Social avoidance and distress in eczema patients based on a health ecology model: a cross-sectional survey study

Social avoidance and distress in eczema patients based on a health ecology model: a cross-sectional survey 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 Social avoidance and distress in eczema patients based on a health ecology model: a cross-sectional survey study Na Cai, Tao Guo, Yue Zhu, Jiaxing Li, Junchen He, Yubin Liu, Zhangyi Wang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7811981/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Patients with eczema often experience profound stigma, low self-esteem, and anxiety due to lesions appearing on exposed areas, leading to social avoidance behaviours and significant distress. This severely impacts overall quality of life. Methods: A convenience sampling method was employed to survey eczema patients across eight grade A tertiary hospitals in China. A questionnaire survey was administered using general information questionnaire, the Social Avoidance and Distress Scale, the Perceived Social Support Scale, the Social Impact Scale, the sense of personal mastery scale , and the Comprehensive Score for Economic Toxicity. Descriptive statistics, mean differences, one-way analysis of variance, correlation analysis, and multiple linear regression analysis were employed to identify relevant influencing factors. Results: Patients with eczema scored (19.00±7.04) on social avoidance and distress. Multivariate linear regression analysis revealed that gender, educational attainment, average monthly household income, perceived social support, stigma, sense of personal mastery, and economic toxicity, when included in the regression equation, explained 86. 1% of the total variance. Conclusion: Patients with eczema experience social avoidance and distress at a moderately high level. Factors influencing social avoidance and distress include gender, educational attainment, average monthly household income, perceived social support, stigma, sense of personal control, and economic toxicity. Clinical trial number: Not applicable. eczema social avoidance and distress perceived social support stigma associated with illness sense of personal control economic toxicity influencing factors health ecology model Figures Figure 1 Figure 2 1 | Background Eczema is an inflammatory, allergic skin condition characterised primarily by recurrent itching and symmetrically distributed polymorphic lesions, with clinical features including a tendency towards moistness, recurrent episodes, and a propensity for chronicity(Chan & Zug, 2021 ). A 15-year cohort study indicates that one in ten German adolescents suffers from hand eczema(Wang et al., 2022 ). German research indicates that the annual incidence of hand eczema ranges from 0.24% to 9.2%, with lifetime prevalence estimated at 2.6% to 16.0%. Eczema can occur across different age groups and ethnicities, representing one of the primary contributors to the global burden of skin diseases(Langan & Weidinger, 2020). Eczema frequently causes disfiguring changes in appearance, presenting as thickened erythema, lichenification, scaling, and intense itching. It commonly occurs on the hands, face, scalp, limbs, trunk, and perineal region(Zuberbier et al., 2023 ). Patients frequently encounter prejudice and discrimination in their professional and social lives due to changes in their skin's appearance. This leads to feelings of low mood, frustration, loneliness, and inferiority, and mayeven foster hostile emotions. The persistent itching disrupts sleep quality, imposing a psychological burden that exacerbates patients' mental distress and impairs their daily work and life(Dalgard et al., 2015 ). Research has demonstrated that individuals with eczema exhibit significantly higher levels of anxiety and depression compared to the general population, thereby giving rise to various psychological issues(Kage & Treudler, 2020). The itching symptoms caused by eczema can lead to sleep disturbances, affecting daily life and work, and further contributing to a decline in quality of life(Al-Naqeeb et al., 2019 ). Certain chronic skin conditions such as psoriasis have now been categorised as psychosomatic disorders, Moreover, research indicates that individuals with eczema exhibit significantly higher rates of anxiety and depression, yet these conditions are often overlooked and fail to receive timely diagnosis. These psychological symptoms, in turn, exacerbate the physical condition, creating a vicious cycle(Silverberg et al., 2019 ; Tang et al., 2022 ). Therefore, as one of the most common skin conditions, eczema and the psychological distress arising from its burden should not be overlooked; clinical practitioners must give due consideration to this in their diagnostic and therapeutic work. With the continuous development of the biopsychosocial medical model, increasing attention is being paid to the physical and psychological development of individuals. Humans are not merely “biological beings”, but also “psychological beings” and “social beings”. The reintegration of patients into society following illness holds significant importance. Social avoidance and distress, as major obstacles to patients' societal return, are receiving increasing attention within the medical field. Social avoidance and distress refer to the tendency to evade social interactions and the accompanying feelings of distress experienced by individuals. This manifests as behavioural patterns and emotional responses where individuals withdraw from social situations to avoid negative evaluations from others(Toth & Neumann, 2013 ). Social avoidance and distress can severely impair patients' quality of life and interpersonal relationships, preventing them from effectively integrating into society(Rodebaugh, Lim, Shumaker, Levinson, & Thompson, 2015 ). Concurrently, patients' social avoidance behaviours frequently exacerbate their depression, feelings of inferiority, and distress, exerting a profoundly detrimental impact on their physical recovery, treatment efficacy, and even disease prognosis. This leads to heightened relapse risks and mortality rates, imposing a significant economic and healthcare burden upon families and society(Kroenke et al., 2017 ). Research indicates that patients with conditions such as psoriasis(Lahousen et al., 2016 )and lung cancer(Yuan et al., 2024 )experience social avoidance and distress. Eczema patients exhibit disfiguring clinical manifestations on the skin, with the appearance of crusting and lichenification on exposed areas significantly impacting their appearance. This can lead to severe negative consequences for social interactions and daily life(Santuzzi, 2011 ). Therefore, enhancing the social engagement of eczema patients is crucial for disease recovery, improving quality of life, and reintegrating into social life. However, research on social avoidance and distress among eczema patients remains scarce both domestically and internationally. Perceived social support refers to the psychological experience of receiving assistance from friends, family, and society, alongside feeling respected and understood. This can create an environment for trauma survivors to share their emotions and energy, helping them generate the motivation to actively confront stressful events and thereby influencing their coping strategies(Kuang et al., 2022 ). Research indicates that individuals who perceive high levels of social support are more likely to interpret others' arbitrary behaviours as supportive. This can motivate individuals to actively seek social opportunities and proactively address social issues, thereby reducing their own social avoidance and distress. If patients become self-isolated and unable to seek effective social support, they are highly likely to bear increasing pressure, leading to the emergence of negative psychological states. This further facilitates the development of a closed mindset, resulting in social avoidance and distress(BrissetteScheier & Carver, 2002). However, among individuals with eczema, the relationship between perceived social support and social avoidance on the one hand, and distress on the other, remains unclear. Stigma refers to the experience of shame felt by patients who suffer discrimination and alienation from others due to their illness(Malone et al., 2025 ). Research on disease-related stigma has primarily focused on conditions such as infectious diseases and cancer that cause alterations in physical appearance and bodily impairment(Chen, Xu, Nian, Pan, & Jiang, 2025 ). Stigma surrounding illness exerts a detrimental effect on patients' psychological state, not only diminishing their self-esteem and hope for recovery but also heightening avoidance of treatment and suicide risk. This consequently impacts social relationships and exacerbates disease symptoms(Whittle et al., 2017 ). Research indicates that patients with high stigma become extremely sensitive to people and situations around them due to alterations in their physical appearance. They frequently exaggerate others' words and actions in social interactions, exhibiting excessive psychological reactivity. Such perceptions lead patients to avoid crowds whenever possible, resulting in social difficulties(Zhao, Huangfu, Li, Liu, & Tang, 2022 ). However, the stigma associated with eczema has not received sufficient attention among sufferers, and the relationship between this stigma and social avoidance and distress among eczema patients remains unclear. Sense of personal control refers to an individual's capacity to adapt to and manage changes in their living environment, serving as a positive factor in predicting self-management and quality of life in chronic diseases(Hobfoll, 2001 ; Mühlberger, Angus, Jonas, Harmon-Jones, & Harmon-Jones, 2017 ). Research indicates that the higher an individual's sense of personal mastery, the more likely they are to adopt proactive health management behaviours and maintain favourable physical and mental states. This enables them to participate in social life with composure and adapt to societal roles(O'Kearney et al., 2020 ). It is evident that enhancing patients' sense of personal control can alleviate negative emotions, promote the adoption of positive coping strategies, facilitate better social functioning, and reduce social avoidance and distress. However, research into sense of personal mastery among chronic disease patients remains in its infancy both domestically and internationally. Few scholars have examined this phenomenon specifically in eczema patients, and the relationship between sense of personal mastery and social avoidance and distress in eczema patients warrants further investigation. Economic toxicity refers to the substantial costs associated with disease diagnosis and treatment, analogous to physical toxicity, which impose a significant objective financial burden and subjective economic distress upon patients and their carers(Zafar & Abernethy, 2013 ). Multiple studies indicate that households with eczema sufferers incur long-term expenses for outpatient consultations, diagnostic tests, topical and oral medications, hospital admissions, and costly functional skincare products. Concurrently, the financial strain is compounded by the ongoing expenditure arising from frequent medical appointments, including associated travel and time costs, income losses due to reduced work efficiency or missed workdays, and the opportunity costs incurred when parents of paediatric patients must reduce working hours or resign entirely to provide care. This persistent expenditure represents a significant and enduring financial challenge for many households, where economic burdens intertwine with health burdens, severely impacting quality of life(Elezbawy et al., 2023 ; Elezbawy et al., 2025 ). Financial pressures may lead patients to avoid social engagements or seeking support, exacerbating feelings of social isolation and subsequently resulting in social avoidance and distress(Dalgard et al., 2015 ). However, the issue of economic toxicity among eczema sufferers has not received sufficient attention, and the relationship between economic toxicity and social avoidance and distress remains largely unknown. To date, few studies have examined social avoidance and distress among eczema patients, with even fewer investigating the impact of perceived social support, stigma, sense of personal mastery, and economic toxicity on these outcomes. Therefore, this study employs a cross-sectional survey grounded in the health ecology model to systematically evaluate the current state of social avoidance and distress among eczema patients and analyse its influencing factors. This provides a reference for healthcare professionals in developing intervention programmes to alleviate social avoidance and distress in eczema patients. 2 | Design and method 2.1 | Theoretical basis The health ecology model emphasises that individual health arises from the reciprocal influence and interaction between personal and environmental factors. This model presents a comprehensive framework organised from the innermost to the outermost layers: individual innate characteristics, psychological behaviours and lifestyle, family and social networks, living and working conditions, and policy environment(Guo et al., 2023 ). This study employs the health ecology model to conduct a multidimensional systematic classification and comprehensive summary of the factors influencing social avoidance and distress among eczema patients. This aims to effectively identify influencing factors, thereby providing a basis for formulating corresponding intervention measures. The health ecology model is illustrated in Fig. 1 . Based on the health ecology model, following a literature review and group discussions, the following factors were ultimately identified as potentially influencing social avoidance and distress among eczema patients: (1) Individual innate characteristics: gender, age, presence of other chronic conditions, eczema type, affected body areas, presence of pruritus, current flare-up status, disease duration; (2) Psychological and behavioural patterns: exercise habits, stigma associated with the condition, perceived personal control; (3) Family and community networks: marital status, living arrangements, perceived social support; (4) Living and working environment: educational attainment, average monthly household income, place of residence, current occupational status; (5) Policy factors: healthcare payment methods, economic toxicity. The hypothesised model for this study is illustrated in Fig. 2 . 2.2 | Research design and objectives This study employs a descriptive and cross-sectional research design to investigate the current state of social avoidance and distress among individuals with eczema, along with its influencing factors, thereby providing a theoretical basis for clinical decision-making. To ensure a thorough and complete reporting of the research, we have adopted the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies(Von Elm et al., 2007 ). 2.3 | Research objects Between January and August 2025, eczema patients from eight Grade A tertiary hospitals in mainland China were selected using convenience sampling. Inclusion criteria were: (1) aged ≥ 18 years; (2) Diagnosed with eczema for over one month; (3) Able to respond correctly, answer questions independently or with researcher assistance, and complete the questionnaire; (4) Informed and voluntarily participating in this study. Exclusion criteria: (1) Severe cognitive or psychiatric impairment; (2) Concurrent severe comorbid conditions. According to the requirements of multi-factor analysis, the medium effect f 2 =0. 15, the two sides of the test level α = 0. 05, the test efficiency 1-β = 0. 90, 13 independent variables, and the required sample size is 162 cases. This study finally collected 323valid questionnaires, sufficient statistical power is ensured. 2.4 | Measures 2.4.1 | General information questionnaire To control for potential confounding factors, 15 general characteristics were included based on a literature review: gender, age, marital status, place of residence, housing conditions, educational attainment, method of payment for medical treatment, occupational status, type of eczema, and duration of illness. 2.4.2 | Social Avoidance and Distress Scale (SAD) The Social Avoidance and Distress Scale, developed by Waston et al. (Watson & Friend, 1969 ) in 1969 and revised by Wang Xiangdong et al. (Ma, 1999)in 1999, comprises two dimensions: social avoidance and social distress. It consists of 28 items scored using a yes/no format, with “yes” responses receiving 1 point and “no” responses receiving 0 points. Items 1, 3, 4, 6, 7, 9, 12, 15, 17, 19, 22, 25, 27, and 28 are reverse-scored. The scale ranges from 0 to 28 points, with higher scores indicating greater severity of social avoidance and distress. The Cronbach’α coefficient for this scale in the present study was 0.910. 2.4.3 | Perceived Social Support Scale(PSSS) Developed by Zimet et al. (Zimet, Powell, Farley, Werkman, & Berkoff, 1990 )in 1988 and translated and revised by Jiang, Qianjin et al.(Jiang, 2001 )in 1999, this instrument measures perceived levels of social support across diverse populations. It comprises three dimensions: family support, friend support, and other support, each containing four items, totalling twelve items. A seven-point scoring method is employed, with scores ranging from 1 (strongly disagree) to 7 (strongly agree). The total score ranges from 12 to 84 points, with higher scores indicating greater perceived social support. The Cronbach's α coefficient for this scale in the present study was 0.977. 2.4.4 | Social Impact Scale(SIS) Developed by Fife et al. (Fife & Wright, 2000 ) and adapted into Chinese by Pan et al. (Pan, Chung, Fife, & Hsiung, 2007 ), this instrument assesses the levels of internal and external rejection and shame experienced by patients or relevant individuals due to enduring a particular illness. It comprises four dimensions: social exclusion (9 items), economic discrimination (3 items), internal shame (5 items), and social isolation (7 items), totalling 24 items. A four-point rating scale is employed, with scores ranging from 1 (strongly disagree) to 4 (strongly agree), yielding a total score between 24 and 96 points. Higher scores indicate greater perceived social impact and stronger stigma. The Cronbach's α coefficient for this scale in the present study was 0.982. 2.4.5 | Personal Mastery scale(PMS) This scale was developed by foreign scholars including Pearlin et al. (Pearlin & Schooler, 1978 )and adapted into Chinese by Yu Yibing et al. (Yu and Zou, 2008) to measure individuals' perceived control over the outcomes of events they experience. The scale comprises seven items rated on a five-point Likert scale, ranging from “strongly disagree” (1) to “strongly agree” (5). Total scores range from 7 to 35, with higher scores indicating greater perceived control over life events. The Cronbach's α coefficient for this scale in the present study was 0.905. 2.4.6 | Comprehensive Score for Financial Toxicity(COST) This scale was developed by Souza et al. (de Souza et al., 2014 )and adapted for Chinese use by Yu Huihui et al. (Yu et al., 2021 ). It comprises two dimensions with 11 items in total: positive wealth status (4 items) and negative psychological reactions (7 items). It employs a 5-point Likert scale, with scores ranging from 0 to 4 corresponding to responses from ‘Never’ to ‘Almost always’. The total score ranges from 0 to 44 points, with lower scores indicating more severe economic toxicity in patients. A score ≥ 26 indicates no impact on quality of life (Grade 0); 14–25 denotes mild impact (Grade 1); 1–13 signifies moderate impact (Grade 2); and 0 represents severe impact (Grade 3). Grade 1 or above is defined as the presence of economic toxicity. The Cronbach's α coefficient for this scale in the present study was 0.932. 2.5 | Data Collection Prior to the investigation, consent was obtained from the management of a Grade A tertiary hospital. Between January and August 2025, questionnaires were distributed to eczema patients meeting inclusion and exclusion criteria via the Wenjuanxing online platform (Hunan Blue Star Information Technology Co., Ltd., Changsha, China). Standardised instructions explained the study's purpose, significance, and questionnaire completion method. Participants were informed they could withdraw at any time without repercussions, that participation was entirely voluntary, and that they would complete the questionnaire anonymously and independently based on informed consent. 2.6 | Quality Control (1) All questions are mandatory; incomplete submissions will not be accepted; (2) Each IP address may submit only once; (3) Questionnaires were excluded if completed in under 3 minutes, contained obvious contradictions between responses, or featured significant inconsistencies in personal details. This survey yielded 331 completed questionnaires. After excluding 8 non-compliant responses, 323 valid questionnaires were retained, representing an effective recovery rate of 97.58%. 2.7 | Statistical analysis In the quantitative analysis phase of this study, all data were analysed using SPSS 21.0 (IBM Corporation, Armonk, NY, USA). Count data were described using frequencies and percentages; continuous data meeting normal distribution were described using mean ± standard deviation; intergroup comparisons employed independent samples t-tests or one-way analysis of variance; Pearson correlation analysis was employed to explore associations between social avoidance and distress and perceived social support, stigma, sense of personal mastery, and economic toxicity. Multivariate linear regression analysis examined factors influencing social avoidance and distress, with P < 0.05 indicating statistical significance. 2.8 | Ethical Considerations This study has been approved by the Medical Ethics Committee of the Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine. All participants signed informed consent forms. The research strictly adhered to the principles of the Declaration of Helsinki, ensuring subjects enjoyed full rights and privacy protection throughout the study. All participants voluntarily signed informed consent forms to participate and retained the right to withdraw at any stage. The study strictly adhered to principles of anonymity and confidentiality. All questionnaires excluded sensitive information such as names or national identification numbers, employing only numerical identifiers. Researchers underwent specialised training and strictly observed confidentiality requirements, implementing data management measures to prevent disclosure of participant information. 3 | Results 3.1 | Scores of social avoidance and distress, perceived social support, stigma, sense of personal mastery and economic toxicity In this study, the total score for social avoidance and distress among 323 eczema patients was (19.00 ± 7.04). Across the two dimensions, the highest mean item score was observed in the social avoidance dimension (0.77 ± 0.42), while the lowest was in the social distress dimension (0.75 ± 0.43). The total score for perceived social support was (44.78 ± 21.26). Among the three dimensions, the highest mean score was for the family support dimension (3.92 ± 1.73), while the lowest was for the friend support dimension (3.76 ± 1.83). The total score for stigma was (71.79 ± 17.48). Among the four dimensions, the highest mean item scores were observed in the social exclusion dimension (3.00 ± 0.76) and the social isolation dimension (3.00 ± 0.79), while the lowest was in the economic discrimination dimension (2.91 ± 0.81). The total score for sense of personal mastery was (17.60 ± 7.20). The total score for economic toxicity was (13.77 ± 9.77). Among the two dimensions, the highest mean item score was observed in the negative psychological reactions dimension (1.31 ± 0.96), while the lowest was in the positive wealth status dimension (1.15 ± 0.83). See Table 1 for details. Table 1 Scores of social avoidance and distress, perceived social support, stigma, sense of personal mastery and economic toxicity(N = 323, (mean ± SD) ) Item Dimensional score Average of entries Ranking Social avoidance and distress total score 19.00 ± 7.04 0.76 ± 0.43 — Social avoidance 9.67 ± 3.66 0.77 ± 0.42 1 Social anxiety 9.33 ± 3.66 0.75 ± 0.43 2 Perceived social support 44.78 ± 21.26 3.72 ± 1.79 — Family support 15.12 ± 7.23 3.92 ± 1.73 1 Friends support 14.85 ± 7.31 3.76 ± 1.83 3 Other Support 14.81 ± 7.23 3.77 ± 1.84 2 Stigma 71.79 ± 17.48 2.99 ± 0.73 — Sense of social exclusion 27.01 ± 6.86 3.00 ± 0.76 1 Economic discrimination 8.73 ± 2.42 2.91 ± 0.81 3 Inner sense of shame 14.81 ± 3.99 2.96 ± 0.80 2 Social isolation 20.99 ± 5.54 3.00 ± 0.79 1 Sense of personal mastery 17.60 ± 7.20 2.51 ± 1.03 — Economic toxicity 13.77 ± 9.77 1.25 ± 0.89 — Positive wealth status 4.61 ± 3.32 1.15 ± 0.83 2 Negative psychological reactions 9.17 ± 6.71 1.31 ± 0.96 1 3.2 | Sociodemographic characteristics and the scores of social avoidance and distress in patients with eczema Comparing social avoidance and distress among eczema patients with differing characteristics, the analysis revealed statistically significant differences ( P < 0.05) in total scores for social avoidance and distress across patients varying by gender, educational attainment, monthly income, eczema type, and disease duration. See Table 2 for details. Table 2 Sociodemographic characteristics and the scores of social avoidance and distress in patients with eczema (N = 323). Variables n % Social avoidance and distress (mean ± SD) t/F value P value Gender 5.729 <0.001 Male 138 42.7 16.52 ± 6.96 Female 185 57.3 20.85 ± 6.53 Age, years 0.506 0.603 <35 139 43.0 18.65 ± 7.31 35ཞ<60 130 40.2 19.05 ± 6.83 ≥ 60 54 16.7 19.78 ± 6.88 Marital status 0.093 0.964 Married 177 54.8 18.99 ± 6.98 Unmarried 120 37.2 18.96 ± 7.14 Divorced or separated 16 5.0 18.69 ± 7.48 Widowed 10 3.1 20.10 ± 7.19 Educational attainment 310.665 <0.001 Primary school and below 74 22.9 26.73 ± 1.17 Lower secondary school 55 17.0 26.64 ± 1.39 Upper secondary school 66 20.4 13.88 ± 3.96 College diploma 79 24.5 13.94 ± 3.94 Bachelor's degree and above 49 15.2 13.82 ± 4.12 Place of residence 0.281 0.779 Town/city 261 80.8 19.05 ± 6.93 Rural area 62 19.2 18.77 ± 7.53 Living arrangements 0.641 0.522 Living alone 95 29.4 19.39 ± 6.89 Not living alone 228 70.6 18.84 ± 7.11 Average monthly household income, yuan 168.224 <0.001 <3000 60 18.6 24.03 ± 4.80 3000ཞ<5000 94 29.1 25.09 ± 4.31 5000ཞ<8000 119 36.8 14.62 ± 4.23 ≥ 8000 50 15.5 11.94 ± 4.46 Methods of Payment for Medical Treatment 1.423 0.226 Urban Employee Medical Insurance 221 68.4 18.56 ± 7.02 Rural Cooperative Medical Scheme 52 16.1 20.73 ± 6.93 Self-funded 24 7.4 17.83 ± 7.11 Private Health Insurance 7 2.2 19.86 ± 8.53 Other 19 5.9 20.53 ± 6.62 Exercise habits 1.110 0.331 Regular exercise 112 34.7 18.44 ± 6.41 Irregular exercise 140 43.3 19.66 ± 7.21 No exercise 71 22.0 18.58 ± 7.61 Current employment status 0.571 0.568 In employment 177 54.8 19.20 ± 7.01 Not in employment 146 45.2 18.75 ± 7.09 Whether have any other chronic conditions -0.104 0.917 Yes 228 70.6 18.97 ± 6.23 No 95 29.4 19.06 ± 8.72 Type of eczema 9.198 <0.001 Acute 107 33.1 18.85 ± 6.69 Chronic 168 52.0 20.14 ± 7.19 Subacute 48 14.9 15.33 ± 6.04 Current Episode 0.190 0.850 First Episode 171 52.9 19.07 ± 6.79 Recurrence 152 47.1 18.92 ± 7.33 Duration, years 8.595 <0.001 <6 months 149 46.1 18.01 ± 6.71 6 months to <1 year 116 35.9 21.73 ± 7.09 1 year to <5 years 36 11.1 16.80 ± 6.13 5 years to <10 years 9 2.8 15.22 ± 5.04 ≥ 10 years 13 4.0 14.69 ± 5.96 Note: SD, standard deviation. 3.3 | The correlation between social avoidance and distress, perceived social support, stigma, sense of personal mastery and economic toxicity Analysis revealed that social avoidance and distress among eczema patients were negatively correlated with both the total score and individual dimension scores of perceived social support ( r =-0.809 to -0.881, P < 0.01); Social avoidance and distress showed positive correlations with both the total score and individual dimension scores of stigma ( r = 0.638–0.711, P < 0.01); Social avoidance and distress showed negative correlations with both the total score and individual dimension scores of sense of personal mastery ( r = -0.789 to -0.823, P < 0.01); Social avoidance and distress were negatively correlated with the total score and all subscale scores of economic toxicity ( r = -0.687 to -0.779, P < 0.01). See Table 3 for details. Table 3 The correlation between social avoidance and distress, perceived social support, stigma, sense of personal mastery and economic toxicity (N = 351, r ) Item The social avoidance and distress total score Social avoidance Social anxiety Perceived social support -0.881** -0.834** -0.860** Family support -0.855** -0.814** -0.829** Friends support -0.857** -0.809** -0.837** Other Support -0.872** -0.822** -0.853** Stigma 0.711** 0.682** 0.685** Sense of social exclusion 0.673** 0.648** 0.644** Economic discrimination 0.685** 0.656** 0.661** Inner sense of shame 0.692** 0.644** 0.685** Social isolation 0.679** 0.638** 0.666** Sense of personal mastery -0.823** -0.792** -0.789** Economic toxicity -0.779** -0.734** -0.763** Positive wealth status -0.726** -0.687** -0.708** Negative psychological reactions -0.776** -0.729** -0.761** Note: ** p <0.01 3.4 | Multiple linear regression analysis of influencing factors of social avoidance and distress in patients with eczema Multivariate linear regression analysis was conducted, employing the total scores for social avoidance and distress among eczema patients as the dependent variable, and variables demonstrating statistical significance in univariate and correlation analyses as independent variables. The specific coding methods for independent variables are detailed in Table 4 . Results indicated that gender, educational attainment, monthly income, perceived social support, stigma, sense of personal mastery, and economic toxicity were the primary factors influencing exercise avoidance among eczema patients ( P < 0.05), explaining 86.1% of the total variance. See Table 5 . Table 4 Description table of virtual variable assignment (N = 323) Variable Assignment mode Gender Male = 0, female = 1 Educational attainment Primary school and below = 1,Lower secondary school = 2,Upper secondary schoo = 3,College diploma = 4,Bachelor's degree and above = 5 Average monthly household income, yuan <3000 = 1, 3000ཞ<5000 = 2,5000ཞ<8000 = 3,≥8000 = 4 Type of eczema Taking "Infectious skin disease" as the reference object, the autoimmune skin disease =(0, 1, 0), and allergic skin disease =(0, 0, 1). Duration, years <6 months = 1, 6 months to <1 year = 2, 1 year to <5 years = 3, 5 years to <10 years = 4,and ≥ 10 years = 5 Perceived social support Original value entry Stigma Original value entry Sense of personal mastery Original value entry Economic toxicity Original value entry Table 5 Multiple linear regression analysis of influencing factors of social avoidance and distress in patients with eczema (N = 323) Variable B SE β t- value p- value Tolerance VIF Constant 27.656 1.292 — 21.410 <0.001 — — Gender 1.262 0.308 0.089 4.095 <0.001 0.919 1.088 Educational attainment -0.619 0.187 -0.122 -3.302 <0.001 0.315 3.178 Average monthly household income, yuan -1.140 0.206 -0.157 -5.537 <0.001 0.541 1.848 Type of eczema Chronic -0.274 0.354 -0.019 -0.775 0.439 0.685 1.46 Subacute -0.178 0.466 -0.009 -0.383 0.702 0.777 1.287 Duration, years 0.024 0.164 0.003 0.145 0.885 0.779 1.283 Perceived social support -0.100 0.017 -0.303 -6.071 <0.001 0.174 5.751 Stigma 0.075 0.011 0.185 6.499 <0.001 0.532 1.88 Sense of personal mastery -0.176 0.039 -0.18 -4.478 <0.001 0.268 3.735 Economic toxicity -0.081 0.027 -0.112 -3.035 0.003 0.316 3.17 Note: R = 0.930 a , R² =0.865, adjusted R² =0.861, F = 199.992, P <0.01 4 | Discussion 4.1 | 323 eczema sufferers experience significant social avoidance and distress The findings of this study indicate that the total scores for social avoidance and distress among 323 eczema patients were (19.00 ± 7.04) points, with an average score per item of (0.76 ± 0.43) points. Overall, these scores were at a relatively high level, slightly exceeding the results reported by Yuan et al. (Yuan et al., 2024 )in their study of lung cancer patients. The reasons for this may be analysed as follows: compared to cancer, eczema is a visible, unavoidable skin condition. Skin lesions, erythema, and scaling readily provoke discomfort, questions, or even discrimination from onlookers. This leads patients to experience intense appearance anxiety and stigmatisation in social settings, directly driving social avoidance and distress. Social avoidance and distress among eczema patients encompass two dimensions: social avoidance and social distress. Scores on the social avoidance dimension consistently exceed those on the social distress dimension, indicating that more patients opt to avoid social engagements altogether rather than endure distress and tension during interactions. Possible reasons for this may include: (1) Eczema sufferers experience intense anticipatory anxiety before engaging in social interactions. To protect themselves, they often choose to avoid social situations altogether to prevent this anticipated anxiety from arising, resulting in a higher behavioural tendency towards avoidance(Dalgard et al., 2020 ); (2) The management of skin conditions consumes considerable psychological and emotional energy, leading to emotional exhaustion. According to resource conservation theory, individuals strive to protect and avoid depleting their finite resources. For patients experiencing both physical and mental fatigue, social engagements represent an activity that is particularly taxing on psychological resources. Consequently, they are more inclined to conserve energy by choosing to avoid such activities, resulting in higher avoidance behaviour scores(Hobfoll, 2001 ); (3) Some patients may indeed have experienced negative social incidents in the past due to their skin condition, developing a psychological state of ‘learned helplessness’ and consequently choosing to avoid social situations(Schmid-Ott, Jaeger, Kuensebeck, Ott, & Lamprecht, 1996 ). Based on the above, clinical healthcare professionals are advised to incorporate screening for social avoidance and distress into routine care to identify high-risk patients early. Through role-play and other methods, practise navigating potentially awkward scenarios, shifting the focus of intervention to manage anticipatory anxiety. Adopt a resource-conservation approach, recognising patients' emotional and energy depletion, and provide supportive, empowering care. Collaborate with patients to develop simple, efficient, and sustainable personalised treatment and care plans to minimise resource expenditure in disease management. Proactively provide information on peer support groups and psychological counselling to supplement social and psychological resources. For patients with chronic social avoidance, assist them in reflecting on past negative experiences to break the cycle of learned helplessness and rebuild a sense of control. This alleviates social avoidance and distress, promoting active social participation and facilitating return to work and daily life. 4.2 | Analysis of Factors Influencing Social Avoidance and Distress Among 323 Eczema Patients 4.2.1 | Gender The findings of this study indicate that gender is a primary factor influencing social avoidance and distress among eczema patients ( B = 1.262, P < 0.01), with female patients exhibiting higher levels of social avoidance and distress than their male counterparts. Possible explanations include: women often hold higher standards regarding appearance. The skin lesions, erythema, scaling, and scratch marks caused by eczema can induce intense appearance anxiety and stigma among patients. Furthermore, women tend to internalise emotions and ruminate over negative social experiences. This persistent, negative-information-focused cognitive pattern amplifies distress in social situations and reinforces avoidance behaviours. In contrast, males may be more inclined to distract themselves or externalise their emotions, resulting in lower levels of social avoidance and distress(Hlavacova, Solarikova, Marko, Brezina, & Jezova, 2017 ). On this basis, it is recommended that clinical healthcare professionals pay particular attention to female eczema patients' social activities, emotional state, and the impact of their condition on self-image. Through mindfulness therapy, acceptance and commitment therapy, and establishing patient support groups, female patients can be assisted in reducing rumination, lowering their sense of stigma and anxiety during social interactions, thereby diminishing their levels of social avoidance and distress. 4.2.2 | Educational attainment The findings of this study indicate that educational attainment is a primary factor influencing social avoidance and distress among eczema patients ( B = -0.619, P < 0.01). Specifically, higher educational attainment correlates with lower levels of social avoidance and distress. Potential explanations include: firstly, patients with higher educational attainment possess greater access to health information, higher health literacy, and stronger capacity to understand and accept their condition; Secondly, patients with higher educational attainment possess stronger work and social skills, broader social networks, and a sound understanding of the negative impacts of social avoidance and the positive benefits of social interaction, thereby exhibiting lower levels of social avoidance. Thirdly, patients with higher educational attainment demonstrate greater capacity and confidence in managing their condition, enabling them to adopt proactive approaches to address negative emotions arising from social interactions and maintain normal social activities(Uchino, 2006 ). Based on this, it is recommended that clinical care providers should pay attention to the impact of educational attainment on social avoidance and distress among eczema patients. Tailored health education should be provided for patients with different levels of education to improve negative disease perceptions among those with lower educational attainment. This approach aims to enhance their health literacy, reduce negative emotions, assist in effective disease management, and lower levels of social avoidance and distress. 4.2.3 | Average monthly household income The findings of this study indicate that average monthly household income is a primary factor influencing psychological avoidance and distress among eczema patients ( B = -1.140, P < 0.01). Specifically, higher average monthly household income correlates with lower levels of social avoidance and distress among patients. The probable rationale is as follows: eczema is a chronic condition prone to recurrence, necessitating prolonged treatment with substantial associated costs that readily impose financial burdens upon patients. Individuals from households with higher average monthly incomes possess greater capacity to cover expensive medical treatments and daily moisturising care products, directly alleviating disease-related economic pressures. Consequently, these patients demonstrate improved disease management and psychological well-being, resulting in lower levels of social avoidance and distress. Conversely, patients from households with lower average monthly incomes experience greater treatment burdens and psychological stress, making them more prone to negative emotions such as anxiety and depression. Their disease management is often suboptimal, leading to higher levels of social avoidance and distress(Jiang, Lyu, Mou, Jiang, & Du, 2023 ). On this basis, it is recommended that clinical healthcare professionals implement structured screening to identify low-income individuals, establish supportive ward environments to mitigate anxiety arising from social comparison, collaborate with doctors to develop more affordable treatment plans, and thereby alleviate patients' financial burdens. This approach aims to reduce patients' levels of social avoidance and distress. 4.2.4 | Perceived social support This study indicates that perceived social support is a primary factor influencing social avoidance and distress among eczema patients ( B = -0.100, P < 0.01). Perceived social support among eczema patients exhibited a negative correlation with social avoidance and distress, meaning higher levels of perceived social support were associated with lower levels of social avoidance and distress. This finding aligns with the results of Yuan et al.'s (Yuan et al., 2024 )study on patients following radical lung cancer surgery. Social support refers to the support an individual receives or desires to receive(Furmark et al., 2009 ), Individuals with high levels of perceived social support are more likely to interpret others' arbitrary behaviours as supportive, thereby experiencing greater support, enhanced psychological capital and coping efficacy. This enables patients to engage more actively in social interactions, derive greater satisfaction from interpersonal relationships, directly buffer perceived stress, and ultimately exhibit lower levels of social avoidance and distress(Brissette et al., 2002 ). Conversely, the lower an individual's perceived capacity for social support, the more passive their participation in social interactions becomes, leading to heightened social avoidance and distress. Therefore, it is recommended that clinical healthcare professionals establish a multi-tiered, integrated support network involving the ‘healthcare system, family, and society’. This should proactively address patients' psychological pressures and life challenges, employing empathetic techniques to convey understanding and support. Establishing peer support groups, providing psychological counselling resources, and incorporating social support into routine chronic disease management protocols will enable patients to feel cared for and supported by the professional community. Secondly, family members should be encouraged to proactively learn eczema care knowledge, avoiding complaints and blame. Instead, they should express support through practical actions such as assisting with medication application, preparing healthy meals, and sharing household responsibilities, thereby providing patients with profound comfort. Finally, patients may be encouraged to selectively disclose their condition to family, close friends, or colleagues, seeking understanding rather than concealing their distress. Community health lectures may be organised to foster an inclusive environment, reducing public misconceptions and discrimination regarding skin conditions. Through systematic interventions, patients receive sustained, consistent positive reinforcement from healthcare professionals, family members, and social circles. This enhances their perceived social support, enabling them to manage their condition with greater positivity and reintegrate into society, thereby reducing instances of social avoidance and distress. 4.2.5 | Stigma The findings of this study indicate that stigmatisation is a primary factor influencing social avoidance and distress among eczema patients ( B = 0.075, P < 0.01). The sense of stigma among eczema patients was positively correlated with social avoidance and distress, meaning that higher levels of stigma were associated with greater social avoidance and distress among eczema patients. This finding is consistent with the results of O'Suilleabhain et al. (O'Suilleabhain et al., 2023 )in their study of adult patients with essential tremor. Yang(Yang, 2007 )The emergence of stigma surrounding illness is posited to comprise three components: direct discrimination against patients by others, the internalisation of negative stereotypes by patients themselves, and systemic discrimination within existing social structures. As a visible skin condition, eczema's symptoms—such as skin lesions, erythema, and desquamation—are readily noticeable to others and may be erroneously associated with negative labels like ‘contagious’ or ‘poor hygiene’. This anticipated or actual negative social evaluation directly triggers feelings of shame, embarrassment, and anxiety, fostering a sense of stigma. This compels individuals to actively avoid social situations, thereby generating social avoidance and distress(Chernyshov, 2019 ). Based on this, it is recommended that clinical healthcare professionals incorporate stigmatisation into routine dermatological clinical assessments to identify patients at high risk of stigmatisation early. Concurrently, they should proactively and clearly explain to patients and their families the non-contagious, chronic and recurrent nature of eczema, alongside current treatment objectives and strategies. Introducing psychosocial support and cognitive behavioural interventions, and encouraging patient participation in support groups, is advised. When formulating treatment plans, full consideration should be given to patients' concerns regarding the visibility of skin lesions. Active and effective management of lesions in visible areas (such as the face and hands) should be prioritised, alongside rapid relief of symptoms like itching. This approach helps patients regain social confidence, reduces levels of stigma, and thereby promotes active social engagement while alleviating social avoidance and distress. 4.2.6 | Sense of personal mastery The findings of this study indicate that personal sense of control is a primary factor influencing social avoidance and distress among eczema patients ( B = -0.176, P < 0.01). A negative correlation exists between personal sense of control and both social avoidance and distress in eczema patients, meaning that higher levels of personal sense of control correlate with lower levels of social avoidance and distress. The sense of personal mastery denotes the degree to which an individual believes that life events and outcomes can be controlled through personal actions rather than determined by external forces. It serves as a crucial psychological resource in coping with stress, with high levels effectively buffering the adverse effects of stressful events on mental health. Within medical contexts, patients' sense of personal mastery manifests in their perceptions of disease management, treatment decision-making, and control over daily life, constituting one of the predictors of quality of life for chronic disease patients(Pearlin & Schooler, 1978 ). Eczema, as a significant negative life event, frequently leads to diminished self-efficacy, altered body image, and detachment from social roles among sufferers. This profoundly undermines their sense of personal control. Such a loss of control readily triggers avoidance behaviours in social situations and considerable psychological distress(Pearlin & Schooler, 1978 ). On this basis, it is recommended that clinical healthcare professionals systematise psychosocial assessments, prioritising high-risk individuals. Employing empowering language, they should explain the purpose of treatment and care in accessible terms, instruct patients in self-management skills, assist in reconstructing bodily intentions, uphold patient dignity, and enhance their sense of personal control. This approach will thereby mitigate levels of social avoidance and distress. 4.2.7 | Economic toxicity The findings of this study indicate that economic toxicity is a primary factor influencing social avoidance and distress among eczema patients ( B = -0.081, P < 0.01). Economic toxicity (inverse scoring) in eczema patients exhibits a negative correlation with social avoidance and distress; that is, lower economic toxicity scores correspond to higher levels of social avoidance and distress among eczema patients. Economic toxicity denotes the adverse impact of substantial treatment costs on patients and their families, encompassing both objective financial burdens and subjective psychological distress(Zafar & Abernethy, 2013 ). The treatment and daily management of eczema entail ongoing substantial expenditure, leading patients to significantly reduce or eliminate budgets allocated to social activities, thereby resulting in diminished participation in such engagements(Whiteley, Emir, Seitzman, & Makinson, 2016 ). Concurrently, severe eczema may disrupt patients' normal work, leading to reduced or interrupted income. This not only exacerbates economic toxicity but also directly diminishes opportunities for social engagement, intensifying psychological distress, anxiety, and feelings of helplessness. These negative emotions compound the itching and sleep deprivation inherent to eczema, significantly impairing patients' emotional regulation and self-confidence. Consequently, they experience distress in social situations and may choose to withdraw from social interactions(Siligato et al., 2024 ). On this basis, it is recommended that clinical healthcare professionals incorporate patients' economic toxicity and psychosocial burden into routine screening protocols, proactively identifying those experiencing financial hardship. When formulating treatment plans, shared decision-making with patients is essential, with full consideration given to their economic capacity. Prioritise cost-effective, sustainable treatment and care options to avoid exacerbating economic toxicity through overtreatment, thereby preventing a vicious cycle. For patients experiencing high economic toxicity, mental health assessments should be conducted at the earliest opportunity. Provide necessary psychological counselling and cognitive behavioural therapy to help them build psychological capital for coping with financial pressures and stigma associated with illness, thereby reducing social avoidance and distress. 5 | Limitations and Recommendations This study employed a health ecology model to analyse the current state and influencing factors of social avoidance and distress among eczema patients, offering an innovative perspective for their care. However, this study has several limitations: (1) The sample was restricted to patients with chronic skin disease from eight Grade A tertiary hospitals in mainland China, with a small sample size and a simple sampling method, resulting in limited representativeness. Future research is advised to employ representative sampling strategies and expand the geographical scope of the sample to enhance the generalisability of the findings; (2) The cross-sectional design precludes accurate determination of causal relationships and directionality between perceived social support, stigma, sense of personal mastery, and social avoidance/distress. Future large-scale, multi-level, multi-centre studies incorporating longitudinal and qualitative research are warranted to validate findings; (3) Self-reported data based on subjective perceptions are susceptible to bias. Subsequent studies should incorporate multi-dimensional perspectives, including assessments by family members and healthcare professionals regarding social avoidance and distress among eczema patients. 6 | Conclusions This study confirms that individuals with eczema experience elevated levels of social avoidance and distress, necessitating urgent implementation of effective interventions. Social avoidance and distress among eczema patients exhibit negative correlations with perceived social support, economic toxicity, and personal sense of control, whilst demonstrating positive associations with stigmatisation. This finding provides a theoretical basis for alleviating social avoidance and distress among eczema patients. Future healthcare institutions may translate these research findings into practical interventions by focusing on assessing and identifying social avoidance and distress, establishing support networks, reducing stigma, enhancing sense of personal mastery, and alleviating treatment burdens. Such approaches will ultimately facilitate patients' social reintegration and improve their quality of life. 7 | Relevance to Clinical Practice In this study, patients with eczema exhibited elevated levels of social avoidance and distress, highlighting the urgent need for healthcare institutions and community health services to prioritise the quality of life and mental health of this population. Furthermore, the findings reveal that social avoidance and distress among eczema patients are negatively correlated with perceived social support, economic toxicity, and sense of personal mastery, while exhibiting a positive association with stigma. Consequently, incorporating these variables into comprehensive health management programmes for eczema patients holds significant reference value. Based on these findings, future healthcare institutions may commence by establishing a multidimensional, systematic psychosocial support framework. This system should integrate multidisciplinary and community resources, with core interventions including: firstly, implementing routine screening using simplified tools to rapidly assess patients' perceived social support, stigma, personal sense of control, and economic toxicity during outpatient visits, enabling early identification of high-risk individuals; Secondly, offering structured interventions such as disease self-management courses to enhance a sense of personal mastery, introducing cognitive behavioural therapy to help patients reframe perceptions of their self-image and reduce stigma, and alleviating economic toxicity through selecting lower-cost treatment options; Thirdly, fostering peer support by establishing patient support groups. Sharing successful coping strategies strengthens social connections and belonging, thereby internally enhancing patients' capacity to perceive social support. This closed-loop management model improves social avoidance and distress among eczema patients, comprehensively elevating their quality of life. Declarations Declaration of moral approval and consent The study protocol was approved by the Medical Ethics Committee of Tianjin Academy of Traditional Chinese Medicine affiliated Hospital.All participants in this study gave informed consent and volunteered to participate in the study, and agreed that the study would be published in an academic journal. Author Contributions Na Cai, Tao Guo and Yue Zhu contributed to the work design, data collection, data acquisition, data analysis, data interpretation, draft the article, revise important intellectual content of the article, and the final approval of the version to be submitted. Jiaxing Li, Junchen He and Yubin Liu contributed to the work design, analysis, data acquisition, data interpretation, draft the article, and the final approval of the version to be submitted. Zhangyi Wang, Dandan Wang and Xue Li contributed to the analysis of the work, data interpretation, draft the article, and the final approval of the version to be submitted. Fengting Zhang and Shijie Huang contributed to the analysis of the work, data interpretation, draft the article, and the final approval of the version to be submitted. Yi Ren contributed to the data interpretation, revise important intellectual content of the article, and the final approval of the version to be submitted. Acknowledgments All researchers would like to express our gratitude to all the participants for taking their precious time to participate in this study, and also thank the hospital managers and nursing administrators for their strong support and help to this study. Fundings This study was supported by the Tianjin Municipal Science and Technology Programme Project [grant numbers: 25KPXCRC00400]. Conflict of Interests Statement The authors declare that there is no conflict of interest. Data Availability Statement The relevant data of this study can be obtained from the first author or corresponding author on reasonable request. Clinical trial number Not applicable. References Al-Naqeeb, J., Danner, S., Fagnan, L. J., Ramsey, K., Michaels, L., & Mitchell, J., et al. (2019). The Burden of Childhood Atopic Dermatitis in the Primary Care Setting: A Report from the Meta-LARC Consortium. J Am Board Fam Med, 32 (2), 191-200. Brissette, I., Scheier, M. F., & Carver, C. S. (2002). The role of optimism in social network development, coping, and psychological adjustment during a life transition. J Pers Soc Psychol, 82 (1), 102-111. Chan, C. X., & Zug, K. A. (2021). Diagnosis and Management of Dermatitis, Including Atopic, Contact, and Hand Eczemas. Med Clin North Am, 105 (4), 611-626. Chen, P., Xu, S., Nian, J., Pan, Y., & Jiang, X. (2025). Mediating effects of sense of coherence and psychological resilience on stigma and quality of life among postoperative middle-aged and older patients with malignant gynecological tumors: a cross-sectional, structural equation model. Support Care Cancer, 33 (9), 792. Chernyshov, P. V. (2019). The Evolution of Quality of Life Assessment and Use in Dermatology. Dermatology, 235 (3), 167-174. Dalgard, F. J., Gieler, U., Tomas-Aragones, L., Lien, L., Poot, F., & Jemec, G. B. E., et al. (2015). The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol, 135 (4), 984-991. Dalgard, F. J., Svensson, Å., Halvorsen, J. A., Gieler, U., Schut, C., & Tomas-Aragones, L., et al. (2020). Itch and Mental Health in Dermatological Patients across Europe: A Cross-Sectional Study in 13 Countries. J Invest Dermatol, 140 (3), 568-573. de Souza, J. A., Yap, B. J., Hlubocky, F. J., Wroblewski, K., Ratain, M. J., & Cella, D., et al. (2014). The development of a financial toxicity patient-reported outcome in cancer: The COST measure. Cancer, 120 (20), 3245-3253. Elezbawy, B., Fasseeh, A. N., Fouly, E., Tannira, M., Dalle, H., & Aderian, S., et al. (2023). Humanistic and Economic Burden of Atopic Dermatitis for Adults and Adolescents in the Middle East and Africa Region. Dermatol Ther (Heidelb), 13 (1), 131-146. Elezbawy, B., Kaló, Z., Fasseeh, A., Inotai, A., Nemeth, B., & Ágh, T. (2025). The hidden burden of atopic dermatitis in central and Eastern European countries. Expert Rev Pharmacoecon Outcomes Res, 25 (2), 257-264. Fife, B. L., & Wright, E. R. (2000). The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J Health Soc Behav, 41 (1), 50-67. Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., & Bohman, B., et al. (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. Br J Psychiatry, 195 (5), 440-447. Guo, L., Zhang, M., Namassevayam, G., Wei, M., Zhang, G., & He, Y., et al. (2023). Effectiveness of health management among individuals at high risk of stroke: An intervention study based on the health ecology model and self-determination theory (HEM-SDT). Heliyon, 9 (11), e21301. Hlavacova, N., Solarikova, P., Marko, M., Brezina, I., & Jezova, D. (2017). Blunted cortisol response to psychosocial stress in atopic patients is associated with decrease in salivary alpha-amylase and aldosterone: Focus on sex and menstrual cycle phase. Psychoneuroendocrinology, 78 , 31-38. Hobfoll, S. E. (2001). The Influence of Culture, Community, and the Nested‐Self in the Stress Process: Advancing Conservation of Resources Theory. Applied Psychology, 50 (3), 337-421. Jiang, H., Lyu, J., Mou, W., Jiang, Q., & Du, J. (2023). Association between financial toxicity and health-related quality of life in cancer survivors: A systematic review. Asia Pac J Clin Oncol, 19 (4), 439-457. Kage, P., Simon, J., & Treudler, R. (2020). Atopic dermatitis and psychosocial comorbidities. J Dtsch Dermatol Ges, 18 (2), 93-102. Kroenke, C. H., Michael, Y. L., Poole, E. M., Kwan, M. L., Nechuta, S., & Leas, E., et al. (2017). Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project. Cancer, 123 (7), 1228-1237. Kuang, J., Yang, L., Lv, R., Li, J., Zhou, K., & Xu, M. (2022). The mediating effect of post-stroke depression between social support and quality of life among stroke survivors: A meta-analytic structural equation modeling. Int J Geriatr Psychiatry, 37 (12). Lahousen, T., Kupfer, J., Gieler, U., Hofer, A., Linder, M. D., & Schut, C. (2016). Differences Between Psoriasis Patients and Skin-healthy Controls Concerning Appraisal of Touching, Shame and Disgust. Acta Derm Venereol, 96 (217), 78-82. Langan, S. M., Irvine, A. D., & Weidinger, S. (2020). Atopic dermatitis. Lancet, 396 (10247), 345-360. Malone, S., Counts, L., Zabotka, L., Williams, A., Loecher, N., & Wynja, K., et al. (2025). Stigma measurement in health: a systematic review. EClinicalMedicine, 86 , 103360. Mühlberger, C., Angus, D. J., Jonas, E., Harmon-Jones, C., & Harmon-Jones, E. (2017). Perceived control increases the reward positivity and stimulus preceding negativity. Psychophysiology, 54 (2), 310-322. O'Kearney, E. L., Brown, C. R., Jelinek, G. A., Neate, S. L., Taylor, K. T., & Bevens, W., et al. (2020). Mastery is associated with greater physical and mental health-related quality of life in two international cohorts of people with multiple sclerosis. Mult Scler Relat Disord, 38 , 101481. O'Suilleabhain, P., Berry, D. S., Lundervold, D. A., Turner, T. H., Tovar, M., & Louis, E. D. (2023). Stigma and Social Avoidance in Adults with Essential Tremor. Mov Disord Clin Pract, 10 (9), 1317-1323. Pan, A., Chung, L., Fife, B. L., & Hsiung, P. (2007). Evaluation of the psychometrics of the Social Impact Scale: a measure of stigmatization. Int J Rehabil Res, 30 (3), 235-238. Pearlin, L. I., & Schooler, C. (1978). The structure of coping. J Health Soc Behav, 19 (1), 2-21. Rodebaugh, T. L., Lim, M. H., Shumaker, E. A., Levinson, C. A., & Thompson, T. (2015). Social Anxiety and Friendship Quality over Time. Cogn Behav Ther, 44 (6), 502-511. Santuzzi, A. M. (2011). Anticipating evaluative social interactions involving persons with disabilities. Rehabil Psychol, 56 (3), 231-242. Schmid-Ott, G., Jaeger, B., Kuensebeck, H. W., Ott, R., & Lamprecht, F. (1996). Dimensions of stigmatization in patients with psoriasis in a "Questionnaire on Experience with Skin Complaints'. Dermatology, 193 (4), 304-310. Siligato, R., Gembillo, G., Di Simone, E., Di Maria, A., Nicoletti, S., & Scichilone, L. M., et al. (2024). Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol. Methods Protoc, 7 (2). Silverberg, J. I., Gelfand, J. M., Margolis, D. J., Boguniewicz, M., Fonacier, L., & Grayson, M. H., et al. (2019). Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol, 181 (3), 554-565. Tang, F., Xiong, Q., Gan, T., Yuan, L., Liao, Q., & Yu, Y. (2022). The prevalence of alexithymia in psoriasis: A systematic review and meta-analysis. J Psychosom Res, 161 , 111017. Toth, I., & Neumann, I. D. (2013). Animal models of social avoidance and social fear. Cell Tissue Res, 354 (1), 107-118. Uchino, B. N. (2006). Social support and health: a review of physiological processes potentially underlying links to disease outcomes. J Behav Med, 29 (4), 377-387. Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., G Tzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies for the STROBE initiative. Bulletin of the World Health Organization, 85 (11), 867-872. Wang, J., Tischer, C., Standl, M., Weidinger, S., von Berg, A., & Herberth, G., et al. (2022). Lifetime prevalence and determinants of hand eczema in an adolescent population in Germany: 15-year follow-up of the LISA cohort study. J Eur Acad Dermatol Venereol, 36 (4), 547-556. Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. J Consult Clin Psychol, 33 (4), 448-457. Whiteley, J., Emir, B., Seitzman, R., & Makinson, G. (2016). The burden of atopic dermatitis in US adults: results from the 2013 National Health and Wellness Survey. Curr Med Res Opin, 32 (10), 1645-1651. Whittle, H. J., Palar, K., Ranadive, N. A., Turan, J. M., Kushel, M., & Weiser, S. D. (2017). "The land of the sick and the land of the healthy": Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States. Soc Sci Med, 190 , 181-189. Yang, L. H. (2007). Application of mental illness stigma theory to Chinese societies: synthesis and new directions. Singapore Med J, 48 (11), 977-985. Yu, H., Yu, Z., Li, H., Zhao, H., Sun, J., & Liu, Y. (2021). The COmprehensive Score for financial Toxicity in China: Validation and Responsiveness. J Pain Symptom Manage, 61 (6), 1297-1304. Yuan, W., Jiang, Y., Sun, M., Zhao, Q., Qiao, G., & Zheng, Y. (2024). Factors influencing social avoidance and distress after radical lung cancer resection: a mediation analysis. Am J Transl Res, 16 (9), 4770-4778. Zafar, S. Y., & Abernethy, A. P. (2013). Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park), 27 (2), 80-81, 149. Zhao, Q., Huangfu, C., Li, J., Liu, H., & Tang, N. (2022). Psychological Resilience as the Mediating Factor Between Stigma and Social Avoidance and Distress of Infertility Patients in China: A Structural Equation Modeling Analysis. Psychol Res Behav Manag, 15 , 391-403. Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess, 55 (3-4), 610-617. Zuberbier, T., Abdul Latiff, A., Aggelidis, X., Augustin, M., Balan, R., & Bangert, C., et al. (2023). A concept for integrated care pathways for atopic dermatitis-A GA(2) LEN ADCARE initiative. Clin Transl Allergy, 13 (9), e12299. Jiang, Q. J. (2001). Perceived Social Support Scale. Chinese Journal of Behavioural Medical Science , 10( 10 ), 41-43. Ma Hong. (1999). Manual for the Mental Health Assessment Scale. Beijing: Chinese Journal of Mental Health Publishing House. Yu Yibing, & Zou Hong. (2008). A Study on the Developmental Characteristics of Positive Psychological Qualities in Migrant Children. Chinese Journal of Special Education (4), 78-83. Additional Declarations No competing interests reported. Supplementary Files Table.docx Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7811981","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547364136,"identity":"9a6886ae-b9e4-42b2-9eb6-2405bb218674","order_by":0,"name":"Na Cai","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Cai","suffix":""},{"id":547364137,"identity":"120e3e8f-dce0-40cc-bd99-822d48820afe","order_by":1,"name":"Tao Guo","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Guo","suffix":""},{"id":547364138,"identity":"b00877e6-7f65-4f01-8955-d32b0bd38066","order_by":2,"name":"Yue Zhu","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Zhu","suffix":""},{"id":547364139,"identity":"2e4ff72e-b61c-4ad4-bead-f44e8c903a1b","order_by":3,"name":"Jiaxing Li","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiaxing","middleName":"","lastName":"Li","suffix":""},{"id":547364141,"identity":"9db3be9c-5c30-4b88-ac57-b54719efb630","order_by":4,"name":"Junchen He","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junchen","middleName":"","lastName":"He","suffix":""},{"id":547364148,"identity":"692c1856-6983-436d-a40d-4ce983db8802","order_by":5,"name":"Yubin Liu","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yubin","middleName":"","lastName":"Liu","suffix":""},{"id":547364151,"identity":"06f4263a-4dae-443e-b45e-709ab4146aed","order_by":6,"name":"Zhangyi Wang","email":"","orcid":"","institution":"Affiliated Hengyang Hospital of Hunan Normal University \u0026 Hengyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhangyi","middleName":"","lastName":"Wang","suffix":""},{"id":547364153,"identity":"6f7a714f-7c44-44e4-9fcc-c9f1e069108c","order_by":7,"name":"Dandan Wang","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dandan","middleName":"","lastName":"Wang","suffix":""},{"id":547364155,"identity":"6ae9cb5a-bd38-4660-bfa0-97fde3bd9a28","order_by":8,"name":"Xue Li","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Li","suffix":""},{"id":547364159,"identity":"00ab7bef-1105-4016-9403-fcbb8560942a","order_by":9,"name":"Fengting Zhang","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fengting","middleName":"","lastName":"Zhang","suffix":""},{"id":547364162,"identity":"fbb40634-91f8-4d52-9b8d-9c00f12017f1","order_by":10,"name":"Shijie Huang","email":"","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shijie","middleName":"","lastName":"Huang","suffix":""},{"id":547364163,"identity":"6b930735-6f97-4d68-946a-65265c50a110","order_by":11,"name":"Yi Ren","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYBACNvbmgw8SDGx42JiZgYwKG8Ja+HiOJRt8KEiT42NnSzZ4cCaNsBY5iRwzyRkfDhvL8fOYST5sO0yEw3jOGEjzGKQltjHzmFUknDnMwD+7gZBf2gqMeQxsgFrYym4kVKQzSNw5QMiWwxuSIbYwb7uRcMaawUAigYAWiQSDwzwGh4FaGMwKQCQRWlIMG2cYHDZmY2YxY0hscyZCCzCQGT4YpMmxMbMlSyScSeORuEFAi3x78/EfCX9seOT7Dx/8+KPCRo5/BgEtGICHRPWjYBSMglEwCrABAJHBQfrxR9NLAAAAAElFTkSuQmCC","orcid":"","institution":"Tianjin Academy of Traditional Chinese Medicine affiliated Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yi","middleName":"","lastName":"Ren","suffix":""}],"badges":[],"createdAt":"2025-10-09 02:37:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7811981/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7811981/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96400104,"identity":"6c982189-33ba-446c-9876-a63ca703c11f","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":543882,"visible":true,"origin":"","legend":"","description":"","filename":"Maindocument.docx","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/2e2158b572395e217f64fbc3.docx"},{"id":96400107,"identity":"04ec3058-e59d-416b-bb7e-be97998db1e2","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":398731,"visible":true,"origin":"","legend":"","description":"","filename":"Figure.docx","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/d13f9c9bf296521775eef669.docx"},{"id":96453173,"identity":"ea6b5a6b-8484-48f9-acb5-51f9ace61efd","added_by":"auto","created_at":"2025-11-21 09:58:39","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49040,"visible":true,"origin":"","legend":"","description":"","filename":"Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/ae68a58df8fc592b998c2eed.docx"},{"id":96453783,"identity":"5c7a76c2-bf8a-4d5f-9008-41b2af7effa5","added_by":"auto","created_at":"2025-11-21 10:01:44","extension":"json","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12392,"visible":true,"origin":"","legend":"","description":"","filename":"dad45040fcdb42a995e3a73051504aa0.json","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/1fdbbb445065826b44e1654b.json"},{"id":96454370,"identity":"c95f7979-b2d1-4f9b-bf2d-e7c8e29d55da","added_by":"auto","created_at":"2025-11-21 10:02:40","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":186838,"visible":true,"origin":"","legend":"","description":"","filename":"dad45040fcdb42a995e3a73051504aa01enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/726c39c086619059ba2d40ac.xml"},{"id":96453800,"identity":"0b16d5f9-50ad-4098-91bb-3cd49bc0f5c2","added_by":"auto","created_at":"2025-11-21 10:01:45","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":204733,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/9e7fa7282957ca6e8b123902.png"},{"id":96453802,"identity":"053e35d3-ecdd-4c7a-bee9-9a317b81dadd","added_by":"auto","created_at":"2025-11-21 10:01:46","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":349568,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/5a0399000b832b1b17df6432.jpeg"},{"id":96454323,"identity":"f0bbf38d-2488-4bba-89d3-feb5adf57c30","added_by":"auto","created_at":"2025-11-21 10:02:38","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":204733,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/20232e94e00f6d44e1e0c6cc.png"},{"id":96400106,"identity":"25eea0c8-b2ca-4f2c-a9d6-2d4d8456aca2","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"jpeg","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":349568,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/b76964e3144eb7c068cd18b9.jpeg"},{"id":96400113,"identity":"46eb9a02-9362-4d9d-8a79-9923b0adeedd","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":46466,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/227b62ba5ff3e90c8cee4bc9.png"},{"id":96400114,"identity":"da1fbd78-068e-4b0b-81d7-8a53855680db","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81462,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/25efa33462e62165bbf62786.png"},{"id":96400110,"identity":"67d2fdf8-3a31-4655-ac27-b5f1a1b01e78","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":46466,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/8d79797f22468dc91a475629.png"},{"id":96400116,"identity":"09904a00-b7ee-47ca-be3c-c8b503122259","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81462,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/d8a33a9818a1fcef95886659.png"},{"id":96400118,"identity":"be585c4d-7f84-4ed2-b8c7-9f7d255e43db","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":181366,"visible":true,"origin":"","legend":"","description":"","filename":"dad45040fcdb42a995e3a73051504aa01structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/20b2fa0caa4a9b19e1dce469.xml"},{"id":96453455,"identity":"8e2dddf9-729a-437f-838a-070b0410a241","added_by":"auto","created_at":"2025-11-21 09:59:58","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":191664,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/2e6366d459abfe4cb54f8e9c.html"},{"id":96400103,"identity":"8250168e-fd2d-4e1f-8aba-3db450c70f90","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":154491,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTheoretical Basis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/b4f13bfd5ff5d540140d90d5.png"},{"id":96400101,"identity":"66a60fa4-e3ac-443d-82d3-200bae3f49cd","added_by":"auto","created_at":"2025-11-20 16:03:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":112546,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHypothetical model\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/d653b09e62644d95b15a95f6.png"},{"id":109612458,"identity":"58ae111e-ca53-47fb-9141-2263ce89c90c","added_by":"auto","created_at":"2026-05-20 07:56:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":748236,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/35784749-d124-437b-95f0-5cf74d20b950.pdf"},{"id":96453956,"identity":"88b8950d-b8e6-45ca-84d8-5d3d3ba1bd1d","added_by":"auto","created_at":"2025-11-21 10:02:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":49040,"visible":true,"origin":"","legend":"","description":"","filename":"Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-7811981/v1/ae71c2db25e1306273ab4eb5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Social avoidance and distress in eczema patients based on a health ecology model: a cross-sectional survey study","fulltext":[{"header":"1 | Background","content":"\u003cp\u003eEczema is an inflammatory, allergic skin condition characterised primarily by recurrent itching and symmetrically distributed polymorphic lesions, with clinical features including a tendency towards moistness, recurrent episodes, and a propensity for chronicity(Chan \u0026amp; Zug, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A 15-year cohort study indicates that one in ten German adolescents suffers from hand eczema(Wang et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). German research indicates that the annual incidence of hand eczema ranges from 0.24% to 9.2%, with lifetime prevalence estimated at 2.6% to 16.0%. Eczema can occur across different age groups and ethnicities, representing one of the primary contributors to the global burden of skin diseases(Langan \u0026amp; Weidinger, 2020).\u003c/p\u003e\u003cp\u003eEczema frequently causes disfiguring changes in appearance, presenting as thickened erythema, lichenification, scaling, and intense itching. It commonly occurs on the hands, face, scalp, limbs, trunk, and perineal region(Zuberbier et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Patients frequently encounter prejudice and discrimination in their professional and social lives due to changes in their skin's appearance. This leads to feelings of low mood, frustration, loneliness, and inferiority, and mayeven foster hostile emotions. The persistent itching disrupts sleep quality, imposing a psychological burden that exacerbates patients' mental distress and impairs their daily work and life(Dalgard et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Research has demonstrated that individuals with eczema exhibit significantly higher levels of anxiety and depression compared to the general population, thereby giving rise to various psychological issues(Kage \u0026amp; Treudler, 2020). The itching symptoms caused by eczema can lead to sleep disturbances, affecting daily life and work, and further contributing to a decline in quality of life(Al-Naqeeb et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Certain chronic skin conditions such as psoriasis have now been categorised as psychosomatic disorders, Moreover, research indicates that individuals with eczema exhibit significantly higher rates of anxiety and depression, yet these conditions are often overlooked and fail to receive timely diagnosis. These psychological symptoms, in turn, exacerbate the physical condition, creating a vicious cycle(Silverberg et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Tang et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Therefore, as one of the most common skin conditions, eczema and the psychological distress arising from its burden should not be overlooked; clinical practitioners must give due consideration to this in their diagnostic and therapeutic work.\u003c/p\u003e\u003cp\u003eWith the continuous development of the biopsychosocial medical model, increasing attention is being paid to the physical and psychological development of individuals. Humans are not merely \u0026ldquo;biological beings\u0026rdquo;, but also \u0026ldquo;psychological beings\u0026rdquo; and \u0026ldquo;social beings\u0026rdquo;. The reintegration of patients into society following illness holds significant importance. Social avoidance and distress, as major obstacles to patients' societal return, are receiving increasing attention within the medical field. Social avoidance and distress refer to the tendency to evade social interactions and the accompanying feelings of distress experienced by individuals. This manifests as behavioural patterns and emotional responses where individuals withdraw from social situations to avoid negative evaluations from others(Toth \u0026amp; Neumann, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Social avoidance and distress can severely impair patients' quality of life and interpersonal relationships, preventing them from effectively integrating into society(Rodebaugh, Lim, Shumaker, Levinson, \u0026amp; Thompson, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Concurrently, patients' social avoidance behaviours frequently exacerbate their depression, feelings of inferiority, and distress, exerting a profoundly detrimental impact on their physical recovery, treatment efficacy, and even disease prognosis. This leads to heightened relapse risks and mortality rates, imposing a significant economic and healthcare burden upon families and society(Kroenke et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Research indicates that patients with conditions such as psoriasis(Lahousen et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)and lung cancer(Yuan et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)experience social avoidance and distress. Eczema patients exhibit disfiguring clinical manifestations on the skin, with the appearance of crusting and lichenification on exposed areas significantly impacting their appearance. This can lead to severe negative consequences for social interactions and daily life(Santuzzi, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Therefore, enhancing the social engagement of eczema patients is crucial for disease recovery, improving quality of life, and reintegrating into social life. However, research on social avoidance and distress among eczema patients remains scarce both domestically and internationally.\u003c/p\u003e\u003cp\u003ePerceived social support refers to the psychological experience of receiving assistance from friends, family, and society, alongside feeling respected and understood. This can create an environment for trauma survivors to share their emotions and energy, helping them generate the motivation to actively confront stressful events and thereby influencing their coping strategies(Kuang et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Research indicates that individuals who perceive high levels of social support are more likely to interpret others' arbitrary behaviours as supportive. This can motivate individuals to actively seek social opportunities and proactively address social issues, thereby reducing their own social avoidance and distress. If patients become self-isolated and unable to seek effective social support, they are highly likely to bear increasing pressure, leading to the emergence of negative psychological states. This further facilitates the development of a closed mindset, resulting in social avoidance and distress(BrissetteScheier \u0026amp; Carver, 2002). However, among individuals with eczema, the relationship between perceived social support and social avoidance on the one hand, and distress on the other, remains unclear.\u003c/p\u003e\u003cp\u003eStigma refers to the experience of shame felt by patients who suffer discrimination and alienation from others due to their illness(Malone et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Research on disease-related stigma has primarily focused on conditions such as infectious diseases and cancer that cause alterations in physical appearance and bodily impairment(Chen, Xu, Nian, Pan, \u0026amp; Jiang, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Stigma surrounding illness exerts a detrimental effect on patients' psychological state, not only diminishing their self-esteem and hope for recovery but also heightening avoidance of treatment and suicide risk. This consequently impacts social relationships and exacerbates disease symptoms(Whittle et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Research indicates that patients with high stigma become extremely sensitive to people and situations around them due to alterations in their physical appearance. They frequently exaggerate others' words and actions in social interactions, exhibiting excessive psychological reactivity. Such perceptions lead patients to avoid crowds whenever possible, resulting in social difficulties(Zhao, Huangfu, Li, Liu, \u0026amp; Tang, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, the stigma associated with eczema has not received sufficient attention among sufferers, and the relationship between this stigma and social avoidance and distress among eczema patients remains unclear.\u003c/p\u003e\u003cp\u003eSense of personal control refers to an individual's capacity to adapt to and manage changes in their living environment, serving as a positive factor in predicting self-management and quality of life in chronic diseases(Hobfoll, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; M\u0026uuml;hlberger, Angus, Jonas, Harmon-Jones, \u0026amp; Harmon-Jones, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Research indicates that the higher an individual's sense of personal mastery, the more likely they are to adopt proactive health management behaviours and maintain favourable physical and mental states. This enables them to participate in social life with composure and adapt to societal roles(O'Kearney et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It is evident that enhancing patients' sense of personal control can alleviate negative emotions, promote the adoption of positive coping strategies, facilitate better social functioning, and reduce social avoidance and distress. However, research into sense of personal mastery among chronic disease patients remains in its infancy both domestically and internationally. Few scholars have examined this phenomenon specifically in eczema patients, and the relationship between sense of personal mastery and social avoidance and distress in eczema patients warrants further investigation.\u003c/p\u003e\u003cp\u003eEconomic toxicity refers to the substantial costs associated with disease diagnosis and treatment, analogous to physical toxicity, which impose a significant objective financial burden and subjective economic distress upon patients and their carers(Zafar \u0026amp; Abernethy, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Multiple studies indicate that households with eczema sufferers incur long-term expenses for outpatient consultations, diagnostic tests, topical and oral medications, hospital admissions, and costly functional skincare products. Concurrently, the financial strain is compounded by the ongoing expenditure arising from frequent medical appointments, including associated travel and time costs, income losses due to reduced work efficiency or missed workdays, and the opportunity costs incurred when parents of paediatric patients must reduce working hours or resign entirely to provide care. This persistent expenditure represents a significant and enduring financial challenge for many households, where economic burdens intertwine with health burdens, severely impacting quality of life(Elezbawy et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Elezbawy et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Financial pressures may lead patients to avoid social engagements or seeking support, exacerbating feelings of social isolation and subsequently resulting in social avoidance and distress(Dalgard et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). However, the issue of economic toxicity among eczema sufferers has not received sufficient attention, and the relationship between economic toxicity and social avoidance and distress remains largely unknown.\u003c/p\u003e\u003cp\u003eTo date, few studies have examined social avoidance and distress among eczema patients, with even fewer investigating the impact of perceived social support, stigma, sense of personal mastery, and economic toxicity on these outcomes. Therefore, this study employs a cross-sectional survey grounded in the health ecology model to systematically evaluate the current state of social avoidance and distress among eczema patients and analyse its influencing factors. This provides a reference for healthcare professionals in developing intervention programmes to alleviate social avoidance and distress in eczema patients.\u003c/p\u003e"},{"header":"2 | Design and method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 | Theoretical basis\u003c/h2\u003e\n \u003cp\u003eThe health ecology model emphasises that individual health arises from the reciprocal influence and interaction between personal and environmental factors. This model presents a comprehensive framework organised from the innermost to the outermost layers: individual innate characteristics, psychological behaviours and lifestyle, family and social networks, living and working conditions, and policy environment(Guo et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). This study employs the health ecology model to conduct a multidimensional systematic classification and comprehensive summary of the factors influencing social avoidance and distress among eczema patients. This aims to effectively identify influencing factors, thereby providing a basis for formulating corresponding intervention measures. The health ecology model is illustrated in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eBased on the health ecology model, following a literature review and group discussions, the following factors were ultimately identified as potentially influencing social avoidance and distress among eczema patients: (1) Individual innate characteristics: gender, age, presence of other chronic conditions, eczema type, affected body areas, presence of pruritus, current flare-up status, disease duration; (2) Psychological and behavioural patterns: exercise habits, stigma associated with the condition, perceived personal control; (3) Family and community networks: marital status, living arrangements, perceived social support; (4) Living and working environment: educational attainment, average monthly household income, place of residence, current occupational status; (5) Policy factors: healthcare payment methods, economic toxicity. The hypothesised model for this study is illustrated in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 | Research design and objectives\u003c/h2\u003e\n \u003cp\u003eThis study employs a descriptive and cross-sectional research design to investigate the current state of social avoidance and distress among individuals with eczema, along with its influencing factors, thereby providing a theoretical basis for clinical decision-making. To ensure a thorough and complete reporting of the research, we have adopted the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies(Von Elm et al., \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 | Research objects\u003c/h2\u003e\n \u003cp\u003eBetween January and August 2025, eczema patients from eight Grade A tertiary hospitals in mainland China were selected using convenience sampling. Inclusion criteria were: (1) aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (2) Diagnosed with eczema for over one month; (3) Able to respond correctly, answer questions independently or with researcher assistance, and complete the questionnaire; (4) Informed and voluntarily participating in this study. Exclusion criteria: (1) Severe cognitive or psychiatric impairment; (2) Concurrent severe comorbid conditions.\u003c/p\u003e\n \u003cp\u003eAccording to the requirements of multi-factor analysis, the medium effect f \u003csup\u003e2\u003c/sup\u003e=0. 15, the two sides of the test level \u0026alpha;\u0026thinsp;=\u0026thinsp;0. 05, the test efficiency 1-\u0026beta;\u0026thinsp;=\u0026thinsp;0. 90, 13 independent variables, and the required sample size is 162 cases. This study finally collected 323valid questionnaires, sufficient statistical power is ensured.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4 | Measures\u003c/h2\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.1 | General information questionnaire\u003c/h2\u003e\n \u003cp\u003eTo control for potential confounding factors, 15 general characteristics were included based on a literature review: gender, age, marital status, place of residence, housing conditions, educational attainment, method of payment for medical treatment, occupational status, type of eczema, and duration of illness.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.2 | Social Avoidance and Distress Scale (SAD)\u003c/h2\u003e\n \u003cp\u003eThe Social Avoidance and Distress Scale, developed by Waston et al. (Watson \u0026amp; Friend, \u003cspan class=\"CitationRef\"\u003e1969\u003c/span\u003e) in 1969 and revised by Wang Xiangdong et al. (Ma, 1999)in 1999, comprises two dimensions: social avoidance and social distress. It consists of 28 items scored using a yes/no format, with \u0026ldquo;yes\u0026rdquo; responses receiving 1 point and \u0026ldquo;no\u0026rdquo; responses receiving 0 points. Items 1, 3, 4, 6, 7, 9, 12, 15, 17, 19, 22, 25, 27, and 28 are reverse-scored. The scale ranges from 0 to 28 points, with higher scores indicating greater severity of social avoidance and distress. The Cronbach\u0026rsquo;\u0026alpha; coefficient for this scale in the present study was 0.910.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.3 | Perceived Social Support Scale(PSSS)\u003c/h2\u003e\n \u003cp\u003eDeveloped by Zimet et al. (Zimet, Powell, Farley, Werkman, \u0026amp; Berkoff, \u003cspan class=\"CitationRef\"\u003e1990\u003c/span\u003e)in 1988 and translated and revised by Jiang, Qianjin et al.(Jiang, \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e)in 1999, this instrument measures perceived levels of social support across diverse populations. It comprises three dimensions: family support, friend support, and other support, each containing four items, totalling twelve items. A seven-point scoring method is employed, with scores ranging from 1 (strongly disagree) to 7 (strongly agree). The total score ranges from 12 to 84 points, with higher scores indicating greater perceived social support. The Cronbach\u0026apos;s \u0026alpha; coefficient for this scale in the present study was 0.977.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.4 | Social Impact Scale(SIS)\u003c/h2\u003e\n \u003cp\u003eDeveloped by Fife et al. (Fife \u0026amp; Wright, \u003cspan class=\"CitationRef\"\u003e2000\u003c/span\u003e) and adapted into Chinese by Pan et al. (Pan, Chung, Fife, \u0026amp; Hsiung, \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e), this instrument assesses the levels of internal and external rejection and shame experienced by patients or relevant individuals due to enduring a particular illness. It comprises four dimensions: social exclusion (9 items), economic discrimination (3 items), internal shame (5 items), and social isolation (7 items), totalling 24 items. A four-point rating scale is employed, with scores ranging from 1 (strongly disagree) to 4 (strongly agree), yielding a total score between 24 and 96 points. Higher scores indicate greater perceived social impact and stronger stigma. The Cronbach\u0026apos;s \u0026alpha; coefficient for this scale in the present study was 0.982.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.5 | Personal Mastery scale(PMS)\u003c/h2\u003e\n \u003cp\u003eThis scale was developed by foreign scholars including Pearlin et al. (Pearlin \u0026amp; Schooler, \u003cspan class=\"CitationRef\"\u003e1978\u003c/span\u003e)and adapted into Chinese by Yu Yibing et al. (Yu and Zou, 2008) to measure individuals\u0026apos; perceived control over the outcomes of events they experience. The scale comprises seven items rated on a five-point Likert scale, ranging from \u0026ldquo;strongly disagree\u0026rdquo; (1) to \u0026ldquo;strongly agree\u0026rdquo; (5). Total scores range from 7 to 35, with higher scores indicating greater perceived control over life events. The Cronbach\u0026apos;s \u0026alpha; coefficient for this scale in the present study was 0.905.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.6 | Comprehensive Score for Financial Toxicity(COST)\u003c/h2\u003e\n \u003cp\u003eThis scale was developed by Souza et al. (de Souza et al., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e)and adapted for Chinese use by Yu Huihui et al. (Yu et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). It comprises two dimensions with 11 items in total: positive wealth status (4 items) and negative psychological reactions (7 items). It employs a 5-point Likert scale, with scores ranging from 0 to 4 corresponding to responses from \u0026lsquo;Never\u0026rsquo; to \u0026lsquo;Almost always\u0026rsquo;. The total score ranges from 0 to 44 points, with lower scores indicating more severe economic toxicity in patients. A score\u0026thinsp;\u0026ge;\u0026thinsp;26 indicates no impact on quality of life (Grade 0); 14\u0026ndash;25 denotes mild impact (Grade 1); 1\u0026ndash;13 signifies moderate impact (Grade 2); and 0 represents severe impact (Grade 3). Grade 1 or above is defined as the presence of economic toxicity. The Cronbach\u0026apos;s \u0026alpha; coefficient for this scale in the present study was 0.932.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5 | Data Collection\u003c/h2\u003e\n \u003cp\u003ePrior to the investigation, consent was obtained from the management of a Grade A tertiary hospital. Between January and August 2025, questionnaires were distributed to eczema patients meeting inclusion and exclusion criteria via the Wenjuanxing online platform (Hunan Blue Star Information Technology Co., Ltd., Changsha, China). Standardised instructions explained the study\u0026apos;s purpose, significance, and questionnaire completion method. Participants were informed they could withdraw at any time without repercussions, that participation was entirely voluntary, and that they would complete the questionnaire anonymously and independently based on informed consent.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e2.6 | Quality Control\u003c/h2\u003e\n \u003cp\u003e(1) All questions are mandatory; incomplete submissions will not be accepted; (2) Each IP address may submit only once; (3) Questionnaires were excluded if completed in under 3 minutes, contained obvious contradictions between responses, or featured significant inconsistencies in personal details. This survey yielded 331 completed questionnaires. After excluding 8 non-compliant responses, 323 valid questionnaires were retained, representing an effective recovery rate of 97.58%.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e2.7 | Statistical analysis\u003c/h2\u003e\n \u003cp\u003eIn the quantitative analysis phase of this study, all data were analysed using SPSS 21.0 (IBM Corporation, Armonk, NY, USA). Count data were described using frequencies and percentages; continuous data meeting normal distribution were described using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; intergroup comparisons employed independent samples t-tests or one-way analysis of variance; Pearson correlation analysis was employed to explore associations between social avoidance and distress and perceived social support, stigma, sense of personal mastery, and economic toxicity. Multivariate linear regression analysis examined factors influencing social avoidance and distress, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating statistical significance.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e2.8 | Ethical Considerations\u003c/h2\u003e\n \u003cp\u003eThis study has been approved by the Medical Ethics Committee of the Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine. All participants signed informed consent forms. The research strictly adhered to the principles of the Declaration of Helsinki, ensuring subjects enjoyed full rights and privacy protection throughout the study. All participants voluntarily signed informed consent forms to participate and retained the right to withdraw at any stage. The study strictly adhered to principles of anonymity and confidentiality. All questionnaires excluded sensitive information such as names or national identification numbers, employing only numerical identifiers. Researchers underwent specialised training and strictly observed confidentiality requirements, implementing data management measures to prevent disclosure of participant information.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3 | Results","content":"\u003cp\u003e\u003cb\u003e3.1 | Scores of social avoidance and distress, perceived social support, stigma, sense of personal mastery and economic toxicity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, the total score for social avoidance and distress among 323 eczema patients was (19.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.04). Across the two dimensions, the highest mean item score was observed in the social avoidance dimension (0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42), while the lowest was in the social distress dimension (0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43). The total score for perceived social support was (44.78\u0026thinsp;\u0026plusmn;\u0026thinsp;21.26). Among the three dimensions, the highest mean score was for the family support dimension (3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73), while the lowest was for the friend support dimension (3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83). The total score for stigma was (71.79\u0026thinsp;\u0026plusmn;\u0026thinsp;17.48). Among the four dimensions, the highest mean item scores were observed in the social exclusion dimension (3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76) and the social isolation dimension (3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79), while the lowest was in the economic discrimination dimension (2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81). The total score for sense of personal mastery was (17.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.20). The total score for economic toxicity was (13.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.77). Among the two dimensions, the highest mean item score was observed in the negative psychological reactions dimension (1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96), while the lowest was in the positive wealth status dimension (1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83). See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eScores of social avoidance and distress, perceived social support, stigma, sense of personal mastery and economic toxicity(N\u0026thinsp;=\u0026thinsp;323, (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) )\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDimensional score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAverage of entries\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRanking\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial avoidance and distress total score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e19.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial avoidance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e44.78\u0026thinsp;\u0026plusmn;\u0026thinsp;21.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e15.12\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFriends support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e14.85\u0026thinsp;\u0026plusmn;\u0026thinsp;7.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e14.81\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e71.79\u0026thinsp;\u0026plusmn;\u0026thinsp;17.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense of social exclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e27.01\u0026thinsp;\u0026plusmn;\u0026thinsp;6.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic discrimination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e8.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInner sense of shame\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e14.81\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial isolation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e20.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense of personal mastery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e17.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic toxicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e13.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive wealth status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative psychological reactions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.2 | Sociodemographic characteristics and the scores of social avoidance and distress in patients with eczema\u003c/h2\u003e\u003cp\u003eComparing social avoidance and distress among eczema patients with differing characteristics, the analysis revealed statistically significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in total scores for social avoidance and distress across patients varying by gender, educational attainment, monthly income, eczema type, and disease duration. See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for details.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics and the scores of social avoidance and distress in patients with eczema (N\u0026thinsp;=\u0026thinsp;323).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSocial avoidance and distress (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003et/F\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.729\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e16.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e20.85\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.506\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.603\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.65\u0026thinsp;\u0026plusmn;\u0026thinsp;7.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35ཞ\u0026lt;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.05\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.093\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.964\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.99\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.96\u0026thinsp;\u0026plusmn;\u0026thinsp;7.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced or separated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e20.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational attainment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e310.665\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e26.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower secondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e26.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUpper secondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e13.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e13.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor's degree and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e13.82\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlace of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.281\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.779\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTown/city\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.05\u0026thinsp;\u0026plusmn;\u0026thinsp;6.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.77\u0026thinsp;\u0026plusmn;\u0026thinsp;7.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving arrangements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.641\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.522\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot living alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.84\u0026thinsp;\u0026plusmn;\u0026thinsp;7.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage monthly household income, yuan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e168.224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e24.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3000ཞ\u0026lt;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e25.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5000ཞ\u0026lt;8000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e14.62\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;8000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e11.94\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMethods of Payment for Medical Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.423\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.226\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban Employee Medical Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.56\u0026thinsp;\u0026plusmn;\u0026thinsp;7.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural Cooperative Medical Scheme\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e20.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-funded\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e17.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate Health Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.86\u0026thinsp;\u0026plusmn;\u0026thinsp;8.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e20.53\u0026thinsp;\u0026plusmn;\u0026thinsp;6.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExercise habits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.331\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegular exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrregular exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.66\u0026thinsp;\u0026plusmn;\u0026thinsp;7.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent employment status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.568\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot in employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.75\u0026thinsp;\u0026plusmn;\u0026thinsp;7.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether have any other chronic conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.06\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of eczema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.85\u0026thinsp;\u0026plusmn;\u0026thinsp;6.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e20.14\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubacute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e15.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Episode\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.850\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst Episode\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.92\u0026thinsp;\u0026plusmn;\u0026thinsp;7.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.595\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.01\u0026thinsp;\u0026plusmn;\u0026thinsp;6.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 months to \u0026lt;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e21.73\u0026thinsp;\u0026plusmn;\u0026thinsp;7.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 year to \u0026lt;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e16.80\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 years to \u0026lt;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e15.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e14.69\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.3 | The correlation between social avoidance and distress, perceived social support, stigma, sense of personal mastery and economic toxicity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnalysis revealed that social avoidance and distress among eczema patients were negatively correlated with both the total score and individual dimension scores of perceived social support (\u003cem\u003er\u003c/em\u003e =-0.809 to -0.881, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01); Social avoidance and distress showed positive correlations with both the total score and individual dimension scores of stigma (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.638\u0026ndash;0.711, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01); Social avoidance and distress showed negative correlations with both the total score and individual dimension scores of sense of personal mastery (\u003cem\u003er\u003c/em\u003e = -0.789 to -0.823, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01); Social avoidance and distress were negatively correlated with the total score and all subscale scores of economic toxicity (\u003cem\u003er\u003c/em\u003e = -0.687 to -0.779, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for details.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe correlation between social avoidance and distress, perceived social support, stigma, sense of personal mastery and economic toxicity (N\u0026thinsp;=\u0026thinsp;351, \u003cem\u003er\u003c/em\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe social avoidance and distress total score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial avoidance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSocial anxiety\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.881**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.834**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.860**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.855**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.814**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.829**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFriends support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.857**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.809**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.837**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.872**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.822**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.853**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.711**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.682**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.685**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense of social exclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.673**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.648**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.644**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic discrimination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.685**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.656**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.661**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInner sense of shame\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.692**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.644**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.685**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial isolation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.679**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.638**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.666**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense of personal mastery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.823**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.792**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.789**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic toxicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.779**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.734**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.763**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive wealth status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.726**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.687**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.708**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative psychological reactions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.776**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.729**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.761**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.4 | Multiple linear regression analysis of influencing factors of social avoidance and distress in patients with eczema\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMultivariate linear regression analysis was conducted, employing the total scores for social avoidance and distress among eczema patients as the dependent variable, and variables demonstrating statistical significance in univariate and correlation analyses as independent variables. The specific coding methods for independent variables are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Results indicated that gender, educational attainment, monthly income, perceived social support, stigma, sense of personal mastery, and economic toxicity were the primary factors influencing exercise avoidance among eczema patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), explaining 86.1% of the total variance. See Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription table of virtual variable assignment (N\u0026thinsp;=\u0026thinsp;323)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssignment mode\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u0026thinsp;=\u0026thinsp;0, female\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational attainment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary school and below =\u0026thinsp;1,Lower secondary school\u0026thinsp;=\u0026thinsp;2,Upper secondary schoo\u0026thinsp;=\u0026thinsp;3,College diploma\u0026thinsp;=\u0026thinsp;4,Bachelor's degree and above =\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage monthly household income, yuan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;3000\u0026thinsp;=\u0026thinsp;1, 3000ཞ\u0026lt;5000\u0026thinsp;=\u0026thinsp;2,5000ཞ\u0026lt;8000\u0026thinsp;=\u0026thinsp;3,\u0026ge;8000\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of eczema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTaking \"Infectious skin disease\" as the reference object, the autoimmune skin disease =(0, 1, 0), and allergic skin disease =(0, 0, 1).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;6 months\u0026thinsp;=\u0026thinsp;1, 6 months to \u0026lt;1 year\u0026thinsp;=\u0026thinsp;2, 1 year to \u0026lt;5 years\u0026thinsp;=\u0026thinsp;3, 5 years to \u0026lt;10 years\u0026thinsp;=\u0026thinsp;4,and \u0026ge;\u0026thinsp;10 years\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOriginal value entry\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOriginal value entry\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense of personal mastery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOriginal value entry\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic toxicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOriginal value entry\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple linear regression analysis of influencing factors of social avoidance and distress in patients with eczema (N\u0026thinsp;=\u0026thinsp;323)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003et-\u003c/em\u003evalue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTolerance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eVIF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.656\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.919\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational attainment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.619\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.178\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage monthly household income, yuan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-5.537\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.541\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.848\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of eczema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.274\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.775\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubacute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.466\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.702\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.777\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.885\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.779\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.283\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-6.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.751\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.499\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense of personal mastery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-4.478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.735\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic toxicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.316\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eNote: \u003cem\u003eR\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.930\u003csup\u003ea\u003c/sup\u003e, \u003cem\u003eR\u0026sup2;\u003c/em\u003e=0.865, adjusted \u003cem\u003eR\u0026sup2;\u003c/em\u003e=0.861, \u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;199.992, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 | Discussion","content":"\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e4.1 | 323 eczema sufferers experience significant social avoidance and distress\u003c/h2\u003e\u003cp\u003eThe findings of this study indicate that the total scores for social avoidance and distress among 323 eczema patients were (19.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.04) points, with an average score per item of (0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43) points. Overall, these scores were at a relatively high level, slightly exceeding the results reported by Yuan et al. (Yuan et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)in their study of lung cancer patients. The reasons for this may be analysed as follows: compared to cancer, eczema is a visible, unavoidable skin condition. Skin lesions, erythema, and scaling readily provoke discomfort, questions, or even discrimination from onlookers. This leads patients to experience intense appearance anxiety and stigmatisation in social settings, directly driving social avoidance and distress. Social avoidance and distress among eczema patients encompass two dimensions: social avoidance and social distress. Scores on the social avoidance dimension consistently exceed those on the social distress dimension, indicating that more patients opt to avoid social engagements altogether rather than endure distress and tension during interactions. Possible reasons for this may include: (1) Eczema sufferers experience intense anticipatory anxiety before engaging in social interactions. To protect themselves, they often choose to avoid social situations altogether to prevent this anticipated anxiety from arising, resulting in a higher behavioural tendency towards avoidance(Dalgard et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); (2) The management of skin conditions consumes considerable psychological and emotional energy, leading to emotional exhaustion. According to resource conservation theory, individuals strive to protect and avoid depleting their finite resources. For patients experiencing both physical and mental fatigue, social engagements represent an activity that is particularly taxing on psychological resources. Consequently, they are more inclined to conserve energy by choosing to avoid such activities, resulting in higher avoidance behaviour scores(Hobfoll, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2001\u003c/span\u003e); (3) Some patients may indeed have experienced negative social incidents in the past due to their skin condition, developing a psychological state of \u0026lsquo;learned helplessness\u0026rsquo; and consequently choosing to avoid social situations(Schmid-Ott, Jaeger, Kuensebeck, Ott, \u0026amp; Lamprecht, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). Based on the above, clinical healthcare professionals are advised to incorporate screening for social avoidance and distress into routine care to identify high-risk patients early. Through role-play and other methods, practise navigating potentially awkward scenarios, shifting the focus of intervention to manage anticipatory anxiety. Adopt a resource-conservation approach, recognising patients' emotional and energy depletion, and provide supportive, empowering care. Collaborate with patients to develop simple, efficient, and sustainable personalised treatment and care plans to minimise resource expenditure in disease management. Proactively provide information on peer support groups and psychological counselling to supplement social and psychological resources. For patients with chronic social avoidance, assist them in reflecting on past negative experiences to break the cycle of learned helplessness and rebuild a sense of control. This alleviates social avoidance and distress, promoting active social participation and facilitating return to work and daily life.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.2 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e|\u003c/span\u003e Analysis of Factors Influencing Social Avoidance and Distress Among 323 Eczema Patients\u003c/h2\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e4.2.1 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e| Gender\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eThe findings of this study indicate that gender is a primary factor influencing social avoidance and distress among eczema patients (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.262, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with female patients exhibiting higher levels of social avoidance and distress than their male counterparts. Possible explanations include: women often hold higher standards regarding appearance. The skin lesions, erythema, scaling, and scratch marks caused by eczema can induce intense appearance anxiety and stigma among patients. Furthermore, women tend to internalise emotions and ruminate over negative social experiences. This persistent, negative-information-focused cognitive pattern amplifies distress in social situations and reinforces avoidance behaviours. In contrast, males may be more inclined to distract themselves or externalise their emotions, resulting in lower levels of social avoidance and distress(Hlavacova, Solarikova, Marko, Brezina, \u0026amp; Jezova, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). On this basis, it is recommended that clinical healthcare professionals pay particular attention to female eczema patients' social activities, emotional state, and the impact of their condition on self-image. Through mindfulness therapy, acceptance and commitment therapy, and establishing patient support groups, female patients can be assisted in reducing rumination, lowering their sense of stigma and anxiety during social interactions, thereby diminishing their levels of social avoidance and distress.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003e4.2.2 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e| Educational attainment\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eThe findings of this study indicate that educational attainment is a primary factor influencing social avoidance and distress among eczema patients (\u003cem\u003eB\u003c/em\u003e = -0.619, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Specifically, higher educational attainment correlates with lower levels of social avoidance and distress. Potential explanations include: firstly, patients with higher educational attainment possess greater access to health information, higher health literacy, and stronger capacity to understand and accept their condition; Secondly, patients with higher educational attainment possess stronger work and social skills, broader social networks, and a sound understanding of the negative impacts of social avoidance and the positive benefits of social interaction, thereby exhibiting lower levels of social avoidance. Thirdly, patients with higher educational attainment demonstrate greater capacity and confidence in managing their condition, enabling them to adopt proactive approaches to address negative emotions arising from social interactions and maintain normal social activities(Uchino, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Based on this, it is recommended that clinical care providers should pay attention to the impact of educational attainment on social avoidance and distress among eczema patients. Tailored health education should be provided for patients with different levels of education to improve negative disease perceptions among those with lower educational attainment. This approach aims to enhance their health literacy, reduce negative emotions, assist in effective disease management, and lower levels of social avoidance and distress.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003e4.2.3 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e|\u003c/span\u003e Average monthly household income\u003c/h2\u003e\u003cp\u003eThe findings of this study indicate that average monthly household income is a primary factor influencing psychological avoidance and distress among eczema patients (\u003cem\u003eB\u003c/em\u003e = -1.140, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Specifically, higher average monthly household income correlates with lower levels of social avoidance and distress among patients. The probable rationale is as follows: eczema is a chronic condition prone to recurrence, necessitating prolonged treatment with substantial associated costs that readily impose financial burdens upon patients. Individuals from households with higher average monthly incomes possess greater capacity to cover expensive medical treatments and daily moisturising care products, directly alleviating disease-related economic pressures. Consequently, these patients demonstrate improved disease management and psychological well-being, resulting in lower levels of social avoidance and distress. Conversely, patients from households with lower average monthly incomes experience greater treatment burdens and psychological stress, making them more prone to negative emotions such as anxiety and depression. Their disease management is often suboptimal, leading to higher levels of social avoidance and distress(Jiang, Lyu, Mou, Jiang, \u0026amp; Du, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). On this basis, it is recommended that clinical healthcare professionals implement structured screening to identify low-income individuals, establish supportive ward environments to mitigate anxiety arising from social comparison, collaborate with doctors to develop more affordable treatment plans, and thereby alleviate patients' financial burdens. This approach aims to reduce patients' levels of social avoidance and distress.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003e4.2.4 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e|\u003c/span\u003e Perceived social support\u003c/h2\u003e\u003cp\u003eThis study indicates that perceived social support is a primary factor influencing social avoidance and distress among eczema patients (\u003cem\u003eB\u003c/em\u003e = -0.100, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Perceived social support among eczema patients exhibited a negative correlation with social avoidance and distress, meaning higher levels of perceived social support were associated with lower levels of social avoidance and distress. This finding aligns with the results of Yuan et al.'s (Yuan et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)study on patients following radical lung cancer surgery. Social support refers to the support an individual receives or desires to receive(Furmark et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), Individuals with high levels of perceived social support are more likely to interpret others' arbitrary behaviours as supportive, thereby experiencing greater support, enhanced psychological capital and coping efficacy. This enables patients to engage more actively in social interactions, derive greater satisfaction from interpersonal relationships, directly buffer perceived stress, and ultimately exhibit lower levels of social avoidance and distress(Brissette et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Conversely, the lower an individual's perceived capacity for social support, the more passive their participation in social interactions becomes, leading to heightened social avoidance and distress. Therefore, it is recommended that clinical healthcare professionals establish a multi-tiered, integrated support network involving the \u0026lsquo;healthcare system, family, and society\u0026rsquo;. This should proactively address patients' psychological pressures and life challenges, employing empathetic techniques to convey understanding and support. Establishing peer support groups, providing psychological counselling resources, and incorporating social support into routine chronic disease management protocols will enable patients to feel cared for and supported by the professional community. Secondly, family members should be encouraged to proactively learn eczema care knowledge, avoiding complaints and blame. Instead, they should express support through practical actions such as assisting with medication application, preparing healthy meals, and sharing household responsibilities, thereby providing patients with profound comfort. Finally, patients may be encouraged to selectively disclose their condition to family, close friends, or colleagues, seeking understanding rather than concealing their distress. Community health lectures may be organised to foster an inclusive environment, reducing public misconceptions and discrimination regarding skin conditions. Through systematic interventions, patients receive sustained, consistent positive reinforcement from healthcare professionals, family members, and social circles. This enhances their perceived social support, enabling them to manage their condition with greater positivity and reintegrate into society, thereby reducing instances of social avoidance and distress.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003e4.2.5\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e|\u003c/span\u003e Stigma\u003c/h2\u003e\u003cp\u003eThe findings of this study indicate that stigmatisation is a primary factor influencing social avoidance and distress among eczema patients (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.075, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The sense of stigma among eczema patients was positively correlated with social avoidance and distress, meaning that higher levels of stigma were associated with greater social avoidance and distress among eczema patients. This finding is consistent with the results of O'Suilleabhain et al. (O'Suilleabhain et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)in their study of adult patients with essential tremor. Yang(Yang, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2007\u003c/span\u003e)The emergence of stigma surrounding illness is posited to comprise three components: direct discrimination against patients by others, the internalisation of negative stereotypes by patients themselves, and systemic discrimination within existing social structures. As a visible skin condition, eczema's symptoms\u0026mdash;such as skin lesions, erythema, and desquamation\u0026mdash;are readily noticeable to others and may be erroneously associated with negative labels like \u0026lsquo;contagious\u0026rsquo; or \u0026lsquo;poor hygiene\u0026rsquo;. This anticipated or actual negative social evaluation directly triggers feelings of shame, embarrassment, and anxiety, fostering a sense of stigma. This compels individuals to actively avoid social situations, thereby generating social avoidance and distress(Chernyshov, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Based on this, it is recommended that clinical healthcare professionals incorporate stigmatisation into routine dermatological clinical assessments to identify patients at high risk of stigmatisation early. Concurrently, they should proactively and clearly explain to patients and their families the non-contagious, chronic and recurrent nature of eczema, alongside current treatment objectives and strategies. Introducing psychosocial support and cognitive behavioural interventions, and encouraging patient participation in support groups, is advised. When formulating treatment plans, full consideration should be given to patients' concerns regarding the visibility of skin lesions. Active and effective management of lesions in visible areas (such as the face and hands) should be prioritised, alongside rapid relief of symptoms like itching. This approach helps patients regain social confidence, reduces levels of stigma, and thereby promotes active social engagement while alleviating social avoidance and distress.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003e4.2.6\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e|\u003c/span\u003e Sense of personal mastery\u003c/h2\u003e\u003cp\u003eThe findings of this study indicate that personal sense of control is a primary factor influencing social avoidance and distress among eczema patients (\u003cem\u003eB\u003c/em\u003e = -0.176, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). A negative correlation exists between personal sense of control and both social avoidance and distress in eczema patients, meaning that higher levels of personal sense of control correlate with lower levels of social avoidance and distress. The sense of personal mastery denotes the degree to which an individual believes that life events and outcomes can be controlled through personal actions rather than determined by external forces. It serves as a crucial psychological resource in coping with stress, with high levels effectively buffering the adverse effects of stressful events on mental health. Within medical contexts, patients' sense of personal mastery manifests in their perceptions of disease management, treatment decision-making, and control over daily life, constituting one of the predictors of quality of life for chronic disease patients(Pearlin \u0026amp; Schooler, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e1978\u003c/span\u003e). Eczema, as a significant negative life event, frequently leads to diminished self-efficacy, altered body image, and detachment from social roles among sufferers. This profoundly undermines their sense of personal control. Such a loss of control readily triggers avoidance behaviours in social situations and considerable psychological distress(Pearlin \u0026amp; Schooler, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e1978\u003c/span\u003e). On this basis, it is recommended that clinical healthcare professionals systematise psychosocial assessments, prioritising high-risk individuals. Employing empowering language, they should explain the purpose of treatment and care in accessible terms, instruct patients in self-management skills, assist in reconstructing bodily intentions, uphold patient dignity, and enhance their sense of personal control. This approach will thereby mitigate levels of social avoidance and distress.\u003cb\u003e4.2.7\u003c/b\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e|\u003c/span\u003e\u003cb\u003eEconomic toxicity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe findings of this study indicate that economic toxicity is a primary factor influencing social avoidance and distress among eczema patients (\u003cem\u003eB\u003c/em\u003e = -0.081, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Economic toxicity (inverse scoring) in eczema patients exhibits a negative correlation with social avoidance and distress; that is, lower economic toxicity scores correspond to higher levels of social avoidance and distress among eczema patients. Economic toxicity denotes the adverse impact of substantial treatment costs on patients and their families, encompassing both objective financial burdens and subjective psychological distress(Zafar \u0026amp; Abernethy, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The treatment and daily management of eczema entail ongoing substantial expenditure, leading patients to significantly reduce or eliminate budgets allocated to social activities, thereby resulting in diminished participation in such engagements(Whiteley, Emir, Seitzman, \u0026amp; Makinson, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Concurrently, severe eczema may disrupt patients' normal work, leading to reduced or interrupted income. This not only exacerbates economic toxicity but also directly diminishes opportunities for social engagement, intensifying psychological distress, anxiety, and feelings of helplessness. These negative emotions compound the itching and sleep deprivation inherent to eczema, significantly impairing patients' emotional regulation and self-confidence. Consequently, they experience distress in social situations and may choose to withdraw from social interactions(Siligato et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). On this basis, it is recommended that clinical healthcare professionals incorporate patients' economic toxicity and psychosocial burden into routine screening protocols, proactively identifying those experiencing financial hardship. When formulating treatment plans, shared decision-making with patients is essential, with full consideration given to their economic capacity. Prioritise cost-effective, sustainable treatment and care options to avoid exacerbating economic toxicity through overtreatment, thereby preventing a vicious cycle. For patients experiencing high economic toxicity, mental health assessments should be conducted at the earliest opportunity. Provide necessary psychological counselling and cognitive behavioural therapy to help them build psychological capital for coping with financial pressures and stigma associated with illness, thereby reducing social avoidance and distress.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"5 | Limitations and Recommendations","content":"\u003cp\u003eThis study employed a health ecology model to analyse the current state and influencing factors of social avoidance and distress among eczema patients, offering an innovative perspective for their care. However, this study has several limitations: (1) The sample was restricted to patients with chronic skin disease from eight Grade A tertiary hospitals in mainland China, with a small sample size and a simple sampling method, resulting in limited representativeness. Future research is advised to employ representative sampling strategies and expand the geographical scope of the sample to enhance the generalisability of the findings; (2) The cross-sectional design precludes accurate determination of causal relationships and directionality between perceived social support, stigma, sense of personal mastery, and social avoidance/distress. Future large-scale, multi-level, multi-centre studies incorporating longitudinal and qualitative research are warranted to validate findings; (3) Self-reported data based on subjective perceptions are susceptible to bias. Subsequent studies should incorporate multi-dimensional perspectives, including assessments by family members and healthcare professionals regarding social avoidance and distress among eczema patients.\u003c/p\u003e"},{"header":"6 | Conclusions","content":"\u003cp\u003eThis study confirms that individuals with eczema experience elevated levels of social avoidance and distress, necessitating urgent implementation of effective interventions. Social avoidance and distress among eczema patients exhibit negative correlations with perceived social support, economic toxicity, and personal sense of control, whilst demonstrating positive associations with stigmatisation. This finding provides a theoretical basis for alleviating social avoidance and distress among eczema patients. Future healthcare institutions may translate these research findings into practical interventions by focusing on assessing and identifying social avoidance and distress, establishing support networks, reducing stigma, enhancing sense of personal mastery, and alleviating treatment burdens. Such approaches will ultimately facilitate patients' social reintegration and improve their quality of life.\u003c/p\u003e"},{"header":"7 | Relevance to Clinical Practice","content":"\u003cp\u003eIn this study, patients with eczema exhibited elevated levels of social avoidance and distress, highlighting the urgent need for healthcare institutions and community health services to prioritise the quality of life and mental health of this population. Furthermore, the findings reveal that social avoidance and distress among eczema patients are negatively correlated with perceived social support, economic toxicity, and sense of personal mastery, while exhibiting a positive association with stigma. Consequently, incorporating these variables into comprehensive health management programmes for eczema patients holds significant reference value.\u003c/p\u003e\n\u003cp\u003eBased on these findings, future healthcare institutions may commence by establishing a multidimensional, systematic psychosocial support framework. This system should integrate multidisciplinary and community resources, with core interventions including: firstly, implementing routine screening using simplified tools to rapidly assess patients\u0026apos; perceived social support, stigma, personal sense of control, and economic toxicity during outpatient visits, enabling early identification of high-risk individuals; Secondly, offering structured interventions such as disease self-management courses to enhance a sense of personal mastery, introducing cognitive behavioural therapy to help patients reframe perceptions of their self-image and reduce stigma, and alleviating economic toxicity through selecting lower-cost treatment options; Thirdly, fostering peer support by establishing patient support groups. Sharing successful coping strategies strengthens social connections and belonging, thereby internally enhancing patients\u0026apos; capacity to perceive social support. This closed-loop management model improves social avoidance and distress among eczema patients, comprehensively elevating their quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of moral approval and consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Medical Ethics Committee of Tianjin Academy of Traditional Chinese Medicine affiliated Hospital.All participants in this study gave informed consent and volunteered to participate in the study, and agreed that the study would be published in an academic journal.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNa Cai, Tao Guo and Yue Zhu contributed to the work design, data collection, data acquisition, data analysis, data interpretation, draft the article, revise important intellectual content of the article, and the final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003eJiaxing Li, Junchen He and Yubin Liu contributed to the work design, analysis, data acquisition, data interpretation, draft the article, and the final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003eZhangyi Wang, Dandan Wang and Xue Li contributed to the analysis of the work, data interpretation, draft the article, and the final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003eFengting Zhang and Shijie Huang contributed to the analysis of the work, data interpretation, draft the article, and the final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003eYi Ren contributed to the data interpretation, revise important intellectual content of the article, and the final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll researchers would like to express our gratitude to all the participants for taking their precious time to participate in this study, and also thank the hospital managers and nursing administrators for their strong support and help to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Tianjin Municipal Science and Technology Programme Project [grant numbers: 25KPXCRC00400].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStatement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe relevant data of this study can be obtained from the first author or corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAl-Naqeeb, J., Danner, S., Fagnan, L. J., Ramsey, K., Michaels, L., \u0026amp; Mitchell, J., et al. (2019). The Burden of Childhood Atopic Dermatitis in the Primary Care Setting: A Report from the Meta-LARC Consortium. \u003cem\u003eJ Am Board Fam Med, 32\u003c/em\u003e(2), 191-200.\u003c/li\u003e\n\u003cli\u003eBrissette, I., Scheier, M. F., \u0026amp; Carver, C. S. (2002). The role of optimism in social network development, coping, and psychological adjustment during a life transition. \u003cem\u003eJ Pers Soc Psychol, 82\u003c/em\u003e(1), 102-111.\u003c/li\u003e\n\u003cli\u003eChan, C. X., \u0026amp; Zug, K. A. (2021). Diagnosis and Management of Dermatitis, Including Atopic, Contact, and Hand Eczemas. \u003cem\u003eMed Clin North Am, 105\u003c/em\u003e(4), 611-626.\u003c/li\u003e\n\u003cli\u003eChen, P., Xu, S., Nian, J., Pan, Y., \u0026amp; Jiang, X. (2025). Mediating effects of sense of coherence and psychological resilience on stigma and quality of life among postoperative middle-aged and older patients with malignant gynecological tumors: a cross-sectional, structural equation model. \u003cem\u003eSupport Care Cancer, 33\u003c/em\u003e(9), 792.\u003c/li\u003e\n\u003cli\u003eChernyshov, P. V. (2019). The Evolution of Quality of Life Assessment and Use in Dermatology. \u003cem\u003eDermatology, 235\u003c/em\u003e(3), 167-174.\u003c/li\u003e\n\u003cli\u003eDalgard, F. J., Gieler, U., Tomas-Aragones, L., Lien, L., Poot, F., \u0026amp; Jemec, G. B. E., et al. (2015). The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. \u003cem\u003eJ Invest Dermatol, 135\u003c/em\u003e(4), 984-991.\u003c/li\u003e\n\u003cli\u003eDalgard, F. J., Svensson, \u0026Aring;., Halvorsen, J. A., Gieler, U., Schut, C., \u0026amp; Tomas-Aragones, L., et al. (2020). Itch and Mental Health in Dermatological Patients across Europe: A Cross-Sectional Study in 13 Countries. \u003cem\u003eJ Invest Dermatol, 140\u003c/em\u003e(3), 568-573.\u003c/li\u003e\n\u003cli\u003ede Souza, J. A., Yap, B. J., Hlubocky, F. J., Wroblewski, K., Ratain, M. J., \u0026amp; Cella, D., et al. (2014). The development of a financial toxicity patient-reported outcome in cancer: The COST measure. \u003cem\u003eCancer, 120\u003c/em\u003e(20), 3245-3253.\u003c/li\u003e\n\u003cli\u003eElezbawy, B., Fasseeh, A. N., Fouly, E., Tannira, M., Dalle, H., \u0026amp; Aderian, S., et al. (2023). Humanistic and Economic Burden of Atopic Dermatitis for Adults and Adolescents in the Middle East and Africa Region. \u003cem\u003eDermatol Ther (Heidelb), 13\u003c/em\u003e(1), 131-146.\u003c/li\u003e\n\u003cli\u003eElezbawy, B., Kal\u0026oacute;, Z., Fasseeh, A., Inotai, A., Nemeth, B., \u0026amp; \u0026Aacute;gh, T. (2025). The hidden burden of atopic dermatitis in central and Eastern European countries. \u003cem\u003eExpert Rev Pharmacoecon Outcomes Res, 25\u003c/em\u003e(2), 257-264.\u003c/li\u003e\n\u003cli\u003eFife, B. L., \u0026amp; Wright, E. R. (2000). The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. \u003cem\u003eJ Health Soc Behav, 41\u003c/em\u003e(1), 50-67.\u003c/li\u003e\n\u003cli\u003eFurmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., \u0026amp; Bohman, B., et al. (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. \u003cem\u003eBr J Psychiatry, 195\u003c/em\u003e(5), 440-447.\u003c/li\u003e\n\u003cli\u003eGuo, L., Zhang, M., Namassevayam, G., Wei, M., Zhang, G., \u0026amp; He, Y., et al. (2023). Effectiveness of health management among individuals at high risk of stroke: An intervention study based on the health ecology model and self-determination theory (HEM-SDT). \u003cem\u003eHeliyon, 9\u003c/em\u003e(11), e21301.\u003c/li\u003e\n\u003cli\u003eHlavacova, N., Solarikova, P., Marko, M., Brezina, I., \u0026amp; Jezova, D. (2017). Blunted cortisol response to psychosocial stress in atopic patients is associated with decrease in salivary alpha-amylase and aldosterone: Focus on sex and menstrual cycle phase. \u003cem\u003ePsychoneuroendocrinology, 78\u003c/em\u003e, 31-38.\u003c/li\u003e\n\u003cli\u003eHobfoll, S. E. (2001). The Influence of Culture, Community, and the Nested‐Self in the Stress Process: Advancing Conservation of Resources Theory. \u003cem\u003eApplied Psychology, 50\u003c/em\u003e(3), 337-421.\u003c/li\u003e\n\u003cli\u003eJiang, H., Lyu, J., Mou, W., Jiang, Q., \u0026amp; Du, J. (2023). Association between financial toxicity and health-related quality of life in cancer survivors: A systematic review. \u003cem\u003eAsia Pac J Clin Oncol, 19\u003c/em\u003e(4), 439-457.\u003c/li\u003e\n\u003cli\u003eKage, P., Simon, J., \u0026amp; Treudler, R. (2020). Atopic dermatitis and psychosocial comorbidities. \u003cem\u003eJ Dtsch Dermatol Ges, 18\u003c/em\u003e(2), 93-102.\u003c/li\u003e\n\u003cli\u003eKroenke, C. H., Michael, Y. L., Poole, E. M., Kwan, M. L., Nechuta, S., \u0026amp; Leas, E., et al. (2017). Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project. \u003cem\u003eCancer, 123\u003c/em\u003e(7), 1228-1237.\u003c/li\u003e\n\u003cli\u003eKuang, J., Yang, L., Lv, R., Li, J., Zhou, K., \u0026amp; Xu, M. (2022). The mediating effect of post-stroke depression between social support and quality of life among stroke survivors: A meta-analytic structural equation modeling. \u003cem\u003eInt J Geriatr Psychiatry, 37\u003c/em\u003e(12).\u003c/li\u003e\n\u003cli\u003eLahousen, T., Kupfer, J., Gieler, U., Hofer, A., Linder, M. D., \u0026amp; Schut, C. (2016). Differences Between Psoriasis Patients and Skin-healthy Controls Concerning Appraisal of Touching, Shame and Disgust. \u003cem\u003eActa Derm Venereol, 96\u003c/em\u003e(217), 78-82.\u003c/li\u003e\n\u003cli\u003eLangan, S. M., Irvine, A. D., \u0026amp; Weidinger, S. (2020). Atopic dermatitis. \u003cem\u003eLancet, 396\u003c/em\u003e(10247), 345-360.\u003c/li\u003e\n\u003cli\u003eMalone, S., Counts, L., Zabotka, L., Williams, A., Loecher, N., \u0026amp; Wynja, K., et al. (2025). Stigma measurement in health: a systematic review. \u003cem\u003eEClinicalMedicine, 86\u003c/em\u003e, 103360.\u003c/li\u003e\n\u003cli\u003eM\u0026uuml;hlberger, C., Angus, D. J., Jonas, E., Harmon-Jones, C., \u0026amp; Harmon-Jones, E. (2017). Perceived control increases the reward positivity and stimulus preceding negativity. \u003cem\u003ePsychophysiology, 54\u003c/em\u003e(2), 310-322.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Kearney, E. L., Brown, C. R., Jelinek, G. A., Neate, S. L., Taylor, K. T., \u0026amp; Bevens, W., et al. (2020). Mastery is associated with greater physical and mental health-related quality of life in two international cohorts of people with multiple sclerosis. \u003cem\u003eMult Scler Relat Disord, 38\u003c/em\u003e, 101481.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Suilleabhain, P., Berry, D. S., Lundervold, D. A., Turner, T. H., Tovar, M., \u0026amp; Louis, E. D. (2023). Stigma and Social Avoidance in Adults with Essential Tremor. \u003cem\u003eMov Disord Clin Pract, 10\u003c/em\u003e(9), 1317-1323.\u003c/li\u003e\n\u003cli\u003ePan, A., Chung, L., Fife, B. L., \u0026amp; Hsiung, P. (2007). Evaluation of the psychometrics of the Social Impact Scale: a measure of stigmatization. \u003cem\u003eInt J Rehabil Res, 30\u003c/em\u003e(3), 235-238.\u003c/li\u003e\n\u003cli\u003ePearlin, L. I., \u0026amp; Schooler, C. (1978). The structure of coping. \u003cem\u003eJ Health Soc Behav, 19\u003c/em\u003e(1), 2-21.\u003c/li\u003e\n\u003cli\u003eRodebaugh, T. L., Lim, M. H., Shumaker, E. A., Levinson, C. A., \u0026amp; Thompson, T. (2015). Social Anxiety and Friendship Quality over Time. \u003cem\u003eCogn Behav Ther, 44\u003c/em\u003e(6), 502-511.\u003c/li\u003e\n\u003cli\u003eSantuzzi, A. M. (2011). Anticipating evaluative social interactions involving persons with disabilities. \u003cem\u003eRehabil Psychol, 56\u003c/em\u003e(3), 231-242.\u003c/li\u003e\n\u003cli\u003eSchmid-Ott, G., Jaeger, B., Kuensebeck, H. W., Ott, R., \u0026amp; Lamprecht, F. (1996). Dimensions of stigmatization in patients with psoriasis in a \u0026quot;Questionnaire on Experience with Skin Complaints\u0026apos;. \u003cem\u003eDermatology, 193\u003c/em\u003e(4), 304-310.\u003c/li\u003e\n\u003cli\u003eSiligato, R., Gembillo, G., Di Simone, E., Di Maria, A., Nicoletti, S., \u0026amp; Scichilone, L. M., et al. (2024). Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol. \u003cem\u003eMethods Protoc, 7\u003c/em\u003e(2).\u003c/li\u003e\n\u003cli\u003eSilverberg, J. I., Gelfand, J. M., Margolis, D. J., Boguniewicz, M., Fonacier, L., \u0026amp; Grayson, M. H., et al. (2019). Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. \u003cem\u003eBr J Dermatol, 181\u003c/em\u003e(3), 554-565.\u003c/li\u003e\n\u003cli\u003eTang, F., Xiong, Q., Gan, T., Yuan, L., Liao, Q., \u0026amp; Yu, Y. (2022). The prevalence of alexithymia in psoriasis: A systematic review and meta-analysis. \u003cem\u003eJ Psychosom Res, 161\u003c/em\u003e, 111017.\u003c/li\u003e\n\u003cli\u003eToth, I., \u0026amp; Neumann, I. D. (2013). Animal models of social avoidance and social fear. \u003cem\u003eCell Tissue Res, 354\u003c/em\u003e(1), 107-118.\u003c/li\u003e\n\u003cli\u003eUchino, B. N. (2006). Social support and health: a review of physiological processes potentially underlying links to disease outcomes. \u003cem\u003eJ Behav Med, 29\u003c/em\u003e(4), 377-387.\u003c/li\u003e\n\u003cli\u003eVon Elm, E., Altman, D. G., Egger, M., Pocock, S. J., G Tzsche, P. C., \u0026amp; Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies for the STROBE initiative. \u003cem\u003eBulletin of the World Health Organization, 85\u003c/em\u003e(11), 867-872.\u003c/li\u003e\n\u003cli\u003eWang, J., Tischer, C., Standl, M., Weidinger, S., von Berg, A., \u0026amp; Herberth, G., et al. (2022). Lifetime prevalence and determinants of hand eczema in an adolescent population in Germany: 15-year follow-up of the LISA cohort study. \u003cem\u003eJ Eur Acad Dermatol Venereol, 36\u003c/em\u003e(4), 547-556.\u003c/li\u003e\n\u003cli\u003eWatson, D., \u0026amp; Friend, R. (1969). Measurement of social-evaluative anxiety. \u003cem\u003eJ Consult Clin Psychol, 33\u003c/em\u003e(4), 448-457.\u003c/li\u003e\n\u003cli\u003eWhiteley, J., Emir, B., Seitzman, R., \u0026amp; Makinson, G. (2016). The burden of atopic dermatitis in US adults: results from the 2013 National Health and Wellness Survey. \u003cem\u003eCurr Med Res Opin, 32\u003c/em\u003e(10), 1645-1651.\u003c/li\u003e\n\u003cli\u003eWhittle, H. J., Palar, K., Ranadive, N. A., Turan, J. M., Kushel, M., \u0026amp; Weiser, S. D. (2017). \u0026quot;The land of the sick and the land of the healthy\u0026quot;: Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States. \u003cem\u003eSoc Sci Med, 190\u003c/em\u003e, 181-189.\u003c/li\u003e\n\u003cli\u003eYang, L. H. (2007). Application of mental illness stigma theory to Chinese societies: synthesis and new directions. \u003cem\u003eSingapore Med J, 48\u003c/em\u003e(11), 977-985.\u003c/li\u003e\n\u003cli\u003eYu, H., Yu, Z., Li, H., Zhao, H., Sun, J., \u0026amp; Liu, Y. (2021). The COmprehensive Score for financial Toxicity in China: Validation and Responsiveness. \u003cem\u003eJ Pain Symptom Manage, 61\u003c/em\u003e(6), 1297-1304.\u003c/li\u003e\n\u003cli\u003eYuan, W., Jiang, Y., Sun, M., Zhao, Q., Qiao, G., \u0026amp; Zheng, Y. (2024). Factors influencing social avoidance and distress after radical lung cancer resection: a mediation analysis. \u003cem\u003eAm J Transl Res, 16\u003c/em\u003e(9), 4770-4778.\u003c/li\u003e\n\u003cli\u003eZafar, S. Y., \u0026amp; Abernethy, A. P. (2013). Financial toxicity, Part I: a new name for a growing problem. \u003cem\u003eOncology (Williston Park), 27\u003c/em\u003e(2), 80-81, 149.\u003c/li\u003e\n\u003cli\u003eZhao, Q., Huangfu, C., Li, J., Liu, H., \u0026amp; Tang, N. (2022). Psychological Resilience as the Mediating Factor Between Stigma and Social Avoidance and Distress of Infertility Patients in China: A Structural Equation Modeling Analysis. \u003cem\u003ePsychol Res Behav Manag, 15\u003c/em\u003e, 391-403.\u003c/li\u003e\n\u003cli\u003eZimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., \u0026amp; Berkoff, K. A. (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. \u003cem\u003eJ Pers Assess, 55\u003c/em\u003e(3-4), 610-617.\u003c/li\u003e\n\u003cli\u003eZuberbier, T., Abdul Latiff, A., Aggelidis, X., Augustin, M., Balan, R., \u0026amp; Bangert, C., et al. (2023). A concept for integrated care pathways for atopic dermatitis-A GA(2) LEN ADCARE initiative. \u003cem\u003eClin Transl Allergy, 13\u003c/em\u003e(9), e12299.\u003c/li\u003e\n\u003cli\u003eJiang, Q. J. (2001). Perceived Social Support Scale. \u003cem\u003eChinese Journal of Behavioural Medical Science\u003c/em\u003e, 10(\u003cem\u003e10\u003c/em\u003e), 41-43.\u003c/li\u003e\n\u003cli\u003eMa Hong. (1999). Manual for the Mental Health Assessment Scale. \u003cem\u003eBeijing: Chinese Journal of Mental Health Publishing House.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eYu Yibing, \u0026amp; Zou Hong. (2008). A Study on the Developmental Characteristics of Positive Psychological Qualities in Migrant Children. \u003cem\u003eChinese Journal of Special Education\u003c/em\u003e (4), 78-83.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"eczema, social avoidance and distress, perceived social support, stigma associated with illness, sense of personal control, economic toxicity, influencing factors, health ecology model","lastPublishedDoi":"10.21203/rs.3.rs-7811981/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7811981/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePatients with eczema often experience profound stigma, low self-esteem, and anxiety due to lesions appearing on exposed areas, leading to social avoidance behaviours and significant distress. This severely impacts overall quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA convenience sampling method was employed to survey eczema patients across eight grade A tertiary hospitals in China. A questionnaire survey was administered using general information questionnaire, the Social Avoidance and Distress Scale, the Perceived Social Support Scale, the Social Impact Scale, the sense of personal mastery scale , and the Comprehensive Score for Economic Toxicity. Descriptive statistics, mean differences, one-way analysis of variance, correlation analysis, and multiple linear regression analysis were employed to identify relevant influencing factors.\u003c/p\u003e\n\u003cp\u003eResults: Patients with eczema scored (19.00±7.04) on social avoidance and distress. Multivariate linear regression analysis revealed that gender, educational attainment, average monthly household income, perceived social support, stigma, sense of personal mastery, and economic toxicity, when included in the regression equation, explained 86. 1% of the total variance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003ePatients with eczema experience social avoidance and distress at a moderately high level. Factors influencing social avoidance and distress include gender, educational attainment, average monthly household income, perceived social support, stigma, sense of personal control, and economic toxicity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Social avoidance and distress in eczema patients based on a health ecology model: a cross-sectional survey study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-20 16:03:37","doi":"10.21203/rs.3.rs-7811981/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e2f0be84-7d02-4e85-8940-e931667a55e2","owner":[],"postedDate":"November 20th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-20T07:51:03+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-20T07:55:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-20 16:03:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7811981","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7811981","identity":"rs-7811981","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}