Indian Journal of Allergy, Asthma and Immunology

ORIGINAL ARTICLE
Year
: 2013  |  Volume : 27  |  Issue : 1  |  Page : 42--46

Comparison between psychological traits of patients with various atopic allergic diseases and healthy volunteers: A case-control study


Seyed Abolghasem Mehrinejad1, Masoumeh Jalili1, Javad Ghaffari2,  
1 Department of Psychology, Alzahra University, Tehran, Iran
2 Molecular and Cell Biology Research Center, Mazandaran University of Medical Sceinces, Sari, Iran

Correspondence Address:
Javad Ghaffari
Department of Allergy and Immunology, Mazandaran University of Medical Sciences, Sari
Iran

Abstract

Purpose: Allergic patients have a specific psychological profile and experience a specific mental and emotional context. This study examines the psychological traits of allergic patients in comparison with those of control group. Materials and Methods: This was a case-control study in which 102 men and women allergic patients who referred to Sari Tooba clinic were selected. One hundred and two people from the normal population were selected as the control group and were matched with allergic samples. Minnesota Multiphasic Personality Inventory (MMPI2) questionnaire was used for data collection. The data were analyzed by variance analysis, t?test, and correlation tests. -test, and correlation tests. Results: The average scores of patients in MMPI2 test for hypochondriasis, hysteria, depression, psychasthenia, and social introversion were significantly higher than for paranoia (P < 0.05). Also, allergic women obtained higher scores in hypochondriasis, psychasthenia, masculinity-femininity, hysteria, and depression scales than allergic men (P < 0.05). These results also showed that hypomania has a higher frequency among asthmatic patients than in patients with allergic rhinitis (P < 0.05). Conclusion: This study showed that psychopathological traits such as hypochondriasis, hysteria, depression, psychasthenia, and social introversion have a higher frequency among allergic patients than in the general population. These results emphasize on considering psychological interventions along with medical treatments.



How to cite this article:
Mehrinejad SA, Jalili M, Ghaffari J. Comparison between psychological traits of patients with various atopic allergic diseases and healthy volunteers: A case-control study.Indian J Allergy Asthma Immunol 2013;27:42-46


How to cite this URL:
Mehrinejad SA, Jalili M, Ghaffari J. Comparison between psychological traits of patients with various atopic allergic diseases and healthy volunteers: A case-control study. Indian J Allergy Asthma Immunol [serial online] 2013 [cited 2019 Dec 10 ];27:42-46
Available from: http://www.ijaai.in/text.asp?2013/27/1/42/116613


Full Text

 Introduction



Allergic diseases lead to daily disability in many people around the world and impose noticeable costs to hygienic and treatment systems in many countries. [1] Allergic disorders have increased in the past several decades and the prevalence is different in different countries. The prevalence of asthma and allergic rhinitis in our region is 12-17% and 18-20%, respectively. [2],[3] Considering the psychopathological traits, allergic treatment methods have been focusing on a three-dimensional view of physical, psychiatric, and social features since two decades. According to this model, the biological factors consist of genetic, nutritional, and biochemical features, and the psychiatric factors include behavioral profile, mood, and personality. The social factors include family members, social connections, home environment, and ability to respond to pressures in life. The effects of these factors with the immune and endocrinal mechanisms, along with the biological features lead to different consequences of a disease. So, we can accept that allergy is a multifactorial disease. [4],[5] Many epidemiological studies have shown the mutual relationship between psychological factors and ectopic disease. [6] Psychological variables have an effect on the initiation and duration of asthma. [7] Studies showed that there is a relationship between IgE level and psychological disorders. Higher level of IgE is detectable in depressed patients or in other common psychological disorders. [8],[9],[10] Systematic review studies show that allergic patients of both genders have a higher frequency of hypochondriasis, hysteria, psychasthenia, and social introversion. [8],[11],[12] These results show that allergic patients have a lower level of mental health in comparison with normal people. [13] Studies have shown the relationship between depression and allergy, but it is not clear which one is the primary cause that leads to the other one. Depressed patients show a more intense allergic reaction of any type. [6],[14],[15],[16],[17] Allergic diseases differ in symptoms; therefore, it is so common to observe different psychological features in patients with type 1 allergy. Bell et al. showed that there is a relationship between being shy and hay fever, but there was not such a relationship between asthmatic patients. [18] Although allergic rhinitis and urticaria are not so dangerous, but they can cause absence from school or missing many functional days. These diseases are unpredictable and impose a heavy psychological load on patients and their family by non-tolerable pruritus and feelings of being deformed. [18] One of the most important aspects in this field is the evaluation of psychiatric factors and related pathological features. By considering cultural differentiations, the aim of this study is to detect specific psychopathological features in patients with allergic disorders in comparison with healthy volunteers.

 Materials and Methods



The study was designed as a case-control research. All patients with allergic disorders including moderate asthma, perennial allergic rhinitis, chronic urticaria, and atopic dermatitis, who referred to Tooba clinic in Sari, were included. One hundred and two allergic patients were selected from May 2010 till August 2010 and were compared with normal volunteers in demographic features such as gender, educational level, and age [Table 1]. Sample size was selected based on SADMEN N table (α =0.5). Allergy diagnosis criteria were based on related professor diagnosis based on textbooks. Selected patients had at least 6 months of definite diagnosis. Patients with allergy so severe that they could not fill the questionnaire were excluded. The excluding criteria included no cooperation, other chronic diseases, less than 18 years of age, and low education (less than 8 years). Minnesota Multiphasic Personality Inventory (MMPI2) questionnaire was used to evaluate the psychopathological features.{Table 1}

Minnesota multiphasic personality inventory

This questionnaire was published by Hathaway and McKinley for the first time in 1943. The second edition, which is compatible with clinical purposes from psychological aspect, has 567 compartments. But only the first 370 compartments that are related to clinical scales were considered. MMPI2 can only be performed if the patient's age is more than 18 and, also, the patient should have more than 8 years of education. This test can be performed either individually or in a group. [19],[20] This questionnaire includes 10 clinical and 4 validity scales. The validity scales are: I don't know (I), lying detection (L), infrequency (F), and correction scale (K). The clinical scales consist of: Hypochondriasis (HS), depression scale (D), hysteria scale (HY), psychasthenia (Pt), masculinity-femininity (MF), paranoia scale (Pa), psychological deviation (Pd), schizophrenic scale (Sc), hypomania (Ma), and social introversion (Si). [19],[20] Sadeghian and Motabi showed that all the MMPI criteria are reliable and the reliability coefficient spectrum is from 0.71 (Ma scale) to 0.84 (Pt scale). The validity coefficient median values for psychiatric patients and normal people were about 0.8 and 0.7, respectively. The validity coefficients of both half tests were in medium range and the amplitudes were 0.5-0.96 with a median of 0.7. MMPI2 guide has mentioned medium validity coefficient. The validity coefficient amplitudes for men were from 0.67 (scale 6) to 0.92 (scale 0) in a time interval of 8.58 days. Similar coefficients were obtained for women [amplitude of 0.58 (scale 6) to 0.91 (scale 0)]. The correlation coefficients were: Sc: 0.47, Ma: 0.31, HY: 0.27, D: 0.29, HS: 0.32, Pa: 0.56, Pt: 0.49, and F: 0.46. They were all significant with P value 0.001. [21],[22]

For analyzing data, we used descriptive statistics (mean and standard deviation), and independent t-test was used to compare the mean of allergic group with that of control group in psychiatric features. One-way analysis of variance (ANOVA) test was used to compare the means in every four groups of allergic types and also to measure linear correlation coefficient to evaluate gender effect on psychological features. Data were analyzed by SPSS-13 software.

 Results



There were 28 males and 74 females in both groups. The mean age of women was 32.56 years and that of men was 31.75 years. Age spectrum was 18-55 years. Educational level in both groups was from high school to Master of Science. In both groups, 41% had an educational level of high school. 78% in both groups were married. Most of the patients were females with allergic rhinitis, as shown in [Table 2]. The differences were significant. In other variables such as lying detection (L), infrequency (F), defense (K), psychosocial deviation (Pd), masculinity-femininity (MF), schizophrenia (Sc), and hypomania (Ma), there was no significant difference between the mean scores of two groups.{Table 2}

The t-test results showed that hypochondriasis (HS), depression (D), hysteria (HY), psychasthenia (Pt), and social introversion (Si) are more frequent in allergic patients than in normal people (P < 0.05). The results also showed that paranoia in normal people is more than in allergic patients (P < 0.05). According to these results, some psychological features are found to have a higher frequency in allergic patients than in normal people.

We used one-way ANOVA test to evaluate the personal features in patients with different types of allergy (allergic rhinitis, allergic asthma, urticaria, and coincidence of asthma and allergic rhinitis). As shown in [Table 2], there was a significant difference between allergic groups in infrequency (F) (P < 0.05, 2.841) and hypomania (Ma) (P < 0.03, 3.301). Post-statistical test of Sheffe was performed and the results are shown in [Table 3]. These results show that the mean score of hypomania in allergic asthma was significantly higher than in allergic rhinitis (P < 0.05) and there was a significant difference in the psychological features between these two allergic groups.{Table 3}

We used bivariate correlation to evaluate the relationship between gender and pathological features. The results are shown in [Table 4]. These results show that there was significant relationship between gender and psychasthenia (P < 0.04), masculinity-femininity (P < 0.01), conversional hysteria (P < 0.01), depression (P < 0.006), and hypochondriasis (P < 0.002). The mean score in women was significantly higher than in men.{Table 4}

 Discussion



This study evaluated the personal and psychopathological features in patients with allergy disorders. The results show that allergic patients have higher scores in pathological features than general population, which indicates that psychological health is lower in allergic patients. These results are similar to those of Lu et al. and Pasaoglu et al. [23],[24] Another study compared the psychological health of allergic patients with that of control group. Results showed that there is a significant difference in physical complaints, anxiety, sensitivity in social relationships, depression, obsessive-compulsive disorders, and hypochondriasis between case and control groups. [24] Patients who have higher score in hypochondriasis scale show more concern about their disease and perhaps use physical disease to affect and control other people, [13],[25],[26] as this study showed the hypochondriasis score was higher in allergic patients than in normal volunteers. Another study that evaluated mood disorders in allergic patients showed that depression has a higher frequency in patients with allergy. [27] Our study showed that depression score in allergic patients is higher than in control group. These results are compatible with Timonen et al.'s study results. [17] People who gained higher scores in depression MMPI questionnaire showed clinical manifestations of depression. They felt sad, depressed, and pessimistic about their future. Allergic patients had higher score in depression MMPI questionnaire. The suggested mechanism explains that the allergic mediators (such as serotonin, histamine, and est.) can affect the mood and behavior like the neurogenic mediators that affect limbic system. [10] Hysteria scale was prominent in patients with medical disease. Psychiatric pressure in these patients can lead to denial or physical reactions. Patients who gain higher score in hysteria accept physical disorders, but deny their concerns. They try to deal with their concerns by limiting their problems to their physical body. These people exaggerate their disease clinical symptoms and use this method to affect others. [19] Allergic patients usually expect more attention and are used to more physical complaints. As a result, they gain higher scores in hysteria scale. [22],[23],[25] Higher scores in hypochondriasis, depression, and hysteria scales show higher frequency in depression and anxiety. [19] Previous studies showed that allergic patients are more anxious and more sensitive to stress. [18] Higher scores in psychasthenia indicate obsessive-compulsive disorder, anxiety, and unstable mood. These people have higher level of discipline and show more concerns about their daily duties. They usually deny their anxiety. Smith et al. have mentioned these results in their study. Their results also showed that obsessive-compulsive disorder is more frequent in allergic patients. [11] In our study, the allergic patients gained higher scores in obsessive-compulsive disorder scale than the control group. Higher scores in psychasthenia scale, along with prominent scores in hypochondriasis, depression, and hysteria scales indicate anxiety, tension, fear, and disability to express emotions. They also have more physical complaints, which is probably secondary to their depression. These people show physical complaints in psychiatric pressures. [19] In our study, the allergic patients' scores in these scales were higher than those of the general population. Allergic patients have lower self-confidence, lower decisional power, and higher social anxiety. [18] Prominent manifestations in people with higher scores in social introversion scale are being shy and alone. These people have lower self-confidence and are usually agitated and worried. Their mood is usually unstable and they experience depression periods. They have lower level of energy and little hobbies. They have difficulty in decision making and are usually conservative, traditional, non-inventive, but serious in performing processes. [19]

Higher score in paranoia indicates deflection of self-harm desire to others. The contents of this scale are sensitivity, moral regulations, being pessimistic, and criticizing others. [19] Allergic patients' scores were lower in this scale than those of control group. These results were not compatible with the results of Muluk et al. and Pasaoglu et al. Their results showed that allergic patients are more sensitive and pessimistic than the general population. [24],[26] Difference in results is perhaps because of the different cases studied and the difference in research situation. Our study also showed that personality features differ in patients with different types of allergy. These results are compatible with Gauci et al.'s study results about differences in personality features in patients with different types of allergy. [11],[25] Our study showed that asthmatic patients have higher scores in hypomania scale than the patients with allergic rhinitis.

Some studies have shown that there is a significant relationship between personality features of allergic patients and gender. [11],[25],[26],[27] Our study showed that there is a significant relationship between gender and psychasthenia, masculinity-femininity, conversional hysteria, depression, and hypochondriasis. The mean scores of allergic women in these scales were higher than those of men. Women's problems and limitations in social activities and their higher level of sensitivity lead to more psychiatric pressures which present with physical diseases.

There are many reasons for psychiatric problems in allergic patients. Psychiatric problems can be one of the complications of allergy. Pruritus, unusual look in urticaria, sudden asthmatic attacks, and fatigue cause depression, anxiety, and decreased physical and psychiatric resistance in these patients. Psychiatric problems decrease the biological function of the affected organ and lead to higher disease intensity and lower life quality. Patients with lower level of life quality show more allergic symptoms. Fear and anxiety prevent proper follow-up in allergic patients as they are hopeless about the cure. Some therapeutic drugs which are used to treat allergy can exacerbate psychiatric problems, perhaps by their effects on neurotransmitters and glucocorticoids.

 Conclusion



As the study results show that allergic patients are more sensitive to psychopathological features (loneliness, tension, confusion, stress, agitation, obsession, and depression) and these have an unfavorable effect on their quality of life, it is important to consider psychological treatment in these patients.

 Acknowledgment



We thank all patients and their parents for their kind cooperation.

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