Anxiety as a mediator between quality of life and body image disturbance in young adults with acne: a cross-sectional study

This cross-sectional study aimed to characterize body image disturbance (BID) and its correlates among young adults with acne in East China, and to examine whether anxiety was statistically consistent with an indirect association between dermatology-specific quality of life and BID. A total of 201 young adults with acne were included. Sociodemographic and clinical data were collected, and psychosocial status was assessed using the Body Image Disturbance Questionnaire, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Dermatology Life Quality Index. Multiple linear regression and PROCESS Model 4 were used. Given the cross-sectional design, mediation findings were interpreted as statistical indirect associations rather than temporal or causal effects. The mean BID score was 30.91 ± 12.49, indicating marked appearance-related concerns in this sample. BID was positively correlated with anxiety, depression, and poorer dermatology-specific quality of life. In multivariable analysis, higher educational attainment was negatively associated with BID, whereas anxiety (β = 0.316, p < 0.001) and poorer quality of life (β = 0.545, p < 0.001) were independently associated with greater BID. Depression showed a negative adjusted association with BID (β = -0.207, p = 0.018), which should be interpreted cautiously due to overlap among psychological variables. The indirect effect of dermatology-specific quality of life on BID through anxiety was 0.229 (95% CI: 0.082-0.409), accounting for 18.1% of the total effect. Poorer dermatology-specific quality of life and higher anxiety were associated with greater BID among young adults with acne. Routine emotional screening may complement dermatologic care, but longitudinal studies are needed to clarify temporal and causal relationships.