1 / WORLD PSORIASIS HAPPINESS REPORT 2017
ARTICLE TITLE / CHAPTER 00
Editors: LEO Innovation Lab and The Happiness Research Institute Copenhagen, Denmark, October 2017
Executive Summary
© LEO Innovation Lab in cooperation with The Happiness Research Institute, 2017. 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 (2017), World Psoriasis Happiness Report 2017. ISBN 978-87-970163-0-5
Available at https://psoriasishappiness.report/
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During the last decade, there’s been a global paradigm shift in our understanding of progress. A nation’s progress cannot and should not be reduced to gross domestic product (GDP) per capita. Instead, the ultimate goal of public policies should be to improve quality of life.
In 2011, the United Nations passed the resolution on happiness. The same year, the OECD included life satisfaction as a parameter for the development of the member countries. It concluded that subjective well-being measures
are valid and reliable and can be used to inform policy makers and citizens.
The World Psoriasis Happiness Report 2017 aims to shed light on what impacts the subjective well-being - interpreted as happiness - of people living with psoriasis.1
We received input from 121,800 people with self-reported psoriasis across 184 countries on how living with this chronic illness impacts their well-being.
EXECUTIVE SUMMARY
3 / WORLD PSORIASIS HAPPINESS REPORT 2017
Executive Summary
The countries included in the detailed analysis in Chapters 2 and 3 have been grouped based on the definitions of EUROVOC and World Happiness Report2 in the following regions3:
Regions Countries
LATIN AMERICA Brazil, Colombia and Mexico
WESTERN EUROPE France, Germany, UK and Ireland
THE NORDICS Norway and Denmark
RUSSIAN FEDERATION Russian Federation
SOUTHERN EUROPE Spain, Portugal, Italy and Greece
NORTHERN AMERICA & AUSTRALIA USA, Canada and Australia
1 As presented in more detail in the Report, the diagnosis was self-reported by the participants in the study.2 The thesaurus of the European Union & Helliwell, J., Layard, R., & Sachs, J. (2017). World Happiness Report 2017, New York: Sustainable
Development Solutions Network.3 It is important to stress that these regions only serve as categories for the 19 countries included in the analysis, and thus only as indications
of the regional performance. For a complete assessment of the regional performance we would need more country cases within each geographical region.
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1) Psoriasis has an impact on happiness
Our study shows that living with psoriasis impacts people’s quality of life across a wide spectrum of subjective well-being indicators. When people report severe symptoms, they also report lower levels of happiness.
Using the World Happiness Report 2017 as a benchmark, our study shows that people living with severe psoriasis in some countries report 30% lower levels of happiness than
their fellow citizens. What stands out is the particular ranking of all 19 countries according to their average happiness levels.
Countries that don’t make the top 10 in the annual UN World Happiness Reports – such as Colombia, Brazil, Mexico and Spain – rank as the top countries, when considering the group of people living with psoriasis. Correspondingly, Norway and Denmark – the two happiest countries
in the world according to the World Happiness Report – are listed as number 9 and 14, respectively. With an average happiness score of 5.65 for people living with psoriasis in Denmark and 5.99 in Norway, the selected countries in the Nordics become subject to the largest happiness gaps considering that the general populations in these countries report an average happiness level of 7.5.
The ten key insights in this report
Psoriasis happiness ranking
6.05.55.04.54.03.53.02.52.01.51.00.50
4,6005,0738,31710,2442,2273,4379,0384,2344181,2365472,4822,5131,0251,1963,2872,048531654
6.5 7.0
MexicoColombiaSpainBrazilCanadaUnited StatesRussian FedPortugalNorwayIrelandGreeceFranceGermanyDenmarkAustraliaItalyUnited KingdomJapanChina
6.806.686.436.316.096.026.026.005.995.865.795.765.705.655.565.485.395.264.28
n
‘It is surprising to see that Norway and Denmark, which have recently been named as the world’s happiest countries in the two most recent annual UN World Happiness Reports, had the biggest happiness gaps among those living with psoriasis, compared to other countries in our research,’ said Meik Wiking, CEO of the Happiness Research Institute. ‘There were similar, large gaps in other countries that have consistently scored high on the UN’s global happiness index, so it could indicate that the negative impact of chronic health conditions may be flying under the policy radar of otherwise healthy and happy societies and leaving people behind.’
EXECUTIVE SUMMARY
5 / WORLD PSORIASIS HAPPINESS REPORT 2017
EXECUTIVE SUMMARY
2) Psoriasis reduces the happiness of women more than men
While both men and women with psoriasis are very much affected physically, emotionally and psychologically, the impact on women is greater. Compared to their countrymen and countrywomen, men and women living with
severe psoriasis report respectively 11.3% and 18.5% lower levels of happiness. However, for moderate severity the difference was marginal. In addition, women consistently reported higher levels of stress and loneliness than men.
Happiness gap per severity and gender
Aver
age
happ
ines
s ga
p
Mild Moderate Severe
5%
0%
-5%
-10%
-15%
-20%
-25%
-11.3%
-18.5%
-3.4%
-7.4%
0.5%
-2.7%
Femalen = 5,148
Malen = 4,801
Femalen = 5,553
Malen = 5,511
Femalen = 1,479
Malen = 1,300
6 / WORLD PSORIASIS HAPPINESS REPORT 2017
ARTICLE TITLE / CHAPTER 00
6 / WORLD PSORIASIS HAPPINESS REPORT 2017
The different symptoms of psoriasis - such as scaling, itchiness and trouble walking - have very different effects on happiness. While ‘scaling’ is associated with 11.7% lower
happiness levels, ‘trouble walking’ is associated with 22% lower happiness levels compared to the average population. This pattern is consistent across the different levels of severity.
3) Different symptoms have different impacts on happiness
-18.3%Avg.
Hap
pine
ss G
ap fo
r peo
ple
repo
rtin
g th
e fo
llow
ing
sym
ptom
s
0%
-2%
-4%
-6%
-8%
-10%
-12%
-14%
-16%
-18%
-20%
-22%
-11.7%
-14.3%
-17.6%
-12.4%
-15.5%
-17.6%
-22%
Scaling FragileSkin
Pain in Lesion
Trouble Sleeping
Itching Bleeding Pain in Joints
Trouble Walking
n = 6,903
EXECUTIVE SUMMARY
Looking at the relationship between happiness levels and where on the body people have psoriasis, we find that psoriasis on the scalp is associated with a happiness gap of -7.5% while psoriasis on the genitals is associated to happiness gap of -12.9%.
This may be due to that psoriasis on intimate areas of the body may create physical or psychological challenges impacting people’s love lives.
4) Different affected body areas have different impacts on happiness
Happiness gaps and body areas affected
EXECUTIVE SUMMARY
7 / WORLD PSORIASIS HAPPINESS REPORT 2017
Thighs
Knees
Lower legs
Stomach
Back
Chest
Face
Skin folds
Neck
Arms
Shoulders
Scalp
Feet
-12.8%
-11.9%
-11.5%
Anal area -11.2%
-10.4%
Hands -10.1%
-9.8%
Nails -9.2%
-9.3%
-9.0%
-9.6%
-8.9%
-8.5%
-8.4%
-7.5%
Genitals -12.9%
-12% n = 43,686
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We analysed a wide range of factors that impact well-being and found that stress is the best psychological predictor of unhappiness for people living with psoriasis. In all countries, the average stress level of people living with psoriasis exceeds that of the general population in the United States (15.2 on a scale from 0 to 40)4. Also, in the majority of countries the average level is even higher than what is considered high stress (scores above 20). In addition, we find that
stress is a non-discriminating factor, in the sense that it affects people living with psoriasis regardless of demographics, socioeconomic status and severity.
Furthermore, of all daily emotions and experience - both positive and negative - distress is the most common among people with psoriasis. 60% report feeling distressed in a moderate to extreme degree in their daily life.
5) Stress is the strongest psychological predictor of unhappiness for people living with psoriasis
EXECUTIVE SUMMARY
10 12 14 16 18 20 22 24 26 28 30
Aver
age
happ
ines
s le
vels
Average stress levels
8.0
7.5
7.0
6.5
6.0
5.5
5.0
4.5
4.0
Happiness and stress - country correlation
20: H
igh
stre
ss
n=9,565
4 Cohen, Sheldon & Janicki-Deverts, Denise (2012) Who’s Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 2009.
9 / WORLD PSORIASIS HAPPINESS REPORT 2017
Aver
age
Stre
ss S
core
Spai
n
Russ
ian
Fede
ratio
n
Col
ombi
a
Mex
ico
Port
ugal
Italy
Braz
il
Uni
ted
Stat
es
Aust
ralia
Uni
ted
King
dom
Irela
nd
Can
ada
Ger
man
y
Den
mar
k
Fran
ce
Gre
ece
20
15
10
5
0
15.2: US general population
20: High Stress
19.7 19.9 20.2 20.3 20.8 20.8 20.9 21.1 21.3 21.4 21.7 22.0 22.9 23.219.7 20.1
Spai
n
Russ
ian
Fede
ratio
n
Col
ombi
a
Mex
ico
Port
ugal
Italy
Braz
il
Uni
ted
Stat
es
Aust
ralia
Uni
ted
King
dom
Irela
nd
Can
ada
Ger
man
y
Den
mar
k
Fran
ce
Gre
ece
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
43%
48%50%
53% 53%
59%
63% 63%65% 66% 66%
70%
81%
91%
44%
49%
Percentage of people who feel distressed in a moderate to extreme degree in their daily life - per country
Stress levels per country
EXECUTIVE SUMMARY
n = 9,656
n = 5,161
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Uni
ted
Stat
es
Uni
ted
King
dom
Den
mar
k
Mex
ico
Aust
ralia
Irela
nd
Gre
ece
spai
n
Ger
man
y
port
ugal
Braz
il
Russ
ian
Fede
ratio
n
Can
ada
Fran
ce
Italy
Col
umbi
a
50%
40%
30%
20%
10%
0%
48% 48% 40% 35% 34% 33% 32% 31% 28% 25% 25% 24% 24% 21%48% 41%
Percentage of people living with loneliness per country
Using the most conservative threshold for loneliness, we find that 33% of all people living with psoriasis are lonely. It impacts their happiness levels and it is the second strongest predictor of unhappiness after stress.
The levels of loneliness vary a lot between the different countries from 21% in Portugal to 48% in the United Kingdom. Furthermore, loneliness is not only non-discriminating in terms of countries, it also affects people regardless of their age, disease severity and socioeconomic status.
The percentage of people living with loneliness varies a lot between the different countries
33%33% of all people living with psoriasis are lonely
21% to 48%From 21% in Portugal to 48% in the United Kingdom
6) Loneliness is widespread among people living with psoriasis
n = 5,108
EXECUTIVE SUMMARY
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ARTICLE TITLE / CHAPTER 00
Our study shows that living with psoriasis has a major negative impact on happiness, well-being and quality of life. Compared to national averages, people living with severe psoriasis are subject to happiness gaps, from 7.3 % less happy in Portugal to 37.4% in Australia.
However, the happiness gaps vary a lot, including cases of positive happiness gaps, notably in Portugal and Greece.
We have identified two assumptions that could explain the variation: • The culture assumption: the countries characterized by small happiness gap are characterized as collectivistic; correspondingly, the countries characterized by large happiness gap can at the same time be characterized as individualistic.
• The social comparison assumption: people with a debilitating condition find it harder to live in an otherwise happy country - explaining the higher prevalence of mental health issues and even suicide rates in richer and happier regions.
7) Countries vary in the level of well-being inequality due to psoriasis
Happiness gaps for severe psoriasis - per country
EXECUTIVE SUMMARY
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-5%-10%-15%-20%-25%-30%-35%-40%-45%-50%
Avg. Happiness Gaps
Severe psoriasis
5%0%
PortugalColombia
GreeceSpain
MexicoBrazil
IrelandUnited States
United Kingdom Russian Federation
Italy France
Denmark NorwayCanada
GermanyAustralia
-7.31%-8.99%-8.63%-9.09%-15.11%-25.12%-26.02%-27.36%-27.58%-27.61%-30.04%-31.00%-34.31%-35.32%-35.51%-37.95%-37.41%
17625161
33224625872
1821142561801506924
1296863
n
12 / WORLD PSORIASIS HAPPINESS REPORT 2017
feel that their healthcare professionals do not fully understand
the impact psoriasis has on their mental well-being and experience
happiness gaps of 21%.
48%Av
erag
e Ha
ppin
ess
Gap
% of people who agree / disagree with statement
0%
-5%
-10%
-15%
-20%
-25%
Happiness gap: -3%% of people: 52%
Happiness gap: -21%% of people: 48%
Agree Disagree
‘My healthcare professional fully understands the impact psoriasis has on my mental well-being’
Our data suggest that increasing the understanding of how psoriasis impacts well-being - especially stress and loneliness - may take us quite far in bridging these health related happiness gap.
48% feel that their healthcare professionals do not fully understand the impact psoriasis has on their mental well-being and experience happiness gaps of 21%. Meanwhile, the 52% who feel that their healthcare professionals fully understand the impact psoriasis has on their mental well-being only experience happiness gaps of 3%.
8) Happiness gaps may be reduced by improving the understanding of how psoriasis impacts well-being
EXECUTIVE SUMMARY
25% 30% 35% 40%
Latin America
Southern Europe
North America & Australia
Western Europe
How many can be lifted out of misery by eliminating extreme stress
0% 5% 10% 15% 20%
Method: These numbers reflect the percentage of people who can be lifted out of misery based on the total number of people in misery. In Western Europe 11.3% of the total population can be lifted out of misery be eliminating extreme stress, and considering that 31.7% are living in misery, a 35.6% of the people in misery can be lifted out of that situation - 0.113/0.317 * 100 = 0.356n= 7,310
35.60%
29.70%
20.90%
25.40%
In order to identify the most affected people – which we label as people in misery – we pinpoint those who have assigned themselves low scores on our main well-being measure – Cantril’s Ladder. (the 11-point scale where scores range from 0 - 10.) Our approach is consistent to that of the The World Happiness Report, where people in misery are identified as everyone who scores themselves between 0 and 4 on the same scale5.
We find that people experiencing stress while living with psoriasis are 23% more likely to be in misery (report a happiness score of 0-4). At
the same time, analysing what factors would reduce the number of people living in misery makes a compelling case for particularly reducing stress levels across all regions.
If we could ensure that no people living with psoriasis experience extreme stress6, we could reduce the number of people living in misery by up to 35.6%. The evidence again suggests that the effects vary between regions, however, it is clear that reducing the most extreme cases of stress can lift a lot of people out of misery, regardless the region we investigate.
9) Up to 35.6% of people with psoriasis can be lifted out of misery by reducing extreme stress
EXECUTIVE SUMMARY
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5 This approach is also consistent with the Gallup classification, where 0-4 are defined as ‘suffering’6 Extreme stress is a conservative stress threshold: Scores above the median score in each region. For Latin America, this encompasses all
respondents with a score above 21; in Southern Europe 22; in Northern America and Australia 23 and in Western Europe 24. As these stress-thresholds are much higher than the threshold provided by the original measure (A stress score of 20) we choose to label this new threshold ‘extreme stress’.
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EXECUTIVE SUMMARY
The prevalence of loneliness and effect varies between regions. However, the impact of loneliness should not be neglected as up to 12.9% people with psoriasis can be lifted out of misery by reducing the extreme loneliness.
If we consider loneliness and stress as ‘psychological drivers’, a reduction of these together would lift more people out of misery than anything else – no matter which region we target.
10) Up to 12.9% of people with psoriasis can be lifted out of misery by reducing extreme loneliness
Limitations of methodology - summary
Latin America
Southern Europe
North America & Australia
Western Europe
How many can be lifted out of misery by eliminating loneliness
n = 7,310
10% 12% 14% 16% 20%18%0% 2% 4% 6% 8%
12.90%
18.60%
7.50%
13.40%
Diagnosis and severity classificationThe participants in the study self-reported both their diagnosis and severity of psoriasis. Data collection and samplingAll data is collected by Self-Administered Questionnaires (SAQs), provided through an app and a web-based (browser enabled)
app. Therefore we must consider both coverage errors (where we fail to reach some certain segments) and non-response bias (due to preferences for certain modes among respondents). Furthermore, survey modes also become important to consider when we compare our data to data collected by different modes. Because a
robust and demographically well-distributed sample can reduce the impact of these errors, we will continue to further refine our methodology to include control variables and weights.
See the full report for more details on Limitations of the study and Methodology.