Stressful Life Events and Psoriasis during the War in Bosnia

Purpose: The basic research goal of the current study was to determine the relationship between stressful life events and the appearance and course of psoriasis under the extreme conditions of war. Patients and Methods: A prospective study was made encompassing 181 patients with psoriasis. One half of the patients were soldiers in active duty under war conditions, the other half consisted of civilians who were living in an area that was frequently subject to shelling from across the nearby frontline. Diagnosis was based on clinical picture, patient history, and auxiliary diagnostic methods. The study has been carried out at the University Clinical Center of Tuzla, as a result of the cooperation between the Departments of Dermatology and Psychiatry. Although numerous measurement instruments were used, the present article concentrates on the analysis of stressful life events with standardized instruments such as ‘Five-Stage Rating Scale’, and ‘Social Readjustment Rating Scale’. Severity of the clinical picture was estimated according to the PASI score, a standardized measurement instrument. Results: Stress levels were observed to be very high: 75% of the soldiers scored above 300 points, with 34% even above 500 points. Civilians scored significant lower, but 51% still had scores above 300 points. Stress was found to be strongly correlated to severity of the disease with correlations of 0.862 and 0.773 (Kendall’s tau-b, p < 0.0001) for soldiers and civilians, respectively. Conclusions: In the past, many authors reported correlations between stress and severity of psoriasis. Our findings demonstrate that under extreme circumstances the correlation between severity of psoriasis and the experience of stress is also extremely strong.