Association of Psychological Stress With Skin Symptoms Among the Population in Saudi Arabia: A Cross-Sectional Study

Background and aim Studies have shown a significant relationship between psychological stress (PS) and health, and it is widely believed that factors such as stress and anxiety may not only be the result of certain diseases but can also cause and exacerbate some diseases. There is a lack of research on PS and its association with other skin conditions. Thus, this study aimed to examine the association of PS with skin symptoms using objective scales in the general population in the Kingdom of Saudi Arabia (KSA). Methods A cross-sectional study was carried out between February 6, 2023, and April 4, 2023. We administered an electronic questionnaire survey, consisting of Cohen's perceived stress scale and a self-reported skin complaint questionnaire, distributed via an online platform in the KSA. In all, 629 completed questionnaires were returned. Statistical analysis was conducted using RStudio. The results were presented as beta coefficients and their respective 95% confidence intervals (95% CIs). A p-value of <0.05 indicated statistical significance. Results The majority of the participants were female (71.7%, n=388), of Saudi nationality (93.2%, n=504), had a bachelor's degree (68.6%, n=371), were aged 18-29 years (58.8%, n=318), and were residing in the Western region (39.9%, n=216). Acne (26.8%, n=145) and eczema (12.8%, n=69) were the most commonly reported skin conditions. The stress level was low in 30.5% of the respondents (n=165), moderate in 64.9% of the respondents (n=351), and high in 4.6% of the respondents (n=25). The average skin symptom score was significantly predicted by the presence of psoriasis (p < 0.001), eczema (p < 0.001), acne (p < 0.001), rash (p < 0.001), and baldness (p = 0.041). Furthermore, the average skin symptoms scores were significantly higher among participants with high stress (median = 1.6, interquartile range (IQR) = 1.4, 1.8) than among those with moderate (median = 1.4, IQR = 1.2, 1.8) and low stress (median = 1.4, IQR = 1.1, 1.4, p < 0.001). Conclusion The general population of Saudi Arabia reported multiple skin symptoms associated with stress. PS can cause various common skin conditions including loss of hair, eczema, and acne. This study highlights the importance of assessing common skin problems in the general population in the KSA and their strong association with PS. Various skin conditions including loss of hair, eczema, and acne can be caused by PS. Dermatologists should be aware of the context of PS when assessing patients with these conditions.