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

Transcription

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: 2,084 Gender distribution Age distribution Other (7) 3 (703) Male 31% (637) 2 (465) 2 (482) Female 69% (1,419) 7% (154) 1 (218 ) Severity distribution (1) (55) (6) Severe (224) Age Severity distribution (N = 1,983) Global (N = 54,438) Moderate 4 (891) Mild 4 (868) Mild 4 37% Moderate 4 47% Severe 16% In, most of the of the survey (roughly 9 out of 10) deemed their psoriasis either mild or moderate, with the two degrees of severity equally represented. The remaining 1 in 10 reported their psoriasis to be severe. 1 Of the countries in the analysis, has the fourth highest number of people with mild psoriasis. Similarly, at, also falls into the group of countries with the smallest proportion of people with 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: 5.7 Happiness ranking: 11th / 21 Happiness Global Happiness level Happiness gap Happiness level Happiness gap Overall % % Gender - female % - male % % Severity - mild % - moderate % - severe % % The average happiness level of 5.7 places as 11th in the happiness ranking of the 21 countries in the analysis. With a positive happiness gap of +19% reported by those living with self-reported mild psoriasis, is actually one of the best countries in this regard as people with psoriasis are happier than the average population. This situation is similar to Portugal, the only other country with significant positive happiness gaps for both selfreported mild and moderate psoriasis. (see Fig. A.3 in the Appendix). It is very important to note that the happiness gaps are relative in the sense that they capture a difference, and should therefore not be mistaken for absolute happiness levels. In other words: the Greek psoriasis populations are not the happiest populations nor the population least often subject to misery. Rather, they are doing better than their fellow citizens. As we can see below, they experience in high percentages stress and loneliness. Some of the things standing out in the table above are that: seen in most of the other countries and on a global scale. The happiness level drops significantly with the severity of people s psoriasis. I.e., people who report severe degrees of psoriasis are significantly less happy and experience increasingly large happiness gaps (more negative), once again in line with the results for other countries and the global picture. Stress & Loneliness As seen from Fig. D.1 and D.2 in the Appendix, the percentages of in who experience high stress and loneliness are: 2 Percentage reporting high stress levels: 68. Percentage experiencing loneliness: 34.7% Thus, more than 2 out of 3 (68%) experience high stress. Compared to other countries, this places in the worse end of the spectrum in this regard. The same is true for loneliness, experienced by more than a third (3) of people with psoriasis in. Women with psoriasis are slightly less happy than their male counterparts, which is the same pattern 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 = 756 None of the below 1 5 (397) Depression or other mental disorders - 1 (114) Psoriatic arthritis High blood pressure Other joint diseases apart from psoriatic arthritis 1 6% 8% (62) (33) 18% (139) Diabetes Heart and vascular diseases Other Lung diseases Kidney diseases Liver diseases Cancer - (35) (20) 6% (32) 7% (20) 8% 1 1% (11) 1% (8) (17) 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 Kidney diseases Liver diseases Cancer -19% -2-18% Average happiness gap WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 6

7 GENERAL DATA & HAPPINESS RESULTS - Comorbidities by gender - Female N = 501 None of the below 1 51% (255) Depression or other mental disorders -1% 17% (85) Psoriatic arthritis 18% (89) High blood pressure 7% (37) Other joint diseases apart from psoriatic arthritis Diabetes -17% (26) (17) Heart and vascular diseases - (9) Other 6% (28) Lung diseases -8% (14) Kidney diseases (9) Liver diseases 1% (4) 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% % 3 31% Average happiness gap WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 7

8 GENERAL DATA & HAPPINESS RESULTS - Comorbidities by gender - Male N = 250 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 -6% -4 % - 18% 1 8% 19% (29) 2 (49) 1 (24) (6) 7% (18) (11) (4) (6) 1% (2) (4) 56% (139) 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 % -16% 2-16% 2-2 9% % 6% -2-19% % 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 Cancer 18% 1 (48) - 16% (55) -1 1 (11) 1% % 1 1 8% MILD N = (7) SEVERE N = 73 58% (194) 1 51% (174) -1% 38% (28) 9% (31) 1 2 (79) -9% 38% (28) 9% (29) 7% (23) -2 1 (9) (15) 6 % (13) -1 9% (5) (14) (7) (13) (11) 1% (3) 1% (5) MODERATE N = (15) (6) (14) 47% 1% (3) 3 1% (5) 1% (2) 6 % (9) % (6) 1 (7) - (4) -2 8% (6) -3 (3) -4 19% (1) - 1% (1) 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% % MILD N= 2, % 7% MODERATE N= 5,962-9% -26% -21% -19% % -21% -19% -2-21% % 2 18% 1 1 SEVERE N= 2,560-21% -4-36% -41% -39% -39% -4-36% -39% -27% -3-28% % 1 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 graph with the overall results on comorbidities and happiness gaps, we note, among other things, that: More than half (5) of the surveyed people in don t experience any of the listed comorbidities, significantly more when compared to the 3 global average. Like almost all other countries, the comorbidities with the highest incidence are depression or other mental disorders (1), psoriatic arthritis (18%), and high blood pressure (8%), although these, especially the first and the latter, are not nearly as reported in as in most other countries. Across all the comorbidities there are almost none with any significant (negative) happiness gaps, indicating that people with psoriasis in are much less affected by their condition, and perhaps also their comorbidities, than in the rest of the world. 3 However, when moving on to the split by self-perceived severity in the bottom graph, we see that: A larger percentage of people with moderate and severe psoriasis experience comorbidities. 58 the people with mild psoriasis reported that they didn t have any of the listed comorbidities, meaning that 4 did. Compare this to 49% with moderate psoriasis and 6 with severe psoriasis who experience comorbidities. Across almost all of the comorbidities, we also begin to see the happiness gaps getting larger (in the sense that they re decreasing, dropping below, and becoming negative) the worse and more severe the psoriasis. Also, the prevalence of psoriatic arthritis increases dramatically with severity, from 9% for mild psoriasis to 2 for moderate and 38% for severe. A similar pattern is seen in many of the other countries and from the global picture. 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 estimated cost to society from lost productivity is: Total cost on society Overall $57m Per 100,000 people in employment $1.4m As GDP 0.0 For reference, the general results for all countries from the World Psoriasis Happiness Report 2018 are shown in the Appendix, Fig. B.6. From this we see that is actually the country with the lowest total cost to society from lost productivity. 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 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 7.1 (310) 53.2 (2,721) - Because of other health issues 74.8 (304) 62.9 (2,633) Percentage of people reporting less than 5 productivity - Because of psoriasis 98% (116) 51% (1,521) - Because of other health issues 2 (66) 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.) People in have extremely low productivity when they should have stayed at home because of their psoriasis. In fact, is the country with the lowest productivity in this regard, as can also be seen in Fig. B.1 in the Appendix. When it comes to other health issues, however, people s productivity isn t affected nearly as much, and here, is in fact the country with the second highest productivity level (see Fig. B.2 in the Appendix). In the same vein as above, we also see that almost all of the (98%) in work with less than half productivity when they should have stayed at home because of their psoriasis. Thus, in, psoriasis seems to play a huge role on people s productivity at work. This makes the country with the largest proportion of people working at below 5 productivity because of their psoriasis. Conversely, is the country with the lowest number of people working below 5 productivity when they should have stayed at home because of other health issues (see 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 percentages of people missing at least 5, 10, and 20 work hours and social hours (in the last 4 weeks), because of psoriasis and because of 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 = 324 N = 326 N = 2,998 N = 2, hours 6% % 10+ hours 17% 17% 20+ hours 1 1 Social hours missed N = 491 N = 493 N = 5,387 N = 5, hours 19% 21% hours % hours 7% 18% 1 In, extremely few people miss out on work, both when it comes to doing so because of other health issues, but especially so when it comes to psoriasis. As little as 6%, which is around 1 in 20, miss 5 work hours or more (over 4 weeks). This is much less than generally seen in other countries and in the global picture. When it comes to social hours, people in generally miss these more often, though still not to the same extent as seen globally and for other countries. Adding these results to what we saw above, it seems like people in very often go to work no matter what, but that their productivity when doing so is severely affected. 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 N = Global - On a scale from 0 to 10, 0 being no impact, Global 10 being - On maximum a scale from impact, 0 to please 10, 0 assess being no how impact, each 10 of the being below maximum aspects impact, has impacted please assess your work how life each in of the the past below 4 weeks aspects has impacted your work life in the N = past 3,902 4 weeks 7.0 N = 3, Trouble walking Bleeding Pain Trouble sleeping Skin flare-up Depression or anxiety Stress Trouble walking Trouble walking Bleeding Bleeding Pain Pain Trouble sleeping Trouble sleeping Skin Depression flare-up Skin Depression or anxiety flare-up or anxiety Stress Stress As seen in the left graph, the aspects with the largest impact on people s work life in are stress, depression or anxiety, and skin flare-ups, which is also what we see in the global picture and for almost all other countries (see also Fig. B.5 in the Appendix). However, it s interesting to note that the size, or strength, of the impact of these aspects is lower for people in than other countries. is, in fact, one of the countries with the lowest impact reported, especially when it comes to aspects such as depression or anxiety, skin flare-ups, trouble sleeping and walking, pain, and bleeding. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 14

15 PRODUCTIVITY & WORK LIFE Support at Work The table below summarises the respondent s opinions 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 % % systems in place to help me manage my psoriasis" (197) (134) (60) (2,336) (1,811) (515) "My manager understands the impact psoriasis has on me and my work performance" 41% (152) 46% (114) 3 (37) 51% (1,939) 5 (1,530) 48% (404) "My work colleagues know about my psoriasis and I get their support when needed" 27% (101) 29% (72) 2 (28) 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" 2 (88) 26% (63) 21% (25) 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.) As seen from the data and results in the table above, people in are, compared to other countries in the analysis, generally less dissatisfied with the support they receive at work on both a company, manager, and colleague/coworker level. Also, women seem to be more dissatisfied than men, especially when it comes to understanding from managers, where 46 women report dissatisfaction compared to 3 of men. However, in itself, it s still worth noting that more than half (5) don t think their company has systems in place to help them manage their psoriasis, and more than 2 in 5 (41%) don t think their manager understands their condition and its impact. Also, around a quarter or more (27% and 2) don t think they get support or understanding from their colleagues and don t have a close coworker 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. 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 and the global case. - HCP Type Who is your primary healthcare professional in relation to your psoriasis? N = 965 Global - HCP Type Who is your primary healthcare professional in relation to Who is your primary healthcare professional in relation to your psoriasis? your psoriasis? 13,533 N = 13,533 Other 16% My Personal Doctor / GP 6% Other 18% Other 18% A nurse A dermatologist 48% A nurse A dermatologist 78% My Personal Doctor / GP 31% A dermatologist 48% - HCP frequency How many times per year are you in contact with healthcare professional due to your psoriasis? N = 644 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 39% Don t see an HCP yearly 27% Once a year 2 Once a year 2 2 to 5 times 26% 2 to 5 times 31% 6 to 12 times 1 6 to 12 times 12+ times per year 1% 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 = 129 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 1 Working in a private institution that you pay out of your pocket for your each visit Other 7% 3 47% 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 29% Working in a private institution that you pay out of your pocket for your each visit Other % Key learnings from these graphs: Almost 4 in 5 (78%) of people in have a dermatologist as their main healthcare professional. This is significantly more than the general picture and for many other countries. In fact, is the country with the largest proportion of people seeing a dermatologist in relation to their psoriasis (see also Fig. C.1 in the Appendix). In regards to frequency of visits, almost 4 of people in don t see their healthcare professional yearly. This is more than for many other countries, and is, in fact, also among the three countries with the most people not seeing their healthcare professional on a yearly basis (see also Fig. C.2 in the Appendix). The most common thing in (as reported by 47%) is going to a private institution, with the saying they are paying out of their own pocket for each visit to see their healthcare professional. is the country with the largest percentage of people doing this, compared to a 29% global average (see also Fig. C.3 in the Appendix). About a third (3) go to a clinic or hospital run as part of the public healthcare sector and they don t have to pay anything (the global average is 38%). WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 18

19 HEALTHCARE PROFESSIONALS Diagnosis & Type of Treatment As seen in the table below, most people in (89%) have had their psoriasis diagnosed by a dermatologist - a proportion far greater the one shown by the global picture and many other countries (see also Fig. C.4 in the Appendix). Was your psoriasis diagnosis by.. (N = 1,189 Global (N = 14,184) Dermatologist 89% 69% Personal doctor / GP 21% Haven t been diagnosed by a doctor 6% Nurse 1% Other As for the type of treatment and how people get 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 = 1,160 Prescription topical treatment (medical creams, ointments or foam) 4 Over-the-counter topical treatment (creams, lotions or ointments) 28% None of the below/not in treatment Systemic therapy (pills or injections) 1 1 Light therapy (sunlight or ultraviolet) 9% Biologic therapy (injections) 7% 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 1 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 = 361 I go to the pharmacy with a prescription and I pay the full price of the product 2 (181) 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 28% (221) I go to the pharmacy without a prescription and I pay the full price of the product 21% (162) I go to the pharmacy with a prescription and I don t pay anything, the price is covered by my insurance completely 1 (110) Other (112) 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 common treatment type in are prescription topicals, used by 4. Next are over-thecounter topicals, used by almost 3 in 10 (28%). These numbers are slightly lower than those seen in the general picture and many other countries (see also Fig. C.5 in the Appendix). As for getting their treatment, most people in go to the pharmacy with a prescription and pay either part of (28%) or the full (2) price of the product. Around 1 in 5 (21%) go without a prescription, paying the full price. 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 5.94 (549) 4.97 (5,853) Gender - Female 5.77 (380) 4.95 (4,604) - Male 6.27 (165) 5.02 (1,220) Severity - Mild 6.1 (229) 5.23 (1,356) - Moderate 5.6 (248) 4.80 (3,157) - Severe 6.3 (67) 5.10 (1,314) (The numbers in parentheses show the total sample size for the scenario in the particular table cell.) People in reported the highest levels of satisfaction among all the analysed countries (see Fig. C.7 in the Appendix), with men reporting slightly higher levels of satisfaction than women. Interestingly, people with self-perceived moderate psoriasis are less satisfied than people with selfperceived mild and severe psoriasis (both in and globally), indicating perhaps that having this middle 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 because of this). 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" (59) 1 (46) 8% (13) 21% (2,813) 2 (968) 1 (188) "The doctor recognised and responded to my emotional state" 18% (92) 2 (73) 1 (19) 3 (1,619) 3 (1,349) 2 (263) "The doctor talked in terms I could understand" 9% (47) 1 (38) 6% (9) 1 (847) 1 (698) (145) "The doctor encouraged me to ask questions" 1 (73) 16% (58) 1 (15) 28% (1,612) 29% (1,333) 2 (273) "The doctor involved me in decisions as much as I wanted" 1 (71) 16% (57) 9% (14) 2 (1,417) 26% (1,165) 2 (244) "The doctor discussed next steps" 17% (87) 19% (68) 1 (19) 26% (1,482) 27% (1,228) 2 (246) "The doctor spent the right amount of time with me" 2 (118) 2 (86) 21% (32) 2 (1,395) 26% (1,148) 19% (241) "The doctor discussed about how my psoriasis affect my mental health and overall well-being" 36% (185) 38% (139) 3 (45) 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.) People with self-reported psoriasis in are generally less dissatisfied with aspects around the interaction with their healthcare professional compared to the global picture and other countries. For example, only around 1 disagree that they got enough information and that the doctor talked in terms they could understand. The only aspects where the disagreement is notable are those related to the time the doctor spent with them (2 disagree) and whether the doctor discussed the impact psoriasis has on their mental health and overall well-being (36% disagree). Finally, as in the global picture, women generally seem to be more dissatisfied than men in regards to their healthcare professional. WORLD PSORIASIS HAPPINESS COUNTRY REPORT 2018 / 22

23 HEALTHCARE PROFESSIONALS Healthcare Professional Relationship The table below shows the number of people disagreeing with different statements around healthcare professional relationship. 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" 3 (307) 37% (232) 29% (75) 4 (5,329) 41% (3,933) 36% (1,341) "My healthcare professionals fully understand the impact psoriasis has on my mental well-being" 47% (421) 49% (309) 4 (111) 5 (7,055) 56% (5,311) 4 (1,683) "I can get in touch with the healthcare professional when I m in need" 3 (297) 3 (218) 31% (79) 36% (4,798) 37% (3,532) 3 (1,227) "I have confidence in the abilities of my healthcare professionals to treat psoriasis" 5 (484) 5 (345) 5 (137) 4 (5,946) 4 (4,344) 39% (1,550) "I always follow the advice of my healthcare professionals" 29% (255) 31% (194) 2 (60) 27% (3,692) 27% (2,611) 28% (1,035) "I ve been informed about all the different treatment options related to my condition" 47% (409) 49% (304) 41% (104) 5 (7,240) 57% (5,424) 5 (1,763) "The system provides me with sufficient financial support in relation to my skin condition" 7 (653) 77% (477) 68% (173) 67% (8,865) 69% (6,535) 6 (2,267) "There is sufficient public awareness regarding my disease" 7 (649) 76% (468) 7 (178) 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 general relationship to their healthcare professionals, people in are not nearly as satisfied as we saw before for the statements around healthcare professional interaction. For instance, more than a third (3) don t think their healthcare professionals are clear with the information on how to treat psoriasis and don t think they can get in touch with their healthcare professional when in need. Close to half (47%) don t think they have been informed of all the different treatment options and also don t think the healthcare professional fully understands the impact of psoriasis on their mental well-being. And even more than half (5) don t have confidence in the abilities of their healthcare professional to treat psoriasis. Finally, as many as 3 in 4 (7) are dissatisfied with the system and financial support as well as the levels of public 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 Kingdom 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% % 49% % 5 49% 21% 21% 1 18% % 8% 1 26% 21% 27% 2 WORLD PSORIASIS HAPPINESS COUNTRY REPORT APPENDIX

26 GENERAL RESULTS & HAPPINESS Figure A.2: ranking: Psoriasis happiness levels per country (With 9 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 9 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 1,109-2 United Kingdom 5,736-2 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 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 States 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 United States % 97% % 49% 48% % 38% 3 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 United States Czech Republic Portugal Russian Federation % % % 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 United States Trouble sleeping Bleeding Trouble walking Czech Republic Portugal Russian Federation United Kingdom 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 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 United States , , , , % 3 76% 48% % 49% 47% 47% 5 51% 3 46% 1 5 9% % 6% % 5 31% 8% 2 9% 1 8% 1 16% % 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 United States 1, , , % 2 19% 31% 2 18% 39% 41% 36% 2 41% 31% 26% 19% 29% 29% 2 16% 2 27% 2 29% % 27% 18% 2 28% 37% 36% 37% % 21% % 41% Sample size 6 to 12 times 12+ times per year Czech Republic Portugal Russian Federation United Kingdom United States 1, , , % 9% 18% % 9% 7% % 6% 1% 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 United States % 78% % % 51% 78% 8 17% 41% % 29% 2 1 8% 8% 2 6% 58% 21% 27% 47% 27% 4 21% 29% 6% 1 1 8% 1 8% 21% 21% 7% 1 1 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 United States ,813 1,058 1,189 1, , , % 56% 37% 7 58% 71% 89% % 81% 8 46% 7 31% 28% 17% 31% 21% % 6% 1 49% 18% 7% 9% 8% 8% Sample size Other A nurse Czech Republic Portugal Russian Federation United Kingdom 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 Kingdom 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, % 5 57% % % 5 39% % 4 28% 3 31% 29% 4 29% 31% 38% 1 1 6% 1 7% 1 1 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 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% 7% 6% 7% 7% 17% 1% 6% 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 United States % % 2 49% % 37% 1 28% % 1 21% 16% 28% 16% 6% 9% % 28% 1 2 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 United States % 19% 1 8% 9% 1% % 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 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 United States 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% 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 United States 1, % 30.1% 30.7% % % 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