ACconnec eVputl goaf rGisi rSlsi ginni fJucianniotrly H Ligohw eSrcsh tohoel: SAelf-Prospective Cross-Sectional Study

Qian Liu1,Yi-Ping Ge1,?,Chun-Yan Cao2

1Department of Cosmetic Surgery,2Nursing Department,Hospital for Skin Diseases(Institute of Dermatology),Chinese Academy of Medical Sciences and Peking Union Medical College,Nanjing,Jiangsu 210042,China.

Abstract

Keywords:acne vulgaris,junior high school student,self-concept,gender,female

Introduction

Acne vulgaris is a common chronic inflammatory disease of the sebaceous glands that usually occurs during puberty,primarily involves the facial area,and tends to cause cosmetically disfiguring pigmentation,depressed scars,or other symptoms.1-4Self-concept, also known as selfawareness, refers to the perception and subjective evaluation of an individual regarding his or her own physical,mental,and social functions and status,including personal consciousness of oneself,nature,others,and social relationships.5-6Self-concept plays an important role in the physical and mental health of adolescents,7-8who is in a stage of confusing self-identity characterized by ever-changing ideas, self-appraisal, self-control, and unstable moods.9People with a low self-concept are more likely to develop depression than those with a high self-concept.8,10-13The occurrence of acne in puberty usually coincides with adolescence, thus significantly decreasing teenagers’confidence,leading to anxiety and depression,and lowering their quality of life and social adaptability.2-3

The present study aimed to investigate the self-concept of teenagers with acne and the risk factors influencing self-concept,to provide evidence for accurate interventions and the promotion of mental and physical health of teenagers in junior high school.

Materials and methods

Study subjects

Grade 7 students from two junior high schools in Nantong,China were selected as the study subjects,and divided into two groups:the group with acne and the healthy group without acne.The diagnosis of acne vulgaris was made by dermatologists in accordance with the criteria proposed in the Chinese Guideline for Diagnosis and Treatment of Acne.1Individuals with severe physical diseases (eg, hearing loss or speech impairment) and mental disorders were excluded. All subjects or the guardians provided written informed consent for study participation. The study was approved by the Ethics Committee of the Hospital for Skin Diseases(Institute of Dermatology),Chinese Academy of Medical Sciences[No.(2017)Kuai-Shen No.(KY028)].

A total of 598 questionnaires were issued,and 576 valid questionnaires were collected (validity percentage 96.32%), including 267 from students with acne(46.35%)and 309 from healthy students(53.65%).

Demographic questionnaire

The questionnaire survey included questions about factors that might affect the self-concept development of students,such as sex, age, parents’ educational background,parents’jobs,relationships with classmates and teachers,and academic record.14-16

Piers-Harris children’s self-concept scale(PHCSS)

The PHCSS was developed by the American psychologists,is applicable to children aged 8-16 years.17It is used for selfassessment study of children,and is widely used due to its good reliability and validity.17-18It consists of 80 items and six subscales:intelligence and school status,physical appearance and attributes,anxiety,behavior,happiness and satisfaction,and popularity.With answer of“yes”or“no”to each item,and 1 point award for the right answer higher score denotes a better self-concept.17-18

Survey process

The surveyed classes received questionnaires issued by trained surveyors 10 minutes before class.The surveyors provided explanations and instructions for the questionnaires.Subsequently,the questionnaires were independently completed by the subjects,and collected after completion.

Statistical analysis

Data were recorded by two independent persons with Epidata, before being checked, corrected and then

imported into SPSS software(version 21.0,SPSS Inc.,Chicago,IL)for statistical analysis.The measurements were represented as mean±standard deviation. The counts were represented as frequencies or percentages.The PHCSS scores for the acne group and the healthy group were compared using the Chi-squared test and nonparametric test.The factors influencing the PHCSS scores were analyzed with multiple linear regression for each individual factor.To conduct multiple regression analysis,the total PHCSS score was regarded as the dependent variable,and the variables with statistical significance in the univariate analysis were selected as the independent variables.A stepwise backward method was adopted.The test level was set at α=0.05.

Results

Demographic information

Among 267 students with acne,122 were male and 145 were female;the mean age was 13.02±0.70 years.Of the 309 healthy students,163 were male and 146 were female,and the mean age was 13.06±0.62 years.There were no significant differences between the two groups regarding age and sex(both P＞0.05).

Comparison of the PHCSS scores between the acne and healthy groups

The popularity subscale score in the acne group was lower than that in the healthy group(8.89±1.78 of 9.45±1.78, P＜0.01). The PHCSS subscale scores for physical appearance and attributes, happiness and satisfaction, and popularity were significantly lower for girls with acne than for healthy girls(P＜0.05 for all).In contrast,the total PHCSS score and subscale scores did not significantly differ between boys with acne and healthy boys(Table 1).

Risk factors influencing the self-concept of girls with acne

The univariate analysis revealed that the factors influencing the PHCSS of girls with acne were:relationship with parents,relationship with classmates,father’s educational background, mother’seducational background, and family care(all P＜0.05,Table 2).

Multiple regression analysis revealed that the factors influencing the PHCSS of girls with acne were:relationship with parents,relationship with classmates,and paternal educational background(Table 3).

Discussion

Our study showed that compared with the healthy girls,the girls with acne had a lower total PHCSS score and lower subscale scores for physical appearance and attributes, happiness and satisfaction, and popularity,

which means that the acne has negative effects on the girls’self-concept.

Table 1Comparison of Piers-Harris children’s self-concept scale scores between the group with and without acne.

Table 2Univariate analysis of the factors inf ulencing the self-concept score of girls with acne by univariate analysis.

The self-concept level of girls is generally better than that of boys during puberty.7,23However,the occurrence of facial acne makes girls dissatisfied with their physical appearance,rendering them socially incompetent,affecting their happiness and satisfaction,and decreasing their level of self-concept.Females with acne are twice as likely to have depression as males with acne;the incidence of depression in females with acne is 10.6%,while that in males is 5.3%.5,19Women with acne had significantly lower scores of self-esteem than men with acne(27 vs.30;P=0.007).20The lever of girls with acne,suffering from depression,was significantly higher than those without acne(51%vs.32%;P＜0.001).21

The self-concept is a stable mental structure that is formed during the dynamic interacting process between the individual and their social environment, and its formation and development are restricted by many factors.22Family is the frontline to society;hence,the development of self-concept is affected by family-related factors.The present survey results showed that the selfconcept level of girls with acne was affected by both their relationship with their parents and their father’s educational background,which is consistent with the results of previous studies.14-16Parents generally have a close bond with their teenage children.A family atmosphere is formed based on family members’way of thinking,job characteristics,way of dealing with people,and inter-relational skills,which continuously affects the self-concept development of teenagers.In addition,the present multiple linear regression result indicates that self-concept development of girls with acne is affected by their relationship with school classmates,which is consistent with the results of previous studies.5,23-24Currently,most students in junior high schools in China are the sole child in their family,and students spend a considerably long time with their peers in school.Thus,their relationship with other students has an important effect on the formation and development of self-concept. Furthermore, girls are generally more sentimental and sensitive than boys,and so relationships with other students exert a greater impact on self-concept for girls than for boys.

Family and school have an important influence on the self-concept level of girls with acne.Parents and teachers should provide more care and help for girls with acne.Parents should actively acquire knowledge regarding acne,seek dermatologists’advice,and properly manage their child’s diet,skin care,use of medicine,and lifestyle to build their child’s confidence in overcoming acne with a positive attitude. Schools should also establish a culture of“appearance is good but being hardworking is better.”Teachers should show sympathy and patience to girls with acne,guide them to divert their attention to learning,and tell them that their confidence relies on their inner qualities rather than outward appearances.In classrooms,fellow students should be encouraged to help girls with acne,as it is a common condition during puberty that might affect anyone at any time.Students would benefit from an open and positive atmosphere.

Table 3Multiple regression analysis of the factors in ful encing the self-concept of girls with acne.

In conclusion,puberty is an important period for the development of self-concept and character.The presence of facial acne significantly reduces the self-concept level of girls.Parents and teachers play an important role in home and school life,respectively,and should exert a positive influence and provide care and support to girls with acne to help them to build active self-concept and prevent and reduce mental issues.These factors are critical to improve the mentality and comprehensive competence of girls with acne,and to promote their physical and mental development.

Acknowledgement

This study was supported by the Peking Union Medical College Young Scholar Research Fund(No.2017330013).