United Kingdom Editors:

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1 Editors: LEO Innovation Lab and The Happiness Research Institute Copenhagen,, October 2018

2 LEO Innovation Lab in cooperation with The Happiness Research Institute, All rights reserved. Any part of this report can be reproduced only with the explicit acknowledgement of the copyright owner. The following reference should be included: LEO Innovation Lab, The Happiness Research Institute (2018), World Psoriasis Happiness Report Available at

3 Contents General Data & Happiness Results General Data & Distributions Happiness & Well-being Stress & Loneliness Psoriasis & Comorbidities Productivity & Work Life Cost of Psoriasis Productivity Missed Work & Social Hours Impact of Symptoms on Work Life Support at Work Healthcare Professionals Healthcare Professional Type & Frequency of Visits Diagnosis & Type of Treatment Levels of Satisfaction with Healthcare Professionals Perceived Quality of the Interaction with Healthcare Professionals Healthcare Professional Relationship Authors: Christian Birch Okkels, MSc Physics, Data Scientist at LEO Innovation Lab Michael Birkjær, MSc Political Science, Analyst at the Happiness Research Institute WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 3

4 GENERAL DATA & HAPPINESS RESULTS General Data & Happiness Results General Data & Distributions. Total sample size: 6,394 Gender distribution Age distribution Other 1% (52) Male 25% (1,559) 2 2 (1,523) (1,562) 21% (1,364) Female 75% (4,726) 1 (657) 1 (893) 5% (328) Severity distribution 9% (22) 1% (45) Severe 27% (1,005) Mild 2 (747) Age Severity distribution (N = 1,983) Global (N = 54,438) Mild 2 37% Moderate 5 (1,947) Moderate 5 47% Severe 27% 16% In the UK, 1 in 5 (2 of the ) reported they had mild psoriasis; more than half (5) moderate, and more than 1 in 4 (27%) severe 1. This makes the UK the sample with the second lowest percentage of selfperceived mild psoriasis among the surveyed countries and with the highest percentage of self-perceived severe psoriasis (see Fig. A.1 in the Appendix). 1 The target population of PsoHappy is people living with self-reported psoriasis, meaning that the do not necessarily have the diagnosis confirmed by a dermatologist. For this reason, the findings of this report can t be cited or referred to as if they were based on a clinical diagnosis confirmed by healthcare specialists. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 4

5 GENERAL DATA & HAPPINESS RESULTS Happiness & Well-being Happiness level: 5.1 Happiness ranking: 20th / 21 Happiness Global Happiness level Happiness gap Happiness level Happiness gap Overall % % Gender - female % - male % % Severity - mild % % - moderate % % - severe % % The overall average happiness gap in the UK is -25%, which also places the UK second last in this regard (see Fig. A.2 and A.3 in the Appendix). Moreover, almost 37% report levels of happiness lower than 4 on the 0-10 scale, which is defined as living in misery (see the World Psoriasis Happiness Report 2018, Chapter 1, for details). Stress & Loneliness As seen from Fig. D.1 and D.2 in the Appendix, the percentages of in the UK who experience high stress and loneliness are: 2 High stress: 72.5% Loneliness: 39.5% Some of the things that stand out in the table above are that: Women with self-reported psoriasis in the UK are slightly less happy than their male counterparts, which follows the pattern seen across almost all surveyed countries. Thus, almost 3 in 4 (7) experience high stress, which places the UK second to last in this regard compared to other countries. As for loneliness, the UK doesn t fare much better, also landing in the bottom handful of countries, with 4 of people living with self-perceived psoriasis being affected by loneliness. The happiness gaps become larger with severity: people suffering from more severe degrees of psoriasis are significantly less happy and experience larger happiness gaps: People living with selfperceived severe psoriasis report a happiness gap of up to -37.8%. 2 See Appendix Fig. D.1 and Fig. D.2 for methodology and calculation used to determine high stress and loneliness. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 5

6 GENERAL DATA & HAPPINESS RESULTS Psoriasis and Comorbidities We have analysed a variety of comorbidities reported by people living with self-perceived psoriasis and their effect on people s happiness and well-being. The graphs below show the overall distribution of comorbidities as well as detailed by gender and self-perceived psoriasis severity. Numbers and results for the global picture of all countries considered are included for reference and comparison. - Comorbidities N = 609 None of the below Depression or other mental disorders Psoriatic arthritis High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes Heart and vascular diseases Other Lung diseases -21% -35% -3-31% % -4 31% (191) 37% (223) 27% (166) 17% (101) 1 (87) 8% (49) 5% (28) 1% (7) (18) Kidney diseases Liver diseases Cancer -37% (10) -38% (16) -4 1% (6) Average happiness gap Global - Comorbidities N=10,828 None of the below Depression or other mental disorders Psoriatic arthritis -8% -29% -26% 28% 26% 3 High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes -2-27% % Heart and vascular diseases Other Lung diseases -2-18% -2 5% Kidney diseases Liver diseases Cancer -19% -25% -18% Average happiness gap WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 6

7 GENERAL DATA & HAPPINESS RESULTS - Comorbidities by gender - Female N = 466 None of the below Depression or other mental disorders Psoriatic arthritis High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes Heart and vascular diseases Other Lung diseases Kidney diseases Liver diseases % -16% -41% -4-39% 3 (139) 4 (187) 27% (124) 15% (72) 16% (75) 8% (37) 5% (21) 1% (6) (14) (8) (12) Average happiness gap Global - Comorbidities by gender - Female N = 8,398 None of the below Depression or other mental disorders Psoriatic arthritis High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes Heart and vascular diseases Other Lung diseases Kidney diseases Liver diseases Cancer -9% -29% -28% -26% -28% -28% -2-17% % -2 18% 1 1 5% 27% 3 31% Average happiness gap WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 7

8 GENERAL DATA & HAPPINESS RESULTS - Comorbidities by gender - Male N = 138 None of the below Depression or other mental disorders Psoriatic arthritis High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes Heart and vascular diseases Other Lung diseases Kidney diseases Liver diseases -19% -4-26% -27% -17% % -37% % (51) 25% (35) 28% (39) 2 (28) 9% (12) 8% (11) 5% (7) 1% (1) (4) 1% (1) (4) Average happiness gap Global - Comorbidities by gender - Male N = 2,369 None of the below Depression or other mental disorders Psoriatic arthritis High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes Heart and vascular diseases Other Lung diseases Kidney diseases Liver diseases Cancer - -25% 18% -16% 2-16% 2-25% 9% % 6% -2-19% 5% % Average happiness gap WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 8

9 GENERAL DATA & HAPPINESS RESULTS - Comorbidities by severity None of the below Depression or other mental disorders Psoriatic arthritis High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes Heart and vascular diseases Other Lung diseases Kidney diseases Liver diseases -1-19% 31% (35) -29% 3 (104) -49% -17% -21% -18% -2-26% -16% -26% MILD N = (45) 18% (20) 17% (19) 1 (13) (5) (3) (2) (3) 1% (5) MODERATE N = (99) -3-26% -2-25% -28% -17% -26% -39% -35% -19% 25% (77) 15% (47) 15% (45) 9% (28) 5% (14) 1% (4) (10) (6) (7) -4-46% -45% -46% -5 SEVERE N = % (47) 4 (82) 37% (69) 19% (35) 15% (27) 9% (16) 6% (11) -26% 1% (1) -58% (5) -4 (4) -6 (7) Average happiness gap Average happiness gap Average happiness gap Global - Comorbidities by severity None of the below Depression or other mental disorders Psoriatic arthritis High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes Heart and vascular diseases Other Lung diseases Kidney diseases Liver diseases Cancer -17% % % -5% -1 MILD N= 2, % 8% 5% 7% MODERATE N= 5,962-9% -26% -21% -19% % -21% -19% -2-21% -2 35% 28% 2 18% 1 1 SEVERE N= 2,560-21% -4-36% -41% -39% -39% -4-36% -39% -27% -35% -28% % 15% 7% Average happiness gap Average happiness gap Average happiness gap WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 9

10 GENERAL DATA & HAPPINESS RESULTS Looking at the first figure with the overall results on comorbidities and happiness gaps, we note, among other things, that: More than 2 in 3 (69%) in the UK reported that they had at least one of the listed comorbidities. The most reported comorbidities in the UK are depression or other mental disorders (37%), psoriatic arthritis (27%), and high blood pressure (17%). Depression or other mental disorders, in particular, seem more common in the UK than globally. Ranging from -3 to -4, the happiness gaps related to many of the comorbidities reported in the UK are larger than the global average happiness gaps created by experiencing comorbidities 3. Turning to the split by gender, we see that: In the UK, significantly more women than men suffer from depression or other mental disorders (4 vs. 25%); however, it s noted that both proportions are high, and higher than the global averages. Moving on to the split by severity shown in the bottom graphs, we see that: A larger percentage of people with self-perceived severe psoriasis experience comorbidities compared to people with self-perceived mild and moderate psoriasis: 6 of those with self-perceived mild psoriasis reported at least one comorbidity, while as 3 in 4 (75%) with severe psoriasis report the same. The prevalence of both depression or other mental disorders as well as psoriatic arthritis increases significantly with severity; the former from 31% for mild psoriasis to 4 for severe psoriasis, and the latter from 18% for mild to 37% for severe. Finally, we see that, similar to the global averages, the worse the self-perceived severity, the larger the happiness gap (although no claim of causality can be made). In spite of this, men suffering from depression or other mental disorders still have a larger happiness gap (-4) than women (-3). Women report larger gaps for most of the other comorbidities reported. 3 It is important to stress the fact that we cannot make any claims of causality in regards to comorbidities and happiness gaps; it s not necessarily one or more particular comorbidities that cause the given happiness gap. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 10

11 Productivity & Work Life WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 11

12 PRODUCTIVITY & WORK LIFE Cost of Psoriasis For the UK, the estimated cost to society from lost productivity: Total cost on society Overall Per 100,000 people in employment $2,638m $8.1m As GDP 0.09% Productivity Levels For reference, the general results for all countries from the World Psoriasis Happiness Report 2018 are shown in Table B.6 in the Appendix. From this we see that the UK lands somewhere in the middle in regards to the total cost to society from lost productivity (as GDP). Nominally, however, this corresponds to as much as $2,638 million, which is still a significant amount of money. The table below shows presenteeism productivity at work (level of productivity reported on a scale from 0-100, 0 being not at all productive and 100 being totally productive, when people with self-perceived psoriasis should have stayed at home because of their psoriasis and, respectively, other health issues). Productivity at work Global Average productivity - Because of psoriasis 62.0 (211) 53.2 (2,721) - Because of other health issues 57.1 (204) 62.9 (2,633) Percentage of people reporting less than 5 productivity - Because of psoriasis 4 (89) 51% (1,521) - Because of other health issues 51% (105) 41% (1,009) (For the average productivity results in the top half of the table, the numbers in parentheses show the total sample size for the scenario in the particular table cell. For the results in the bottom half of the table, the numbers in parentheses show the number of corresponding to the particular percentage.) Compared to the global results, people in the UK have a higher productivity, on average, when they should have stayed at home because of their psoriasis. When it comes to other health issues, though, their average productivity is slightly lower. As it can also be seen from Fig. B.1 and B.2 in the Appendix, the UK is in the higher half of countries when it comes to productivity at work when people should have stayed at home due to psoriasis, but in the lower half when it comes to other health issues. In the same vein as above, more than 2 in 5 (4) in the UK work at less than 5 productivity when they should have stayed at home because of their psoriasis, and roughly half (51%) when because of other health issues. Compared to other countries, this places the UK similarly as above (see also Fig. B.3 and B.4 in the Appendix). WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 12

13 PRODUCTIVITY & WORK LIFE Missed Work & Social Hours Shown in the table below are the number and percentage of people missing at least 5, 10, and 20 work hours and social hours (in the last 4 weeks) because of psoriasis and other health issues. Social hours include things such as family and social activities. Global Work and social hours missed Because of psoriasis Because of other health issues Because of psoriasis Because of other health issues Work hours missed N = 237 N = 235 N = 2,998 N = 2, hours 2 21% 2 26% 10+ hours 17% 15% 17% 17% 20+ hours 9% 1 1 Social hours missed N = 407 N = 407 N = 5,387 N = 5, hours % hours % hours 2 15% 18% 1 In the UK, people miss around the same number of work hours because of psoriasis as we see with the global averages, but for social hours the percentages are higher. For instance, 1 in 4 (2) in the UK have missed at least 5 or more work hours in the last 4 weeks) because of psoriasis, while more than 2 in 5 (4) have missed as many social hours. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 13

14 PRODUCTIVITY & WORK LIFE Impact of Symptoms on Work Life In this section, we look at the impact of psoriasis on people s work life. Shown in the table below is the average impact on people s work life, as rated on a scale from 0-10, for a number of different aspects and symptoms. - On a scale from 0 to 10, 0 being no impact, 10 being maximum impact, please assess how each of the below aspects has impacted your work life in the past 4 weeks Global - On a scale from 0 to 10, 0 being no impact, 10 being maximum impact, please assess how each of the below aspects has impacted your work life in the past 4 weeks N = N = 3, Trouble walking Bleeding Pain Trouble sleeping Skin flare-up Depression or anxiety Stress Trouble walking Bleeding Pain Trouble sleeping Skin Depression flare-up or anxiety Stress As seen in the left graph above, the aspects with the largest impact on people s work life in the UK are stress, depression or anxiety, and skin flare-ups, while also trouble sleeping and pain have significant impacts. What stands out compared to the global numbers in the graph on the right is that the size, or strength, of the impact is much higher in the UK across all of the different aspects except stress (which still has the highest impact). Looking at Fig. B.5 in the Appendix, we also see that the UK is one of a few countries with the largest absolute impact levels. In particular, bleeding seems to be more of a problem for the in the UK; similarly pain, trouble walking and sleeping. In fact, all other aspects have a greater impact than is seen in other countries. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 14

15 PRODUCTIVITY & WORK LIFE Support at Work In this section we analyse people s opinion on various aspects related to work and their psoriasis. % who Disagree or Strongly disagree Global Overall Women Men Overall Women Men "The company I work for has formal and informal 55% 5 61% % systems in place to help me manage my psoriasis" (175) (131) (44) (2,336) (1,811) (515) "My manager understands the impact psoriasis has on me and my work performance" 48% (154) 46% (113) 57% (41) 51% (1,939) 5 (1,530) 48% (404) "My work colleagues know about my psoriasis and I get their support when needed" 4 (132) 38% (93) 5 (39) 39% (1,397) 39% (1,080) 38% (314) "I have a close co-worker who under stands what it means to live with psoriasis and we often talk about the impact it has on my work life" 45% (144) 4 (104) 56% (40) 41% (1,449) 41% (1,124) 4 (322) (The numbers in parentheses indicate the number of corresponding to the particular percentages, and are therefore not the total sample sizes.) In the UK, around half (4 to 55%) are generally dissatisfied with the support they receive at work on both a company / manager and colleague/co-worker level. What stands out, however, is that a larger proportion of men report disagreement across all four aspects in regards to work support. In general, it s still worth noting that: More than half of (55%) don t think their company has systems in place to help them manage their psoriasis. A note on the significance of these factors in relation to the happiness levels reported by the : when testing which of these 4 statements are linked to happiness, we found only the third one, My work colleagues know about my psoriasis and I get their support when needed, to be significant. It does however have a substantial effect. An interpretation of this result could be that the well-being of people living with self-reported psoriasis is more dependent on having acknowledging and inclusive social environments, than simply having one-on-one relationships that attempt to provide the same. Close to half (5) don t think their manager understands their condition and its impact on productivity. More than 2 in 5 (4 and 45%) also don t think they get support from their colleagues nor have a close co-worker who understands and they can talk to. 4 Please refer to the World Psoriasis Happiness Report 2018, Chapter 2, for more details on this analysis. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 15

16 Healthcare Professionals WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 16

17 HEALTHCARE PROFESSIONALS A variety of aspects related to the perceived relationship with healthcare professionals (HCPs) are analysed. This includes people s satisfaction with their healthcare providers overall, as well as general perceptions of the quality of the relationship and interactions with them. Healthcare Professional Type & Frequency of Visits First, we consider the distributions for the type of healthcare professional, how often people see their healthcare professional, and where the healthcare professional works. These are shown in the figures below for both the UK and the global averages. - HCP Type Who is your primary healthcare professional in relation to your psoriasis? N = 1,065 Global - HCP Type Who is your primary healthcare professional in relation to your psoriasis? N = 13,533 Other 8% A nurse A dermatologist 35% Other 18% A nurse A dermatologist 48% My Personal Doctor / GP 5 My Personal Doctor / GP 31% - HCP frequency How many times per year are you in contact with healthcare professional due to your psoriasis? N = 953 Global - HCP Frequency How many times per year are you in contact with healthcare professional due to your psoriasis? N = 13,062 Don t see an HCP yearly 26% Don t see an HCP yearly 27% Once a year 18% Once a year 2 2 to 5 times 6 to 12 times 1 37% 2 to 5 times 6 to 12 times 31% 12+ times per year 7 % 12+ times per year 6% WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 17

18 HEALTHCARE PROFESSIONALS - HCP institution Is your primary helthcare professional for your poriasis: N = 426 Global -- HCP institution Is your primary helthcare professional for your poriasis: N = 5,736 Working in an institution (clinic or hospital) run as part of the public healthcare sector (free for you) Working in a private institution that is paid by your private health insurer Working in a private institution that you pay out of your pocket for your each visit Other 8 Working in an institution (clinic or Working hospital) in run an as institution part of the (clinic public or hospital) healthcare run sector as part (free of the for public you) healthcare sector (free for you) 38% 38% Working in a private institution that Working is paid by in your a private private institution health insurer that is paid by your private health insurer 29% 29% Working in a private institution Working that you in pay a private out of your institution pocket for that your you each pay visit out of your pocket for your each visit 7% Other 1 Other Some of the things we see from the figures above are that: The most reported case in the UK is that people with self-perceived psoriasis have their personal doctor or GP as their main healthcare professional in relation to their psoriasis: 5. This contrasts to what we see in the global averages and many other countries, in which a dermatologist is the main healthcare professional. In the UK, only around a third of the (35%) mentioned a dermatologist. As seen in Fig. C.1 in the Appendix, the UK is one of the three countries with the largest proportion of people seeing a personal doctor or GP. In the UK, 8 of the go to see a healthcare professional for their psoriasis to a healthcare institution under the public sector (which is thus free for them). The UK has the largest proportion of people reporting this among the countries surveyed (see also Fig. C.3 in the Appendix). In regards to the frequency of visits, around 1 in 4 (26%) in the UK don t see their healthcare professional yearly, while 37% see their healthcare professional 2-5 times. This makes the UK one of the countries where people see their healthcare professional most often (see also Fig. C.2 in the Appendix). WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 18

19 HEALTHCARE PROFESSIONALS Diagnosis & Type of Treatment As seen in the table below, only 46 in the UK have had their psoriasis diagnosed by a dermatologist, while around half (49%) have had it diagnosed by a personal doctor or GP, making the UK stand out from other countries and the global averages in this regard (as also seen in Fig. C.4 in the Appendix). Was your psoriasis diagnosis by.. (N = 1,808) Global (N = 14,184) Dermatologist 46% 69% Personal doctor / GP 49% 21% Haven t been diagnosed by a doctor 6% Nurse 1% Other 1% As for the type of treatment and how people get access to it, this is shown in the figures below. - Treatment type Which of the following forms of treatment are you currently using (you may use more than one)? N = 3,184 Prescription topical treatment (medical creams, ointments or foam) 68% Over-the-counter topical treatment (creams, lotions or ointments) 31% None of the above/not in treatment 11 % Systemic therapy (pills or injections) 1 Light therapy (sunlight or ultraviolet) 1 Biologic therapy (injections) 5% Other (please specify) Don t know Global - Treatment type Which of the following forms of treatment are you currently using (you may use more than one)? N = 36,574 Prescription topical treatment (medical creams, ointments or foam) 5 Over-the-counter topical treatment (creams, lotions or ointments) 3 None of the above/not in treatment 15% Systemic therapy (pills or injections) 1 Light therapy (sunlight or ultraviolet) 1 Biologic therapy (injections) 7% Other (please specify) Don t know WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 19

20 HEALTHCARE PROFESSIONALS When getting your treatment, which of the statements below best fits your situation? N = 627 I go to the pharmacy with a prescription and I pay the full price of the product 37% I go to the pharmacy with a prescription and I pay part of the price of the product, the rest is covered by my insurance I go to the pharmacy without a prescription and I pay the full price of the product 6% 6% I go to the pharmacy with a prescription and I don t pay anything, the price is covered by my insurance completely 2 Other 29% Global When getting your treatment, which of the statements below best fits your situation? N = 8,388 I go to the pharmacy with a prescription and I pay the full price of the product 3 I go to the pharmacy with a prescription and I pay part of the price of the product, the rest is covered by my insurance 26% I go to the pharmacy without a prescription and I pay the full price of the product 17% I go to the pharmacy with a prescription and I don t pay anything, the price is covered by my insurance completely 1 Other 1 The most reported treatment type in the UK is prescription topicals, reported by more than 2 in 3 (68%). Next are over-the-counter topicals, reported by 31%. As seen in Fig. C.5, the UK is the country with the largest proportion of people living with self-perceived psoriasis on prescription topicals. As for getting their treatment, most people in the UK (37%) said they go to the pharmacy with a prescription and pay the full price (which specifically for the UK might refer to the cost for dispensing the medicine, different than the price of the treatment), while 2 have the cost fully covered by their insurance. (See also Fig. C.6 in the Appendix for a comparison with other countries). WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 20

21 HEALTHCARE PROFESSIONALS Levels of Satisfaction with Healthcare Professionals The table below shows the average satisfaction reported by people living with self-reported psoriasis, as rated on a scale from 0-10 overall, by gender and by severity. On a scale from 0 to 10, how satisfied are you overall with your healthcare provider in regards to your psoriasis? Global Overall 5.16 (438) 4.97 (5,853) Gender - Female 5.12 (340) 4.95 (4,604) - Male 5.35 (95) 5.02 (1,220) Severity - Mild 5.61 (61) 5.23 (1,356) - Moderate 5.18 (225) 4.80 (3,157) - Severe 4.90 (148) 5.10 (1,314) (The numbers in parentheses show the total sample size for the scenario in the particular table cell.) Overall, people in the UK are slightly more satisfied with their healthcare professionals than globally. Looking at Fig. C.7 in the Appendix, we also see that the UK is in the better handful of countries in this regard. What also stands out in the table above is that men are slightly more satisfied with their healthcare professionals than women. Finally, the patient satisfaction level decreases for people having mild, moderate, and severe psoriasis, respectively, indicating perhaps that people with more severe forms of self-reported feel that they are not receiving the best possible care. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 21

22 HEALTHCARE PROFESSIONALS Perceived Quality of the Interaction with Healthcare Professionals The table below shows the number and percentages of who disagreed or strongly disagreed with a number of statements in relation to their most recent interaction with their healthcare professional in relation to their psoriasis. Please assess the following aspects of your most recent interaction with a doctor / healthcare professional for your psoriasis : % who Disagree or Strongly disagree Global Overall Women Men Overall Women Men "The doctor gave me as much information as I wanted" 25% (104) 26% (84) 2 (20) 21% (2,813) 2 (968) 15% (188) "The doctor recognised and responded to my emotional state" 3 (139) 3 (110) 3 (29) 3 (1,619) 3 (1,349) 2 (263) "The doctor talked in terms I could understand" 1 (52) (36) 18% (16) 15% (847) 1 (698) (145) "The doctor encouraged me to ask questions" 3 (123) 31% (101) 25% (22) 28% (1,612) 29% (1,333) 2 (273) "The doctor involved me in decisions as much as I wanted" 27% (110) 27% (86) 28% (24) 25% (1,417) 26% (1,165) 2 (244) "The doctor discussed next steps" 28% (114) 28% (90) 26% (23) 26% (1,482) 27% (1,228) 2 (246) "The doctor spent the right amount of time with me" 27% (113) 28% (90) 25% (22) 25% (1,395) 26% (1,148) 19% (241) "The doctor discussed about how my psoriasis affect my mental health and overall well-being" 59% (246) 6 (194) 56% (49) 5 (2,794) 5 (2,328) 37% (453) (The numbers in parentheses indicate the number of corresponding to the particular percentages, and are therefore not the total sample sizes.) Compared to the global averages, people in the UK are roughly equally dissatisfied with aspects around the interaction with their healthcare professionals. The largest degree of dissatisfaction with the statements is seen in regards to people s emotional state and mental health; for instance, a third (3) in the UK disagree that the doctor recognised and responded to their emotional state, while almost 3 in 5 (59%) disagree that the doctor discussed how psoriasis affects their mental health and overall well-being. Men and women in the UK report very similar levels of (dis)agreement. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 22

23 HEALTHCARE PROFESSIONALS Healthcare Professional Relationship The table below shows the number and percentages of who disagreed or strongly disagreed with a number of statements around the relationship between people living with self-perceived psoriasis and their healthcare professionals. To what extent do you agree with each of the following statements? % who Disagree or Strongly disagree Global Overall Women Men Overall Women Men "My healthcare professionals are clear with the information about how to treat psoriasis" 46% (427) 46% (338) 45% (85) 4 (5,329) 41% (3,933) 36% (1,341) "My healthcare professionals fully understand the impact psoriasis has on my mental well-being" 68% (628) 69% (497) 66% (127) 5 (7,055) 56% (5,311) 4 (1,683) "I can get in touch with the healthcare professional when I m in need" 4 (389) 4 (306) 4 (79) 36% (4,798) 37% (3,532) 3 (1,227) "I have confidence in the abilities of my healthcare professionals to treat psoriasis" 5 (479) 5 (377) 51% (98) 4 (5,946) 4 (4,344) 39% (1,550) "I always follow the advice of my healthcare professionals" 26% (239) 26% (185) 27% (52) 27% (3,692) 27% (2,611) 28% (1,035) "I ve been informed about all the different treatment options related to my condition" 6 (559) 65% (447) 6 (109) 55% (7,240) 57% (5,424) 5 (1,763) "The system provides me with sufficient financial support in relation to my skin condition" 6 (556) 6 (433) 65% (119) 67% (8,865) 69% (6,535) 6 (2,267) "There is sufficient public awareness regarding my disease" 87% (765) 87% (606) 85% (156) 79% (10,127) 8 (7,524) 7 (2,532) (The numbers in parentheses indicate the number of corresponding to the particular percentages, and are therefore not the total sample sizes.) In regards to aspects around their general relationship to their healthcare professionals, people with selfperceived psoriasis in the UK are generally more dissatisfied than the global averages. Around half (46% and 5) don t think their healthcare professionals are clear with the information on how to treat psoriasis and don t have confidence in their abilities to do so. Also, as many as roughly 2 in 3 disagree that their healthcare professionals fully understand the impact of psoriasis on their mental well-being, that they have been informed of all the different treatment options, and that the system provides them with sufficient financial support. Finally, the largest degree of disagreement is related to public awareness, where almost 9 in 10 (87%) in the UK don t think there is enough of awareness regarding psoriasis. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 23

24 Appendix

25 GENERAL RESULTS & HAPPINESS General Results & Happiness Figure A.1: Distribution of subjective, self-perceived severity by country Severity by country Sample size Mild Moderate Severe Australia Colombia Czech Republic Ireland Japan Norway Portugal Russian Federation United States 967 6,590 2,287 2, ,190 3,546 2,560 1, ,080 1,732 3,032 1,127 4,810 4,944 4,671 3,699 3,382 27% 4 26% 37% % % 37% 56% 36% 3 39% 57% 36% 2 27% 5 47% % 5 57% 5 45% 49% 49% 35% % 49% 5 49% 21% 21% 1 18% % 8% 15% 26% 21% 27% 2 WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

26 GENERAL RESULTS & HAPPINESS Figure A.2: ranking: Psoriasis happiness levels per country (With 95% confidence interval bands) Sample size Colombia Russian Federation Portugal Ireland Belgium Norway United States Japan Australia Czech Republic United kingdom China 4,284 4,075 7,849 9,786 8,717 5,646 1,564 3,641 1, ,893 1,109 4,875 4,246 5,451 4,754 1,427 1, , Average Happiness Score Average happiness score for each country. Colours show the score difference, with green indicating an average score higher than 6 and dark blue a lower average score. The context is filtered on Cantril Ladder which ranges from WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

27 GENERAL RESULTS & HAPPINESS Figure A.3: Average happiness gap by country (With 95% confidence interval bands) Sample size Portugal Colombia 5,646 1,893 4, % Russian Federation Japan 4,284 8,717 7,849 9,786 1,427 4,754-1% -8% -9% -9% Ireland Czech Republic United States 5,451 1, , % , , ,564-2 Norway 1, ,736-25% Australia 1,660-27% Average happiness gap WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

28 PRODUCTIVITY & HAPPINESS Productivity & Happiness Figure B.1: Productivity at work (measured on a scale from 0-100) when people should have stayed home because of their psoriasis In the last 4 weeks, for the time when you worked even though you felt you should be at home because of your psoriasis, how productive would you say you were? Use a scale from 0 to 100, 0 being not at all productive, 100 being totally productive. Sample size United States Czech Republic Portugal Russian Federation Average productivity at work when people should have stayed home because of their psoriasis WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

29 PRODUCTIVITY & HAPPINESS Figure B.2: Productivity at work (measured on a scale from 0-100) when people should have stayed home because of other health issues Using the same scale, how affected was your productivity at work while you felt you should have stayed home because of other health issues? 0 means not at all productive, 100 means totally productive. Sample size Russian Federation Portugal Czech Republic United States Average Productivity at work when people should have stayed home because of other health issues WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

30 PRODUCTIVITY & HAPPINESS Figure B.3: Percentage of people working at 5 productivity or less (measured on a scale from 0-100) when they should have stayed home because of their psoriasis In the last 4 weeks, for the time when you worked even though you felt you should be at home because of your psoriasis, how productive would you say you were? Use a scale from 0 to 100, 0 being not at all productive, 100 being tptally productive. Sample size Russian Federation Portugal Czech Republic United States % 97% 65% 65% 6 57% 49% 48% % 38% 35% 3 Percentage of people working at 5 productivity or less when they should have stayed home because of their psoriasis WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

31 PRODUCTIVITY & HAPPINESS Figure B.4: Percentage of people working at 5 productivity or less (measured on a scale from 0-100) when they should have stayed home because of other health issues Using the same scale, how affected was your productivity at work while you felt you should have stayed home because of other health issues? 0 means not at all productive, 100 means totally productive. Sample size United States Czech Republic Portugal Russian Federation % % 45% 4 39% 38% % Percentage of people working at 5 productivity or less when they should have stayed home because of other health issues WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

32 PRODUCTIVITY & HAPPINESS Figure B.5: Average impact of symptoms on work life in the past 4 weeks, as measured on a scale from 0-10 On a scale from 0 to 10, 0 being no impact, 10 being maximum impact, please assess how each of the below aspects has impacted your work life in the past 4 weeks Stress Depression or anxiety Skin flare-up Pain Czech Republic Portugal Russian Federation United States Trouble sleeping Bleeding Trouble walking Czech Republic Portugal Russian Federation United States WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

33 PRODUCTIVITY & HAPPINESS Table B.6: Estimated cost to society from lost productivity (adjusted for purchase) power parity): Annual cost Absenteeism ($Million) % Absenteeism due to psoriasis Annual cost Presenteeism ($Million) % Presenteeism due to psoriasis Total cost ($Million) Total cost per people in employment ($Million) Total cost as a percentage of GDP $2, $ % $3,413 $ $ % $ $767 $ % $ % $ % $574 $ $17, $3, % $20,497 $ % $14, $1, % $15,985 $ % $ % $ $57 $ $2, % $1, $3,211 $ $ % $ % $1,070 $ % Portugal $ $ % $215 $ % Russia $2, % $ % $3,450 $ % $1, % $ $1,313 $ % UK $2, % $ $2,638 $ % US $22, % $7, $30,517 $ % WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

34 HEALTHCARE PROFESSIONALS & PSORIASIS Healthcare professionals and Psoriasis Figure C.1: Distribution of type of healthcare professionals engaged for psoriasis by country Who is your primary healthcare professional in relation to your psoriasis? Sample size A dermatologist My personal doctor/gp A nurse Other Czech Republic Portugal Russian Federation United States , , , , % 3 76% 48% 35% 6 78% 49% 47% 47% 5 51% 35% 46% 1 55% 9% 4 55% 29% 6% 3 25% 35% 1 31% 5 31% 5% 8% 2 9% 15% 8% 1 16% 15% % 16% 8% 21% WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

35 HEALTHCARE PROFESSIONALS & PSORIASIS Figure C.2: Frequency of visits to healthcare professional for psoriasis by country How many times per year are you in contact with healthcare professionals dues to your psoriasis? Sample size Don t see an HCP yearly Once a year 2 to 5 times Czech Republic Portugal Russian Federation United States 1, , , % 2 19% 31% 2 18% 39% 41% 36% 2 41% 31% 26% 19% 29% 29% 2 16% 25% 27% 2 29% % 27% 18% 2 28% 37% 36% 37% 3 35% 26% 21% % 41% Sample size 6 to 12 times 12+ times per year Czech Republic Portugal Russian Federation United States 1, , , % 9% 18% % 9% 7% % 6% 6% 1% 5% 7% 6% WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

36 HEALTHCARE PROFESSIONALS & PSORIASIS Figure C.3: Healthcare Professional institution by country Is your primary healthcare professional for your psoriasis? Sample size Working in an institution (clinic or hospital) run as part of the public healthcare sector (free for you) Working in a private institution that is paid by your private health health insurer Working in a private institution that you pay out of your pocket for your each visit Other Czech Republic Portugal Russian Federation United States % 78% % % 51% 78% 8 17% 41% % 29% 25% 1 8% 8% 2 6% 58% 21% 27% 5% 47% 27% 45% 21% 29% 6% 1 1 8% 1 8% 21% 21% 7% 1 15% 8% 1 6% WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

37 HEALTHCARE PROFESSIONALS & PSORIASIS Figure C.4: Distribution of who has diagnosed their psoriasis (please note this report is based on self-reported psoriasis) Has your psoriasis been diagnosed by: Sample size A dermatologist My personal doctor/gp I haven t been diagnosed by a doctor Czech Republic Portugal Russian Federation United States ,813 1,058 1,189 1, , , % 56% 37% 75% 58% 71% 89% 8 75% 69% 81% 8 46% 7 31% 28% 17% 31% 21% % 6% 1 49% 18% 7% 9% 5% 8% 5% 5% 5% 8% 5% Sample size Other A nurse Czech Republic Portugal Russian Federation United States ,813 1,058 1,189 1, , , % 1% 1% 1% 1% 1% 1% 1% WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

38 HEALTHCARE PROFESSIONALS & PSORIASIS Figure C.5: Distribution of treatment type by country Which of the following forms of treatments are you currently using (you may use more than one)? Sample size Prescription topical treatment (medical creams, ointments or foam) Over-thecounter topical treatment (creams, lotions or ointments) Systemic therapy (pills or injections) Light therapy (sunlight or ultraviolet) Czech Republic Portugal Russian Federation United States 2,120 1, ,005 2,762 1,968 1,546 2,295 1,026 1,845 1,160 1,778 3,184 1,542 45% 6 41% 5 57% % 4 55% % 5 39% % 4 28% 3 31% 29% 45% 29% 31% 38% 1 1 6% 1 7% 1 15% 9% % 17% % 9% 1 7% % Sample size Biologic therapy (injections) Other (please specify) None of the above/not in treatment Don t know Czech Republic Portugal Russian Federation United States 2,120 1, ,005 2,762 1,968 1,546 2,295 1,026 1,845 1,160 1,778 3,184 1,542 7% 5% 5% 5% 7% 6% 7% 7% 5% 17% 5% 1% 6% 5% 1 1 6% 1 16% % WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

39 HEALTHCARE PROFESSIONALS & PSORIASIS Figure C.6: Distribution of how people get and pay for their treatment When getting your treatment, which of the statements below best fits your situation? Sample size I go to the pharmacy with a prescription and I pay the full price of the product I go to the pharmacy without a prescription and I pay the full price of the product I go to the pharmacy with a prescription and I pay part of the price of the product, the rest is covered by my insurance Czech Republic Portugal Russian Federation United States % % 2 49% % 17% 37% 1 28% % 1 21% 16% 28% 16% 6% 9% % 28% 1 25% 1% 6% 5 46% 57% 5 Sample size I go to the pharmacy with a prescription and I don t pay anything, the price is covered by my insurance completely Other Czech Republic Portugal Russian Federation United States % 19% 1 8% 9% 1% % 1 15% 9% 1 1 9% 1 1 9% 16% 1 8% 29% 2 WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

40 HEALTHCARE PROFESSIONALS & PSORIASIS Figure C.7: Average levels of satisfaction with healthcare provider in relation to psoriasis by country, as measured on a scale from 0-10 On a scale from 0 to 10, how satisfied are you overall with your healthcare provider in regards to your psoriasis? Sample size Portugal United States Czech Republic Russian Federation Average HCP satisfaction WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

41 LEVELS OF SELF-REPORTED STRESS & LONELINESS Levels of self-reported Stress & Loneliness Figure D.1: Percentage of people living with high stress 1 Sample size Norway 624 Colombia 787 Japan 534 Russian Federation 1,341 1,201 1,712 Czech Republic Ireland 459 Portugal 1,639 United States 1,813 Australia 884 1,744 1, ,699 2,252 2,340 1, % 51.7% 51.8% 56.8% 57.7% % 63.9% 64.6% 65.7% % % 68.7% 72.5% 75. Percentage living with high stress 1 In this case, high stress is characterised by a score of 20 or higher on Cohen s Self-perceived Stress Scale. This scale consists of 10 questions related to how the respondent experiences life events and gives an indication of the general resilience of the respondent. The Perceived Stress Scale is not suitable to give an actual stress diagnosis of the individual, but is often used to evaluate and address stress levels in sub-groups of the population. Source: Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

42 LEVELS OF SELF-REPORTED STRESS & LONELINESS Figure D.2: Percentage of people living in loneliness. (The methodology employed for exploring loneliness was a revised version of the UCLA Loneliness Scale, considered by some the golden standard. The methodology consists of three questions related to social isolation and loneliness 2. The analysis of the results used the most conservative interpretation of the loneliness scores. 3 ) Sample size Portugal 1,201 1,234 1,189 Russian Federation 916 Japan 521 1, Norway 613 Colombia Czech Republic 93 1,445 1, ,250 1,739 Australia 649 Ireland 207 United States 1, % % % % 30.1% 30.7% % % % % 43.1% Percentage living in loneliness 2 The three questions are: How often do you feel that you lack companionship?, How often do you feel left out?, and How often do you feel isolated from others?, all of which are answered with often, some of the time, or hardly ever. Source: Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging, 26, Examples of establishing a minimum score for loneliness: A total score of at least 4 (Chalise, Kai, & Saito, 2010), 6 (Hand et al.,2014; Shiovitz-Ezra & Ayalon, 2012) and 7 (Boehlen et al., 2014). We have picked the latter, which is the most conservative approach. It means that the have to answer at least often to one of the 3 questions and at least some of the time to the other two. Source: Boehlen, F., Herzog, W., Quinzler, R., Haefeli, W. E., Maatouk, I., Niehoff, D., et al. (2014). Loneliness in the elderly is associated with the use of psychotropic drugs. International Journal of Geriatric Psychiatry. WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX