The associations between personality traits,education,occupation and the occurrence of eczema in adulthood

Introduction

By focusing on social and psychological factors in childhood and adulthood, this study looks at the correlates of eczema (atopic dermatitis). Previous investigations indicate that the aetiological factors of eczema are not attributable to a single factor (Arima et al., 2005). Furthermore, while there are associations between eczema and personality traits, it is unclear whether it plays an aetiological role in eczema, and what the psycho-biological mechanisms of the development of eczema would be (Buske-Kirschbaum et al., 2001). Eczema has, however, been noted to have a distinct psychological and personality profile from other dermatological and atopical conditions (Bahmer et al., 2007; Mizara et al., 2012; Scheich et al., 1993; Takahashi et al., 2012; 2013).

There have been some attempts to associate the Big Five personality factors with eczema. Studies have consistently indicated that high levels of trait Neuroticism are found in eczema patients (Al-Ahmar and Kurban, 1976; Schut et al., 2014; White et al., 1990) as well as temperaments that indicate lower levels of emotional stability (Takahashi et al., 2013; White et al., 1990). Correlations with other Big Five related factors, however, have been less consistent; Extraversion has been thought to negatively associated with eczema (Schut et al., 2014), while other researchers indicate no correlation (Al-Ahmar and Kurban, 1976). In a clinical sample, Schut et al. (2015) investigated the associations between personality traits Agreeableness and self-consciousness and psoriasis (a frequent skin disease accompanied by itch). They found that in psoriasis patients public self-consciousness was significantly associated with more induced itch (r = .56; p < .001), and Agreeableness was significantly associated with less induced scratching (r = −.44; p < .05) (Schut et al., 2015).

Personality correlates have also been found to relate with Immunoglobulin E (IgE) levels in eczema. Higher levels of IgE is associated with an increase in allergic reactions and mast cell stimulation (Gould et al., 2003), of which eczema is one of the most common causes. Compared to eczema patients with normal levels of IgE, patients with higher levels (and thus a stronger allergic response) have been found to have increased levels of emotionality (Neuroticism) and worse stress coping mechanisms (Scheich et al., 1993), suggesting a psycho-biological mechanism that mediates the exhibited behaviours in eczema.

An extensive review by Friedman and Kern (2014) indicates that factors such as depression and anxiety, both strongly associated with trait Neuroticism, play a part in many illnesses, including eczema (Al-Ahmar and Kurban, 1976; Kim et al., 2006; Mizara et al., 2012; Schut et al., 2014; Slattery and Essex, 2011; Takahashi et al., 2013). Depression has been thought to only be a strong association of eczema when co-morbidity with anxiety is accounted for (Klokk et al., 2010), particularly with face eczema. Trait anxiety appears to play a differing role to depression in the exacerbation of eczema, while higher depression has been associated with increased severity of eczema (Arima et al., 2005), state and trait anxiety has been found to be associated with increased duration of the illness (Kim et al., 2006)

Neurotic people are more prone to stress. Furthermore, there appear to be sex differences on the association between depression and inflammatory markers; stress may drive inflammation and subsequent depressive symptoms shown in women, not in men (Hiles et al., 2015).

There is a large body of literature in the links between social class, education and mental and physical health and illness (Feinstein and Bynner, 2004; Marmot, 2007; Wilkinson and Pickett, 2006), and between intelligence, socioeconomic position and health and mortality (Batty et al., 2009). Although higher parental socioeconomic status (SES) is linked with better child health outcomes, Corlin et al. (2013) found children with a relatively lower household income were significantly more likely to have an asthmatic condition, in the case of eczema findings do not seem to systematically support the protective role of SES. In a number of studies, eczema is characterized as the disease of the affluent and privileged children and several studies have shown that its prevalence increases with the SES of the family (Corlin et al., 2013; Hammer-Helmich et al., 2014; Heinrich et al., 1998; Stewart et al., 2001; Weber and Haidinger, 2010; Williams et al., 1994). Other studies found no relationship between eczema and SES (e.g. Mercer et al., 2004). However, there are speculations for this positive association as it can be susceptible to several biases. It is possible that high SES parents have a better health education and hence a better perception and interpretation of atopic symptoms are more worried about their children’s health and seek medical help earlier (Mercer et al., 2004; Weber and Haidinger, 2010).

Method

Results

Descriptive analysis

Table 1 shows the characteristics of the study population according to the occurrence of eczema at 50 years. There were significant sex differences in the prevalence of eczema. It appears that the rate of the reported eczema was greater for women than for men (8.3% for women and 6.8% for men). ANOVA showed that the differences were statistically significant (t(df = 5832) = 5.10, p < .05).

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Table 1.

Social and demographic characteristics of the study population and prevalence of eczema at age 50 years.

	n	%	Prevalence of eczema (%)
Gender
Male	2879	49.3	6.8
Female	2955	50.7	8.3
Parental social class at birth
Unskilled (V)	427	5.7	5.9
Partly skilled (IV)	678	10.7	6.9
Skilled manual (III)	2835	47.5	7.4
Skilled non-manual (III)	651	13.0	8.8
Managerial/tech (II)	925	18.6	8.9
Professional (I)	318	4.5	6.3
Educational qualifications at age 33 years
No qualifications	414	7.3	7.7
CSE 2-5/equivalent NVQ 1	656	7.7	5.2
O Level/equivalent NVQ 2	2016	40.0	8.7
A level/equivalent NVQ 3	904	14.3	7.0
Higher qualification/equivalent NVQ 4	961	14.3	6.6
University degree/equivalent NVQ 5, 6	883	16.4	8.2
Own current social class at age 50 years
Unskilled (V)	120	3.9	14.2
Partly skilled (IV)	623	10.5	7.4
Skilled manual (III)	1027	15.2	6.5
Skilled non-manual (III)	1213	22.3	8.1
Managerial/tech (II)	2481	38.9	6.9
Professional (I)	370	9.3	11.1

NVQ: National Vocational Qualification.

Correlation matrices of all variables in the study are shown in Appendix 1. It shows self-reported eczema in adulthood was significantly and positively associated with childhood intelligence, traits Agreeableness and Openness, and negatively associated with Emotional Stability. The self-reported eczema in adulthood was significantly associated with eczema in childhood diagnosed by physicians.

Regression analysis

Table 2 shows results of logistic regression model using self-reported eczema in adulthood as dependent variable. As predicted, the model shows that traits Emotional Stability (i.e. low Neuroticism) was associated with less reported eczema in adulthood. The model also shows that traits Agreeableness and Openness were associated with more eczema in adulthood. Furthermore, those with more education (compared with no education) and higher levels of occupation (compared with unskilled workers) were less likely to report eczema in adulthood.

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Table 2.

Odds ratios (95% CI) for eczema at age 50 years, according to eczema in childhood, childhood intelligence, educational qualifications, occupational levels and personality traits.

Measures	All		Males		Females
	Odds ratio (95% CI)	p-value	Odds ratio (95% CI)	p-value	Odds ratio (95% CI)	p-value
Parental social class at birth (unskilled as reference group)
Partly skilled	1.06 (0.71, 1.94)	0.848	1.11 (0.50, 2.47)	0.796	0.99 (0.49, 2.00)	0.972
Skilled manual	1.20 (0.77, 1.88)	0.414	1.19 (0.60, 2.37)	0.618	1.21 (0.67, 2.16)	0.531
Skilled non-manual	1.46 (0.87, 2.40)	0.155	1.33 (0.60, 2.91)	0.483	1.54 (0.79, 3.01)	0.205
Managerial/tech	1.39 (0.85, 2.27)	0.193	1.42 (0.67, 3.01)	0.363	1.33 (0.69, 2.56)	0.400
Professional	0.99 (0.53, 1.88)	0.984	0.94 (0.36, 2.49)	0.904	1.03 (0.44, 2.43)	0.937
Eczema at age 7 years	5.38 (3.58, 8.08)***	0.000	6.93 (3.80, 12.63)***	0.001	4.78 (2.71, 8.43)***	0.001
Childhood intelligence at age 11 years	1.14 (1.04, 1.29)*	0.030	1.23 (1.03, 1.47)*	0.024	1.09 (0.92, 1.29)	0.328
Educational qualifications (no qualification as reference group)
CSE 2-5/equivalent NVQ 1	0.56 (0.33, 0.95)*	0.032	0.36 (0.13, 0.95)*	0.038	0.68 (0.36, 1.30)	0.244
O Level/equivalent NVQ 2	0.92 (0.60, 1.40)	0.692	1.17 (0.60, 2.29)	0.643	0.80 (0.46, 1.41)	0.443
A level/equivalent NVQ 3	0.69 (0.43, 1.13)	0.144	0.85 (0.41, 1.75)	0.660	0.59 (0.29, 1.20)	0.149
Higher qualification/equivalent NVQ 4	0.59 (0.36, 0.98)*	0.042	0.57 (0.26, 1.26)	0.165	0.66 (0.34, 1.27)	0.210
University degree/equivalent NVQ 5, 6	0.63 (0.37, 1.08)	0.093	0.52 (0.23, 1.17)	0.112	0.78 (0.38, 1.58)	0.484
Own social class (unskilled as reference group)
Partly skilled	0.41 (0.22, 0.77)**	0.005	0.27 (0.10, 0.69)**	0.007	0.61 (0.26, 1.44)	0.262
Skilled manual	0.39 (0.22, 0.71)**	0.002	0.23 (0.10, 0.53)***	0.001	0.82 (0.33, 2.03)	0.668
Skilled non-manual	0.38 (0.21, 0.68)***	0.001	0.28 (0.12, 0.70)**	0.006	0.56 (0.25, 1.28)	0.172
Managerial/tech	0.34 (0.19, 0.60)***	0.001	0.23 (0.10, 0.53)***	0.001	0.48 (0.21, 1.10)	0.084
Professional	0.63 (0.32, 1.23)	0.178	0.43 (0.17, 1.09)	0.075	0.95 (0.35, 2.55)	0.914
Extraversion	0.93 (0.83, 1.04)	0.198	0.82 (0.69, 0.97)*	0.020	1.03 (0.88, 1.21)	0.671
Emotional stability	0.88 (0.79, 0.98)*	0.015	0.93 (0.80, 1.09)	0.386	0.83 (0.72, 0.95)**	0.008
Agreeableness	1.20 (1.05, 1.36)**	0.008	1.40 (1.16, 1.70)***	0.001	1.01 (0.84, 1.22)	0.884
Conscientiousness	0.94 (0.84, 1.04)	0.237	0.95 (0.81, 1.12)	0.536	0.93 (0.81, 1.03)	0.353
Openness	1.15 (1.02, 1.30)*	0.023	1.21 (0.92, 1.15)*	0.039	1.11 (0.94, 1.31)	0.239

CI: confidence interval; CSE : Certificate of Secondary Education, NVQ: National Vocational Qualification.

Adjusted for gestational age and birth weight.

*

p < .05; **p < .01;***p < .001.

There were sex differences in the associations between eczema and other indicators. For men, childhood intelligence, education, occupation, traits Extraversion, Agreeableness and Openness were all significantly associated with eczema in adulthood, whereas for women, apart from childhood eczema, which was a strong indicator of adult eczema, for both men and women, trait Emotional Stability was the only variable which was significantly associated with eczema in adulthood.

Discussion

This study sets out to explore the associations between personality factors as well as social factors and the occurrence of self-reported eczema in adulthood. Trait Emotional Stability, higher social class and better education were associated with the low occurrence of eczema in adulthood as predicted.

Further analyses showed there were sex effects on the associations between social and psychological factors and the outcome variable. For females, trait Neuroticism was a significant predictor, a trait often implicated in both mental and physical illness. Stress-proneness (or low stress tolerance/resilience), especially for women, may increase the risk of eczema by increasing systemic inflammation, which in turn may lead to enhanced promotion of eczema-related inflammation (Kuebler et al., 2015). For males, trait Agreeableness was the strongest predictor. This may indicate males who are too tender-hearted and unassertive who may be manipulated by less Agreeable, tough-minded others leading in turn to stress and its consequences as described above.

Previous research has indicated that Agreeable people are less likely to have eczema (Schut et al., 2014). This study, however, indicates the opposite; higher levels of Agreeableness are found in eczema patients although further analysis by sex shows this association is only for men, not for women. Studies indicate that eczema patients have high vulnerability to stress in situations of social conflict (Buske-Kirschbaum et al., 2008), have maladaptive schemas that fear social isolation (Mizara et al., 2012) and struggle to cope with hostility and anger (White et al., 1990). Furthermore, eczema patients are found to have higher harm avoidance scores, indicating a strong shyness and anticipatory anxiety element (Kim et al., 2006). This study suggests similar findings; eczema patients are high on Agreeableness, which can be postulated to result in a willingness to employ certain behavioural patterns in order to calm social conflict, avoid social anxiety and hostility, and satisfy their needs to be near others. Further investigations need to be conducted, however, to confirm these postulations.

This study also shows the significant associations between trait Openness and eczema in adulthood and between trait Extroversion and the outcome variable for men but not for women. While Extraversion has been found to be associated with joy, fun and leisure activities (Furnham, 2008) which may reduce stress, compared with women, men are more active in those outdoor pursues (football and other sports) thus may reduce stress-related eczema more effectively. Stress vulnerability to uncertainness (Buske-Kirschbaum et al., 2008) and higher levels of hypochondriasis (Al-Ahmar and Kurban, 1976) could relate to the observed high Openness to experience scores; a need to know all of the variables in a situation, and knowledge of all the potential damaging variables noted in hypochondriacs that leads to worry. This high need for control may explain the occurrence of stress-related conditions. Furthermore, trait Openness is correlated with intelligence, and thus could further explain the role of childhood intelligence in eczema. Children who are considered to be more intellectual may exhibit a greater need for approval of their performance, increasing their vulnerability to stress. Nonetheless, the present finding presents possibilities in further research on the effect of trait Openness on eczema and atopic conditions where a sparse number of literature has focused on.

The study also shows that brighter people are more likely to suffer from eczema, which is not in line with the previous findings, that tended to show that intelligent children grew up to have better adult mental and physical health outcomes (Batty et al., 2009; Feinstein and Bynner, 2004). This might be related to responsibility induced stress, which may worsen the skin problems such as dermatitis or urticarial (Dave et al., 2011). Intelligent individuals are more likely to have more professional occupation with greater responsibilities; they may suffer more stress-related eczema or other skin problems. This might be more salient in men than in women, as the proportion of managerial status is larger in men than in women.

Finally, the regression but not the correlational results showed a link between SES and eczema although true for males and not females. This may be due to a working environments which exacerbates a whole range of skin diseases.

These results have shown that eczema appears to have a powerful biological component: the best predictor of eczema at 50 years was having the problem diagnosed at 7 years. However, this study did show the role of personality factors in adulthood. Furthermore, work needs to try to understand the effect of personality on eczema and vice versa and to spell out the mechanisms explaining the relationship. In this sense, medical practitioners may be able to give more targeted and individualized advice to eczema patients if they have some insight into their personality.