Clinical features and personality traits associated with psychological distress in systemic sclerosis patients Thomas N. Hyphantis a , Niki Tsifetaki b , Christina Pappa a , Paraskevi V. Voulgari b , Vasiliki Siafaka a , Marina Bai a , Yannis Alamanos c , Alexandros A. Drosos b, 4 , Venetsanos Mavreas a a Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece b Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece c Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece Received 30 May 2006; received in revised form 27 July 2006; accepted 31 July 2006 Abstract Objective: The aim of the present study was to identify certain clinical parameters and personality characteristics asso- ciated with various forms of psychopathology in systemic sclerosis (SSc) patients. Methods: Fifty-six SSc patients partici- pated in the study, and 74 healthy participants served as controls. A wide range of clinical information was collected, and the following self-report instruments were used: General Health Questionnaire, Symptom Distress Checklist-90-R, Defense Style Questionnaire, Sense of Coherence (SOC) Scale, and Hostility and Direction of Hostility Questionnaire. Results: The odds of being assessed with a psychiatric diagnosis upon interview were 4.5 times greater among SSc patients compared with controls. Disease duration and lower rates of SOC were found to be associated with elevated symptoms of general psychological distress. Elevated symptoms of depression were strongly associated with esophageal involvement, hostility, and defense style used. Elevated symptoms of anxiety were mainly associated with arthritis-related painful conditions and SOC, while psy- chotic-like symptoms were only associated with age and a specific personality structure. Conclusions: SSc patients experi- ence elevated symptoms of psychological distress. Several clinical parameters are associated with distress, but the role of various personality traits could not be disregarded. Early psychiatric assessment and intervention could prevent psycho- logical distress in SSc patients. D 2007 Elsevier Inc. All rights reserved. Keywords: Systemic sclerosis; Psychological distress; Depression; Personality; Sense of coherence; Ego mechanisms of defense Introduction Systemic sclerosis (SSc) is a connective tissue disease in which inflammatory, fibrotic, and degenerative changes in the skin (scleroderma) lead to disfiguring skin thickening. It also affects multiple organ systems, particularly the musculoskeletal system, the lungs, the heart, the kidneys, and the gastrointestinal (GI) tract [1,2]. Although SSc cannot be cured, treatment of involved organ systems can relieve symptoms and improve function [2]. SSc has an impact on many aspects of an individual’s life, including psychological well-being [3,4]. Medical interventions in the areas of discomfort, dysfunction, and distress could be important for the management of this progressive disease and the quality of the patient’s life. Although evidence suggests that depression contributes to the disability associated with chronic illnesses [5] and especially with rheumatic diseases [3,6], few studies have examined in detail the psychosocial sequelae of SSc [3]. Available data suggest that approximately half of SSc patients experience mild-to-severe depressive symptoms [3,7–9]. However, most of these studies have mainly focused only on depressive symptoms, whereas few detailed 0022-3999/07/$ – see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2006.07.028 4 Corresponding author. Department of Internal Medicine, Medical School, University of Ioannina, Ioannina 45110, Greece. Tel.: +30 26510 99755, +30 26510 97503; fax: +30 26510 97054. E-mail address: adrosos@cc.uoi.gr (A.A. Drosos). Journal of Psychosomatic Research 62 (2007) 47 – 56