Psychological Impact and Quality of Life in Chronic Psoriasis Patients: A Mixed-Methods Study Combining a Validated Researcher-Developed Questionnaire With In-Depth Patient Narratives

Background: Psoriasis is a chronic inflammatory skin disease associated with a significant physical and psychosocial burden. It adversely affects not only the skin but also psychological well-being, social functioning, and overall quality of life. Although quantitative assessment tools provide valuable estimates of disease burden, they do not fully capture patients' lived experiences. This concurrent mixed-methods study aimed to explore the impact of chronic psoriasis on psychological well-being, quality of life, and coping strategies among affected individuals. Methods: A concurrent cross-sectional mixed-methods study was conducted among 60 adults with chronic psoriasis attending a tertiary care dermatology clinic. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI) and categorized as mild, moderate, or severe. Quantitative data were collected using a researcher-developed questionnaire assessing quality of life, psychological impact, social functioning, coping strategies, and patient-reported support needs. The questionnaire was developed following a review of the published literature, underwent expert content validation by a three-member multidisciplinary panel (Content Validity Index = 0.90), and demonstrated good internal consistency (Cronbach's α = 0.80). A purposive subsample of 20 participants subsequently underwent in-depth semistructured interviews, and qualitative data were analyzed using inductive thematic analysis. Results: Among the 60 participants, PASI-based disease severity assessment classified 28 (46.67%) participants as having moderate psoriasis and 18 (30.0%) as having severe psoriasis. Moderate-to-severe impairment in quality of life was observed in 48 (80.0%) participants, while psychological distress was present in 44 (73.3%), including moderate distress in 17 (28.3%) and severe distress in nine (15.0%) participants. Social interaction was adversely affected in 39 (65.0%) participants, and work performance was impaired in 34 (56.7%). Feelings of embarrassment were reported by 41 (68.3%) participants, anxiety by 36 (60.0%), and low self-esteem by 33 (55.0%). Qualitative analysis identified four major themes: perceived stigma, emotional burden, social withdrawal, and coping strategies. Conclusion: Chronic psoriasis was associated with substantial impairment in quality of life and significant psychological distress. Integrating quantitative findings with qualitative patient narratives provided a more comprehensive understanding of the psychosocial burden experienced by affected individuals. The findings highlight the importance of incorporating psychosocial assessment, patient education, and appropriate psychological support into comprehensive dermatological care.