United States 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: 5,589 Gender distribution Age distribution Male 3 (1,624) Other 5% (275) 18% (1,031) 16% (913) 2 (1,258) 2 (1,114) Female 65% (3,589) 1 (664) 8% (472 ) Severity distribution 1% (44) (93) Severe 2 (823) Mild 27% (903) Age Severity distribution (N = 3,382) Global (N = 54,438) Mild 27% 37% Moderate 49% (1,656) Moderate 49% 47% Severe 2 16% In the US, roughly 1 in 4 (27 the ) reported they had mild psoriasis, 2 in 4 (49%) moderate, and the remaining 1 in 4 (2) severe. Of all the countries in the analysis, This makes the US one of the countries with the smallest percentage of with self-reported mild psoriasis among the surveyed countries (see also 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: 5.6 Happiness ranking: 13th / 21 Happiness Global Happiness level Happiness gap Happiness level Happiness gap Overall % % Gender - female % - male % % Severity - mild % - moderate % - severe % % The average happiness level of 5.6 places the US as 13th in the happiness ranking of the 21 countries in the analysis. With an overall average happiness gap of -2, the US is also among the countries with the largest gaps (see also Fig. A.2 and A.3 in the Appendix). Some of the things that stand out in the table above are that: Women with self-perceived psoriasis in the US are less happy than their male counterparts, which is the same pattern seen globally and in almost all of the other countries. Stress & Loneliness As seen from Fig. D.1 and D.2 in the Appendix, the percentages of in the US who experience high stress and loneliness are 2 : High stress: 64.6% Loneliness: 43.1% Almost 2 in 3 (65%) experience high stress, placing the US roughly in the middle compared to other countries. However, loneliness is a major cause of concern, as 4 of are affected by it, making the US the country with the highest percentage of loneliness. The happiness level drops slightly between people with self-perceived mild and moderate psoriasis, and then takes a significant plunge for people with severe psoriasis: the happiness gap for people with selfperceived mild psoriasis is -17%, and -35% for those with self-perceived severe psoriasis. 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 = 517 None of the above 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 -18% -36% % % -26% -28% -41% -17% Average happiness gap 19% (99) 41% (210) 46% (239) 31% (162) 2 (104) 2 (101) 7% (34) (18) (17) (16) (17) 3 % (16) Global - Comorbidities N=10,828 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 -8% -29% -26% -2-27% % % 26% 19% 1 1 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 = 445 None of the above 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 -2-36% % -3-28% -26% -26% -31% -36% Average happiness gap 18% (81) 4 (187) 47% (211) 29% (131) 21% (92) 19% (85) 7% (29) (17 ) (16) (15) (15) 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 = 66 None of the above 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 -9% 27% (18) -28% 27% (17) -27% -26% 38% (25) 4 (28) -45% 17% (11) -2 21% (14) -51% 8% (5) -57% (1) -28% (1) 29% (1) -79% (2) 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 above -7% Depression or other mental disorders -21% Psoriatic arthritis -29% High blood pressure Other joint diseases apart from psoriatic arthritis Diabetes Heart and vascular diseases Other Lung diseases Kidney diseases Liver diseases -18% 3-21% -2-28% -21% -57% MILD N = 82 5% 21% (17) 4 (35) 35% (29) 29% (24) 18% (15) 17% (14) 7% (6) (3) (3) 5% (4) 1% (1) -3 MODERATE N = % -28% -25% -3-28% -21% -3-19% -3-39% 2 (60) 38% (98) 4 (102) 31% (79) 2 (52) 19% (48) 5% (14) 5% (13) (9) (9 ) (8) -27% -45% -4-47% % SEVERE N = (22) 4 (77) 61% (108) 3 (59) 21% (37) 2 (39) 8% (14) -5 1% (2) -37% (5) -2 (3) -41% (8) 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: 4 in 5 (81%) of the in the US reported at least one of the listed comorbidities. This is a high figure, and significantly higher than is the global average of 66% who report comorbidities. The most reported comorbidities in the US are depression or other mental disorders (41%), psoriatic arthritis (46%), and high blood pressure (31%). Other joint diseases and diabetes are also reported by high numbers: 1 in 5 (2). Compared to other countries and the global picture, there is a much larger proportion of people with self-perceived psoriasis reporting comorbidities in the US. Likewise, the happiness gaps related to almost all of the comorbidities are higher in the US than globally, with liver diseases, depression or other mental disorders, and other joint diseases standing out with gaps of up to -41% 3. Turning to the split by gender, we see that: Although the percentage of self-reported comorbidities is very high for both women and men in the US, more women experience them. 8 of women reported at least a comorbidity, while 7 of men reported the same. Almost half (47%) of women in the US reported psoriatic arthritis, while 2 in 5 (38%) men did the same; once again, much higher percentages than the global averages. Conversely, more men than women (4 vs. 29%) reported high blood pressure, which is also higher than the global average. Finally, the happiness gaps for most of the comorbidities are higher for women than for men, in line with the finding that living with self-perceived psoriasis and its different aspects impacts women in a higher degree. Moving on to the split by severity in the bottom graphs, we see that: A larger percentage of people with self-perceived severe psoriasis experience comorbidities compared to those with mild and moderate psoriasis. 88 people with self-perceived severe psoriasis reported comorbidities, while 79 those with mild psoriasis did. The percentage of psoriatic arthritis increased significantly with severity, from 35% for self-reported mild psoriasis to 61% for severe. Lastly, we see that, in general, the worse the severity, the larger the happiness gap (although no claim of causality can be made). Also, significantly more women than men reported depression or other mental disorders (4 vs. 27%), although both proportions are very high-and much higher than the global averages. 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 US, the estimated cost to society from lost productivity is as follows: Total cost on society Overall $30,517m Per 100,000 people in employment $19.6m As GDP 0.16% 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 US is the country with the fourth highest total cost to society from lost productivity (as GDP). Nominally, this corresponds to an estimate of $30,517 million per year. Productivity Levels 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 they should have stayed at home because of their psoriasis and, respectively, other health issues). Productivity at work Global Average productivity - Because of psoriasis 62.2 (195) 53.2 (2,721) - Because of other health issues 60.1 (196) 62.9 (2,633) Percentage of people reporting less than 5 productivity - Because of psoriasis 38% (75) 51% (1,521) - Because of other health issues 45% (88) 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 case, in the US have, on average, a higher productivity when went to work even though they should have stayed at home because of their psoriasis. When it comes to other health issues, their average productivity is slightly lower. As can also be seen from Fig. B.1 and B.2 in the Appendix, the US is in the better half of countries when it comes to productivity at work when people should have stayed at home due to psoriasis, but in the worse half when it comes to other health issues. In the same vein as above, almost 2 in 5 (38%) in the US work at 5 productivity or less when they should have stayed at home because of their psoriasis, and slightly more (45%) when it s because of other health issues. Compared to other countries, this places the US 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 like 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 = 213 N = 213 N = 2,998 N = 2, hours 25% 21% 2 26% 10+ hours 19% 1 17% 17% 20+ hours 9% 5% 1 1 Social hours missed N = 367 N = 365 N = 5,387 N = 5, hours 45% 37% 35% hours % hours 25% 1 18% 1 In the US, people missed around the same number of work hours because of psoriasis as we see in the global case, but for social hours the percentages are higher. For instance, 1 in 4 (25%) in the US missed at least 5 or more work hours in the last 4 weeks because of psoriasis, while for missed social hours the percentage is almost half (45%). WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 13

14 PRODUCTIVITY & WORK LIFE Impact of Symptoms on 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 of living with psoriasis 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 flare-up Depression or anxiety Stress As seen in the left graph above, the aspects with the largest impact on people s work life in the US are stress, depression or anxiety, skin flare-ups, trouble sleeping and pain, with stress having the largest impact and the latter four having almost equal impacts. What stands out compared to the global numbers in the right graph is that the size, or strength, of the impact is much higher in the US across all of the different aspects. Looking at Fig. B.5 in the Appendix, we also see that the US is probably the country with the highest absolute impact levels. 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 58% 58% 59% % systems in place to help me manage my psoriasis" (105) (92) (13) (2,336) (1,811) (515) "My manager understands the impact psoriasis has on me and my work performance" 55% (99) 56% (88) 5 (11) 51% (1,939) 5 (1,530) 48% (404) "My work colleagues know about my psoriasis and I get their support when needed" 45% (81) 4 (69) 55% (12) 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" 51% (92) 51% (81) 5 (11) 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 US, around half or more of the (45% to 58%) are generally dissatisfied with the support they receive at work on both a company/manager and colleague/co-worker level. This goes for both men and women, although more men disagreed with the statement around having colleagues who know about their psoriasis. In general, it s worth noting that: Around 3 in 5 (58%) don t think their company has systems in place to help them manage their psoriasis. More than half (55%) don t think their manager understands their condition and its impact on their productivity. Around half (45% and 51%) also don t think they get support from their colleagues nor that they have a close co-worker who understands and they can talk to. 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 4. 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. 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 / 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 US and the global case. - HCP Type Who is your primary healthcare professional in relation to your psoriasis? N = 950 Global - HCP Type Who is your primary healthcare professional in relation to your psoriasis? N = 13,533 Other 21% A nurse A dermatologist 46% Other 18% A nurse A dermatologist 48% My Personal Doctor / GP 31% My Personal Doctor / GP 31% - HCP frequency How many times per year are you in contact with healthcare professional due to your psoriasis? N = 923 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 19% Don t see an HCP yearly 27% Once a year 2 to 5 times 6 to 12 times 12+ times per year 6% % Once a year 2 to 5 times 6 to 12 times 12+ times per year 6% 2 31% WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 17

18 HEALTHCARE PROFESSIONALS - HCP institution Is your primary helthcare professional for your poriasis: N = 3833 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) 17% Working in an institution (clinic or hospital) run as part of the public healthcare sector (free for you) 38% Working in a private institution that is paid by your private health insure 58% Working in a private institution that is paid by your private health insurer 29% Working in a private institution that you pay out of your pocket for your each visit 1 Working in a private institution that you pay out of your pocket for your each visit 2 Other Other 1 Some of the things we see from the figures above are e.g. that: Almost half of the (46%) in the US see a dermatologist as their main healthcare professional in relation to their psoriasis, while almost a third (31%) see a personal doctor or GP. This is very much like the global picture and many other countries (see also Fig. C.1 in the Appendix). the countries where people see their healthcare professionals most often (see also Fig. C.2 in the Appendix). More than half (58%) reported they go to a private healthcare institution paid by their private health insurer for their psoriasis. This makes the US stand out from other countries, as seen in Fig. C.3 in the Appendix. In regards to the frequency of visits, around 1 in 5 (19%) in the US don t see their healthcare professionals yearly, while more than 2 in 5 (41%) see their healthcare professionals 2-5 times. This makes the US one of WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 18

19 HEALTHCARE PROFESSIONALS Diagnosis & Type of Treatment As seen in the table below, almost 3 in 4 (7) in the US said their psoriasis was diagnosed by a dermatologist, a proportion slightly greater than seen in the global averages. Was your psoriasis diagnosis by.. (N = 596) Global (N = 14,184) Dermatologist 7 69% Personal doctor / GP 18% 21% Haven t been diagnosed by a doctor 5% 6% Nurse 1% 1% Other 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 = 1,542 Prescription topical treatment (medical creams, ointments or foam) 5 Over-the-counter topical treatment (creams, lotions or ointments) 38% None of the above/not in treatment 1 Systemic therapy (pills or injections) 2 Light therapy (sunlight or ultraviolet) 15% Biologic therapy (injections) 17% Other (please specify) 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 = 572 I go to the pharmacy with a prescription and I pay the full price of the product 1 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 46% I go to the pharmacy without a prescription and I pay the full price of the product 9% I go to the pharmacy with a prescription and I don t pay anything, the price is covered by my insurance completely 1 Other 2 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 US is prescription topicals, used by 5. Next are over-thecounter topicals, used by 38%. What s interesting, however, is the fact that 2 are on systemic therapy and 17% on biologic therapy, which is more than we see in the global case. As seen in Fig. C.5, these two treatment types are also much more common in the US than other countries. As for getting their treatment, most in the US (46%) said they go to the pharmacy with a prescription and pay part of the price, with the rest being covered by their insurance. Similarly, and as seen in Fig. C.6 in the Appendix, this makes US one of the countries where it s reportedly very rare for people to pay the full price either with or without a prescription. 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 5.28 (395) 4.97 (5,853) Gender - Female 5.28 (346) 4.95 (4,604) - Male 5.11 (45) 5.02 (1,220) Severity - Mild 5.25 (63) 5.23 (1,356) - Moderate 5.12 (194) 4.80 (3,157) - Severe 5.51 (138) 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 US are slightly more satisfied with their healthcare professionals than globally. Looking at Fig. C.7 in the Appendix, we also see that the US places fourth best in this regard. What also stands out in the table above is that women are slightly more satisfied with their their healthcare professionals than men. Finally, as in the global case, it s interesting to see how people in the US with self-perceived moderate psoriasis are less satisfied than people with self-perceived mild and severe psoriasis, indicating perhaps that having this middle or moderate severity of the disease places people in a grey zone where they suffer more than people with mild psoriasis but don t get the same extra attention that people with severe psoriasis might receive (assuming their higher satisfaction level is related to this). WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 21

22 HEALTHCARE PROFESSIONALS Perceived Quality of the Interaction with Healthcare Professionals TThe 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" 21% (79) 2 (74) 1 (4) 21% (2,813) 2 (968) 15% (188) "The doctor recognised and responded to my emotional state" 31% (115) 3 (106) 2 (8) 3 (1,619) 3 (1,349) 2 (263) "The doctor talked in terms I could understand" 6% (24) 7% (22) 5% (2) 15% (847) 1 (698) (145) "The doctor encouraged me to ask questions" 21% (79) 2 (72) 15% (6) 28% (1,612) 29% (1,333) 2 (273) "The doctor involved me in decisions as much as I wanted" 18% (69) 19% (64) 1 (4) 25% (1,417) 26% (1,165) 2 (244) "The doctor discussed next steps" 2 (81) 2 (75) 1 (5) 26% (1,482) 27% (1,228) 2 (246) "The doctor spent the right amount of time with me" 2 (81) 2 (75) 1 (5) 25% (1,395) 26% (1,148) 19% (241) "The doctor discussed about how my psoriasis affect my mental health and overall well-being" 5 (199) 57% (186) 29% (12) 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 picture, the in the US were roughly equally dissatisfied with aspects around the latest interaction with their their healthcare professional, if perhaps a little bit less in some respects. For instance, only 6% disagree that the doctor talked in terms they could understand (vs. 15% globally). It s worth pointing out, however, that, as in the global case, the largest degree of dissatisfaction is seen with the extent to which doctors address how psoriasis affects people s mental health and overall well-being: 5 disagreed. We see that women in the US are generally much more dissatisfied than men in regards to the interaction with their their healthcare professionals, especially in regards to the aspect around how doctors address mental health, for which as many as 57 women (and only 29 men) disagreed. 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" 37% (326) 37% (262) 27% (55) 4 (5,329) 41% (3,933) 36% (1,341) "My healthcare professionals fully understand the impact psoriasis has on my mental well-being" 5 (471) 55% (393) 48% (69) 5 (7,055) 56% (5,311) 4 (1,683) "I can get in touch with the healthcare professional when I m in need" 25% (208) 26% (174) 25% (32) 36% (4,798) 37% (3,532) 3 (1,227) "I have confidence in the abilities of my healthcare professionals to treat psoriasis" 38% (333) 38% (273) 38% (56) 4 (5,946) 4 (4,344) 39% (1,550) "I always follow the advice of my healthcare professionals" 25% (217) 2 (169) 31% (44) 27% (3,692) 27% (2,611) 28% (1,035) "I ve been informed about all the different treatment options related to my condition" 45% (363) 47% (310) 4 (50) 55% (7,240) 57% (5,424) 5 (1,763) "The system provides me with sufficient financial support in relation to my skin condition" 56% (455) 58% (390) 49% (62) 67% (8,865) 69% (6,535) 6 (2,267) "There is sufficient public awareness regarding my disease" 76% (617) 79% (529) 6 (80) 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 the relationship to their healthcare professionals, in the US are again roughly on par with the global norm. In some cases, however, there are slightly fewer people in the US reporting disagreement; for example, when assessing aspects like being able to get in touch with the healthcare professionals and being informed of treatment options, the levels of disagreement in the US were slightly lower than the global averages. Still, 1 in 4 (25%) don t think they can get in touch with their healthcare professionals when in need, and almost half (45%) don t think they have been informed of all the different treatment options. The largest degree of dissatisfaction is seen in regards to financial support and public awareness, for which 56% and 76% in the US disagree with the respective statements. Finally, women report in higher percentages disagreement to these aspects of their relationship to the healthcare professionals, but it doesn t translate into not following the doctor s advice: almost a third (31%) of men said they don t always follow the advice of their healthcare professionals, compared to only 2 of the women. 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 Kingdom 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 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 5,451 1, , % , , ,564-2 Norway 1,109-2 United Kingdom 5,736-25% 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 Kingdom 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 Kingdom 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 Kingdom % 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 Kingdom 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 Kingdom Trouble sleeping Bleeding Trouble walking Czech Republic Portugal Russian Federation United Kingdom 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 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 Kingdom , , , , % 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 Kingdom 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 Kingdom 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 Kingdom % 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 Kingdom ,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 Kingdom ,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 Kingdom 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 Kingdom 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 Kingdom % % 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 Kingdom % 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 Kingdom 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 1,813 Australia 884 1,744 1, ,699 2,252 United Kingdom 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 United Kingdom 1,739 Australia 649 Ireland 207 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