003c/p\u003e\n \u003cp\u003eCurrent psychiatric disorders reported by 21 (15.7%) of the patients: three (2.2%) were diagnosed with depression, two (1.5%) with sleep disorder and each one patient had anxiety disorder, panic disorder and obsessive-compulsive disorder. Among the participants, 71 of them (52.6%) were not smoking; 130 (96.3%) were not consuming alcohol. Posttraumatic stress related to IPV was measured with the PCL-5 score, the mean value was 26.82\u0026thinsp;\u0026plusmn;\u0026thinsp;19.97.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of the patients with and without IPV exposure\u003c/h2\u003e\n \u003cp\u003eThe participants were divided into two groups regarding their IPV exposure. Groups did not differ regarding age (U\u0026thinsp;=\u0026thinsp;2104.00, p\u0026thinsp;=\u0026thinsp;0.765), civil status (\u0026chi;\u0026sup2;=2.944, p\u0026thinsp;=\u0026thinsp;0.086), income (\u0026chi;\u0026sup2;=0.286, p\u0026thinsp;=\u0026thinsp;0.593), educational level (\u0026chi;\u0026sup2;=4.462, p\u0026thinsp;=\u0026thinsp;0.216), and psoriasis severity (Fisher\u0026apos;s exact test p\u0026thinsp;=\u0026thinsp;0.216). Clinical variables of the two groups, PASI, DLQI, and PCL-5 were compared. Female psoriasis patients with lifetime IPV exposure had worse dermatological quality of life (U\u0026thinsp;=\u0026thinsp;1545.00, p\u0026thinsp;=\u0026thinsp;0.004) and higher posttraumatic stress symptoms (U\u0026thinsp;=\u0026thinsp;1272.00, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of the clinical variables of the participant groups with and without IPV exposure.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLifetime IPV Exposure\u003c/p\u003e\n \u003cp\u003eMedian (Q1-Q3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo Exposure\u003c/p\u003e\n \u003cp\u003eMedian (Q1-Q3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTest values\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePASI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.55 (0.90\u0026ndash;8.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.70 (1.20\u0026ndash;5.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1626.00 p\u0026thinsp;=\u0026thinsp;0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDLQI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.00 (14.75-24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.00 (6.75\u0026ndash;22.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1545.00 p\u0026thinsp;=\u0026thinsp;0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCL-5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.00 (18.00\u0026ndash;51.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.00 (5.75-32.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1272.00 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003ePASI: Psoriasis Area Severity Index, DLQI: Dermatology Life Quality Index, PCL-5: Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\u003cbr\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eSpearman Correlation Analyses\u003c/h2\u003e\n \u003cp\u003eHigher PASI scores were associated with worse dermatological quality of life (\u0026rho;\u0026thinsp;=\u0026thinsp;0.285, p\u0026thinsp;=\u0026thinsp;0.002). Posttraumatic stress of IPV was related to higher PASI (\u0026rho;\u0026thinsp;=\u0026thinsp;0.184, p\u0026thinsp;=\u0026thinsp;0.047) and higher DLQI scores (\u0026rho;\u0026thinsp;=\u0026thinsp;0.654, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMedian values, quartiles, and Spearman Correlation Analyses of study variables.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian (Q1-Q3), n\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePASI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDLQI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePASI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.70 (1.20\u0026ndash;6.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDLQI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.00 (11.75-23.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.285**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCL-5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.50 (9.00- 39.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.184*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.654**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003ePASI: Psoriasis Area Severity Index, DLQI: Dermatology Life Quality Index, PCL-5: Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cem\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cem\u003e*. Correlation is significant at the 0.05 level (2-tailed).\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eBased on the hypothesis that the impaired HPA axis might play a role in the development of both psoriasis and IPV-associated PTSD, we aimed to evaluate IPV findings and PTSD in female psoriasis patients according to the disease severity. To the best of our knowledge, this is the first study to examine the presence of IPV and related PTSD in female psoriasis patients.\u003c/p\u003e \u003cp\u003eConcerning lifetime IPV exposure and psoriasis, the major findings of our study were almost half of the patients (46.3%) reported that they had been exposed to IPV and most frequently (45.5%) they reported psychological IPV. Patients with lifetime IPV exposure had worse quality of life (higher DLQI score) and higher levels of post-traumatic stress.Additionally, IPV-related post-traumatic stress was related to psoriasis severity, even so, the relationship was weak.\u003c/p\u003e \u003cp\u003eAlthough no study to date has examined the potential role of IPV in psoriasis onset, several studies have shown that stressful life events and adulthood traumas increase the vulnerability of psoriasis [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Simonic et al. investigated the presence of traumatic events in psoriasis patients and found that lifespan negative experiences such as emotional abuse were significantly higher in patients than in controls. They suggested that negative life events experienced in childhood and adulthood, together with a lack of positive experiences, may have increased the vulnerability to psoriasis onset [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a chronic traumatic stressor, exposure to IPV is associated with negative physical and mental health consequences. The effects of IPV can occur both during times of violence and in the long-term period following violence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A meta-analysis by Golding et al. showed that suicidal ideation, substance abuse, and depression were three to five times more frequent among female victims of IPV compared with non-victimised women [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It is well documented that women affected by IPV are at high risk of developing chronic pain, neurologic disorders, gastrointestinal disorders, migraine, headaches, and other physical disabilities, as well as PTSD [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eApart from the negative psychosocial effects caused by psoriasis, poor physical functioning during the disease is comparable to those seen in patients with cancer, hypertension, and heart disease [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Several studies reported that regarding the gender-dependent differences in the quality of life, female psoriasis patients presented poorer quality of life compared to men [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It is also documented that women with emotional and physical disabilities are at higher risk of sexual assault and IPV [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. To date, there is only one study in the field of dermatology comparing the presence of IPV and sexual assault victimization in hidradenitis suppurativa and acne. This study reported that patients with hidradenitis were more exposed to IPV compared to acne showing that those with these disabilities are at higher risk of abuse [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIPV is a globally prevalent issue affecting women of all ages, ethnicities, and socioeconomic levels. Several individual risk factors have been identified for IPV including childhood exposure to abuse, history of depression, low socioeconomic status, female education less than high school level, and early age of marriage [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In our study, as we evaluated IPV exposure in female psoriasis, more than half of the patients were unpaid domestic workers and the most common (35.1%) educational status was primary school. Additionally, a history of depression was the most common psychiatric disorder in our patients. Looking at the VAWI subscales regarding IPV, 61 (45.5%) of our psoriasis patients reported exposure to psychological violence, 21 (15.7%) to physical violence, and 11 (8.2%) to sexual violence by an intimate partner. In our study, higher IPV exposure rates were recorded in all three VAWI subscales of domestic violence compared to the population-based cross-sectional studies in China [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and Sweden [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Similarly, in Sweden, L\u0026ouml;vestad et al. reported lower physical (6.6%) and sexual (2.4%) violence rates than our participants [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, in an Indian cross-sectional study, the prevalence of physical violence was found to be %31.1 which was higher than our results, while sexual violence was similar to our study [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Measuring IPV is challenging across different countries, regarding its cultural complexity and traumatic nature for the study participants and the interviewers [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Psoriasis is linked to chronic stress; IPV may deteriorate symptoms and quality of life by being a chronic stressor factor.\u003c/p\u003e \u003cp\u003eEvidence confirms that altered HPA axis activity and hypocortisolism have been identified with stress-induced conditions such as PTSD [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. PTSD may be considered as an underlying triggering factor for chronic, recurrent, and stress-reactive skin diseases [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The HPA axis maintains an optimum homeostatic state for the adaptation to environmental stimuli. Activation of the acute stress response in patients with intact HPA axes results in the secretion of glucocorticoids and catecholamines. Thus, glucocorticoids and catecholamines stimulate the differentiation of T helper (Th) cells into the Th1/Th17 phenotype, resulting in the downregulation of Th1-related cytokines. It has been shown that adequate levels of cortisol reduce the inflammation in Th1-dominant diseases such as psoriasis, moving the response towards a Th2-mediated pathway. However, in psoriasis patients who persistently experience higher levels of daily stress may lead to downregulation of the HPA axis which may result in less circulating cortisol. This dysregulation of the HPA axis results in alterations in the glucocorticoid response to stress factors thereby a decrease of the desired anti-inflammatory effect of cortisol [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are a limited number of studies that have investigated the posttraumatic stress symptoms in stress-reactive dermatoses [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Sagaltıcı et al. evaluated the psychological status of acne vulgaris patients during the COVID-19 pandemic and higher levels of PTSD symptoms were found in acne patients compared to the control group. According to this study, acne patients had significantly higher (median: 32) PCL-5 scores than the control group (median: 29.5) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Drake et al. conducted a large cross-sectional national survey on alopecia areata patients and reported that one in 3 patients met the criteria for PTSD related to their hair loss problem. In this study, the mean PCL-5 score of the patients was 48.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3 [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The lower PCL-5 scores in our study may be explained by differences in the patients' sociodemographic characteristics, as well as the possibility that they may have developed coping strategies for posttraumatic stress symptoms.\u003c/p\u003e \u003cp\u003eThe limitation of the present study is the cross-sectional and single-center design. Thus, it is not possible to reflect a causal relationship. IPV occurs with multiple disadvantages like low education, poverty, or general health issues. Selecting IPV as a main variable is challenging since diverse disadvantages overlap. On the other hand, the same reason can make IPV a usable indicator as a social determinant of health. The strengths of the study are measuring IPV with widely utilized measurements, and focusing on women with psoriasis which is an under-researched population regarding IPV.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur findings highlighted that violence against women is a common issue in psoriasis patients, and psychological IPV is the most prevalent form of IPV. Furthermore, lifetime IPV exposure was associated with higher posttraumatic stress and lower dermatological quality of life; additionally, there is a weak relationship with disease severity. Both clinicians and healthcare providers should be aware of the risk of IPV exposure in female psoriasis patients. Interventions to reduce the causes of chronic stress in psoriasis patients may be beneficial for lowering the severity of the disease. Maintaining secure intimate relationships may be a target for psychological interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIPV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Intimate partner violence\u003c/p\u003e\n\u003cp\u003eWHO\u0026nbsp;\u0026nbsp;\u0026nbsp; World Health Organization\u003c/p\u003e\n\u003cp\u003ePTSD \u0026nbsp; \u0026nbsp;Posttraumatic stress disorder\u003c/p\u003e\n\u003cp\u003eHPA\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; Hypothalamic-pituitary axis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePASI\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; Psoriasis Area Severity Index\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDLQI\u0026nbsp;\u0026nbsp;\u0026nbsp; Dermatology Life Quality Index \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVAWI \u0026nbsp;Violence Against Women Instrument\u003c/p\u003e\n\u003cp\u003ePCL-5 \u0026nbsp; Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTh \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;T helper\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInstitutional Ethics Committee approval was obtained from the Eskişehir Osmangazi University Faculty of Medicine Ethics Committee (approval number: 33, date: 07.09.2021).\u0026nbsp;Informed consent was obtained from all participants. This research was conducted ethically in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent was obtained from each participant for the publication of survey data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets generated and/or analyzed in the current study are presented in the text.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eE.A. conceptualization, design, analysis and preparation of the manuscript. I.G.Y.K. conceptualization, design, analysis and supervision. F.A. design and data collection. H.K.E. design and supervision.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePicardi A, Abeni D. Stressful life events and skin diseases: Disentangling evidence from myth. Psychother Psychosom. 2001;70:118-36.\u003c/li\u003e\n \u003cli\u003eMalhotra SK, Mehta V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria. Indian J Dermatol Venereol Leprol. 2008;74:594-9.\u003c/li\u003e\n \u003cli\u003eZhang H, Wang M, Zhao X, Wang Y, Chen X, Su J. Role of stress in skin diseases: A neuroendocrine-immune interaction view.\u0026nbsp;Brain Behav Immun. 2024;116:286-302.\u003c/li\u003e\n \u003cli\u003eTorales J, Echeverr\u0026iacute;a C, Barrios I, Garc\u0026iacute;a\u0026nbsp;\u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/?term=Garc%C3%ADa+O\u0026cauthor_id=32543743\"\u003eO,\u0026nbsp;\u003c/a\u003eO\u0026rsquo;Higgins M, Castaldelli-Maia JM, et al. Psychodermatological mechanisms of psoriasis. Dermatol Ther. 2020;33:e13827.\u003c/li\u003e\n \u003cli\u003eYang H, Zheng J. Influence of stress on the development of psoriasis. Clin Exp Dermatol. 2020;45:284-8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKyle J. Intimate Partner Violence. Med Clin North Am. 2023;107:385-95.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eO\u0026apos;Doherty L, Hegarty K, Ramsay J, Davidson LL, Feder G, Taft A. Screening women for intimate partner violence in healthcare settings. Cochrane Database Syst Rev. 2015;2015: CD007007.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWorld Health Organization, 2024. Violence Against Women. Retrieved March 25, 2024, from. https://www.who.int/news-room/fact-sheets/detail/violence-against-women.\u003c/li\u003e\n \u003cli\u003eGolding JM. Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence. 1999;14;99-132.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBuske-Kirschbaum A, Ebrecht M, Kern S, Hellhammer DH. Endocrine stress responses in TH1-mediated chronic inflammatory skin disease (psoriasis vulgaris)--do they parallel stress-induced endocrine changes in TH2-mediated inflammatory dermatoses (atopic dermatitis)? Psychoneuroendocrinology. 2006;31:439-46.\u003c/li\u003e\n \u003cli\u003eEvers AW, Verhoeven EW, Kraaimaat FW, de Jong EM, de Brouwer SJ, et al. How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol. 2010;163:986-91.\u003c/li\u003e\n \u003cli\u003eInslicht SS, Marmar CR, Neylan TC, Metzler TJ, Hart SL, Otte C, et al. Increased cortisol in women with intimate partner violence-related posttraumatic stress disorder. Psychoneuroendocrinology. 2006;3:825-38.\u003c/li\u003e\n \u003cli\u003eAlhalal E, Falatah R. Intimate partner violence and hair cortisol concentration: A biomarker for HPA axis function. Psychoneuroendocrinology. 2020;122:104897.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFredriksson T, Pettersson U. Severe psoriasis - oral therapy with a new retinoid. Dermatologica. 1978;157:238-44.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFinlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210-6.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOzt\u0026uuml;rkcan S, Ermertcan AT, Eser E, Sahin MT. Cross validation of the Turkish version of dermatology life quality index. Int J Dermatol. 2006;45:1300-7.\u003c/li\u003e\n \u003cli\u003eB\u0026uuml;lb\u0026uuml;l Başkan E. Determining disease severity. Turkderm-Turk Arch Dermatol Venereol. 2022;56(Suppl 1):3-5.\u003c/li\u003e\n \u003cli\u003eEllsberg M, Heise L. Researching Violence Against Women: A Practical Guide for Researchers and Activists. Washington DC, United States: World Health Organization, PATH; 2005.\u003c/li\u003e\n \u003cli\u003eHacettepe University Institute of Population Studies. T\u0026uuml;rkiye\u0026apos;de Kadına Y\u0026ouml;nelik Aile İ\u0026ccedil;i Şiddet Araştırması, Ankara: Elma Teknik Basım Matbaacılık, 2015.\u003c/li\u003e\n \u003cli\u003eNybergh L, Taft C, Krantz G. Psychometric properties of the WHO Violence Against Women instrument in a female population-based sample in Sweden: a cross-sectional survey. BMJ Open. 2013;3:e002053.\u003c/li\u003e\n \u003cli\u003eBoysan M, Guzel Ozdemir P, Ozdemir O, Selvi Y, Yilmaz E, Kaya N. Psychometric properties of the Turkish version of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, (PCL-5). Psychiatry and Clinical Psychopharmacology. 2017;27:300-10.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBlevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. \u0026nbsp;The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. 2015;28:489-98.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSimonić E, Ka\u0026scaron;telan M, Peternel S, Pernar M, Brajac I, Rončević-Gržeta I, et al. Childhood and adulthood traumatic experiences in patients with psoriasis. J Dermatol. 2010;37:793-800.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eManolache L, Petrescu-Seceleanu D, Benea V. Life events involvement in psoriasis onset/recurrence. Int J Dermatol. 2010;49:636-41.\u003c/li\u003e\n \u003cli\u003eStubbs A, Szoeke C. The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. Trauma Violence Abuse. 2022;23:1157-72.\u003c/li\u003e\n \u003cli\u003eRapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41:401-7.\u003c/li\u003e\n \u003cli\u003eObradors M, Blanch C, Comellas M, Figueras M, Lizan L. Health-related quality of life in patients with psoriasis: a systematic review of the European literature. Qual Life Res. 2016; 25:2739-54.\u003c/li\u003e\n \u003cli\u003eNapolitano M, Mastroeni S, Fania L, Pallotta S, Fusari R, Uras C, et al. Sex and gender-associated clinical and psychosocial characteristics of patients with psoriasis. Clin Exp Dermatol. 2020;45:705-11.\u003c/li\u003e\n \u003cli\u003eBrownridge DA. Partner violence against women with disabilities: prevalence, risk, and explanations. Violence Against Women. 2006;12:805-22.\u003c/li\u003e\n \u003cli\u003eSisic M, Tan J, Lafreniere KD. Hidradenitis Suppurativa, Intimate Partner Violence, and Sexual Assault. J Cutan Med Surg. 2017;21:383-87.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYakubovich AR, St\u0026ouml;ckl H, Murray J, Melendez-Torres GJ, Steinert JI, Glavin CEY, et al. Risk and Protective Factors for Intimate Partner Violence Against Women: Systematic Review and Meta-analyses of Prospective-Longitudinal Studies. Am J Public Health. 2018; 108: e1-e11.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChang X, Yang Y, Li R. The characteristics of husbands and violence against women in Wuhan, China: a cross-sectional study. BMC Women\u0026rsquo;s Health 2022;22:73.\u003c/li\u003e\n \u003cli\u003eNybergh L, Taft C, Enander V, Krantz G. Self-reported exposure to intimate partner violence among women and men in Sweden: results from a population-based survey. BMC Public Health. 2013;13:845.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eL\u0026ouml;vestad S, L\u0026ouml;ve J, Vaez M, Krantz G. Prevalence of intimate partner violence and its association with symptoms of depression; a cross-sectional study based on a female population sample in Sweden. BMC Public Health. 2017;17:335.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eArumugaperumal R, Ravichandhiran G, Agadi S, Muthuchamy V, D R, S S, et al. Evaluation of Intimate Partner Violence and Its Association With Depression Among Women in Chengalpattu District, India: A Cross-Sectional Study. Cureus. 2024;16:e59825.\u003c/li\u003e\n \u003cli\u003eHeim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25:1-35.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRaison CL, Miller AH. When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 2003;160: 1554-65.\u003c/li\u003e\n \u003cli\u003eSagaltici E, Tas B. Mental health and psychological resilience among acne vulgaris patients during the pandemic: A cross-sectional controlled study. J Cosmet Dermatol. 2021;20: 3739-46.\u003c/li\u003e\n \u003cli\u003eKwon CW, Fried RG, Nousari Y, Ritchlin C, Tausk F. Psoriasis: Psychosomatic, somatopsychic, or both? Clin Dermatol 2018;36:698-703.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDrake L, Li SJ, Reyes-Hadsall S, Lee K, Huang K, Mostaghimi A. Post-Traumatic Stress Disorder in Patients with Alopecia Areata: A Survey Study in the USA. Skin Appendage Disord. 2023;9:342-5. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Psoriasis, women, intimate partner violence, post-traumatic stress disorder, quality of life","lastPublishedDoi":"10.21203/rs.3.rs-6975817/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6975817/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Intimate partner violence (IPV) exposure is a chronic stressful condition that prevalently affects women's health and quality of life. As a chronic stressor factor, the presence of IPV and related posttraumatic stress have never been examined in psoriasis patients. The present study aims to evaluate the prevalence of emotional, physical and sexual IPV exposure, posttraumatic stress symptoms and quality of life among female psoriasis patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This cross-sectional study was conducted on 134 female psoriasis patients. The disease severity was assessed with the Psoriasis Area Severity Index (PASI) by a dermatologist. Patients were asked to complete the Dermatology Life Quality Index (DLQI), the Violence Against Women Instrument (VAWI), and the Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Sixty-two patients (46.3%) were exposed to at least one type of IPV and psychological IPV (45.5%) was the most prevalent form of IPV. Patients with lifetime IPV exposure had worse dermatological quality of life (U=1545.00, p=0.004) and higher posttraumatic stress symptoms (U=1272.00, p\u0026lt;0.001). Posttraumatic stress of IPV was related to higher PASI (ρ=0.184, p=0.047) and higher DLQI scores (ρ=0.654, p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eIPV exposure is a common stressor that influences the psychological health of female psoriasis patients. Lifetime IPV exposure is associated with lower dermatological quality of life and higher posttraumatic stress. Acknowledging IPV-related chronic stress in patients with psoriasis may help increase quality of life. Healthcare providers should be aware of IPV and prevent the deleterious effects of violence on this vulnerable group of women.\u003c/p\u003e","manuscriptTitle":"Intimate partner violence exposure, posttraumatic stress and quality of life among women with psoriasis: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-07 08:24:54","doi":"10.21203/rs.3.rs-6975817/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-28T08:49:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T21:18:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73266675282925489696336493237785707172","date":"2025-10-20T13:26:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73266675282925489696336493237785707172","date":"2025-10-06T12:12:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206297367354428780538443520087106908202","date":"2025-09-24T10:05:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-03T15:23:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146845704801965296744775084803198900865","date":"2025-07-03T13:03:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-03T09:52:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-26T10:17:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-25T23:36:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-25T23:35:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-06-25T14:23:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e42fd494-81a6-4c5f-bb71-4696c6d80182","owner":[],"postedDate":"July 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:03:25+00:00","versionOfRecord":{"articleIdentity":"rs-6975817","link":"https://doi.org/10.1186/s12905-025-04170-8","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-11-28 15:58:08","publishedOnDateReadable":"November 28th, 2025"},"versionCreatedAt":"2025-07-07 08:24:54","video":"","vorDoi":"10.1186/s12905-025-04170-8","vorDoiUrl":"https://doi.org/10.1186/s12905-025-04170-8","workflowStages":[]},"version":"v1","identity":"rs-6975817","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6975817","identity":"rs-6975817","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}