MEANING OF ILLNESS AND QUALITY OF LIFE IN PSORIASIS: A MODERATED MEDIATION APPROACH

Abstract

Background: Psoriasis is a chronic, immune-mediated skin condition that creates a heavy emotional and social burden. Using Leventhal’s Common-Sense Model of Self-Regulation as a guide, this study looked at how the Meaning of Illness indirectly affects Quality of Life through Psychopathology (Anxiety and Depression). It also explored whether Avoidant Coping acts as a boundary condition that changes these pathways. Methods: A cross-sectional study was conducted with 300 psoriasis patients (M = 36.09 years, SD = 11.21; age range: 13–65) selected from hospital clinics in Islamabad and Rawalpindi, Pakistan. Participants filled out validated Urdu versions of the Meaning of Illness Questionnaire (29 items), Hospital Anxiety and Depression Scale (14 items), Brief Approach/Avoidance Questionnaire (Avoidance Subscale, 6 items), and Dermatology Life Quality Index (10 items). Data were analyzed using Pearson correlations, and a moderated mediation model was tested using Hayes PROCESS Macro (Model 58). Results: Positive Meaning of Illness was linked to better Quality of Life (r = .16, p < .01) and lower Avoidant Coping (r = -.45, p < .01), Anxiety (r = -.44, p < .01), and Depression (r = -.52, p < .01). Avoidant coping was positively linked to Anxiety (r = .31, p < .01) and Depression (r = .37, p < .01), but negatively linked to Quality of Life (r = -.20, p < .01). Total Psychopathology significantly mediated the link between Meaning of Illness and Quality of Life (β= -.45, p < .01). Avoidant coping moderated the Stage 1 path between Meaning of Illness and Psychopathology (β = .005, p < .05). Holding a positive illness meaning helped protect Quality of Life across low (β = .08), medium (β = .06), and high (β = .04) levels of avoidance, but using high avoidant coping steadily weakened this protective buffer. Conclusion: Avoidant coping interferes with the self-regulatory process. Dermatologists and psychologists should work together to help patients replace avoidant behaviors with active coping strategies, while helping them build positive representations of their illness to support better quality of life.