Life Events Preceding Alopecia Areata Onset—a Descriptive Retrospective Cohort Study Focusing on Strain

Background: Patients often relate preceding life events to the onset of alopecia areata (AA). This cohort study systematically examined number and type of life events together with experienced strain during two years before AA onset. Methods: The study involved 100 patients with AA who reported life events through the Social Readjustment Rating Scale (SRRS). Life event strain was examined using the Streiner model, a stress-based model in which strain is defined as undesirable, unanticipated and uncontrollable. SRRS readjustment rating and the rated strain for each life event were obtained. Percentages of strainful life events for each SRRS category were calculated. Associations between AA disease-variables, sociodemographic-variables, Beck Depression Inventory-scores and Beck Anxiety Inventory-scores were examined in relation to the number of SRRS events and the number of strainful events. Results: Total life events reported were median (range) 7.0 (0– 22), almost two times higher than lifetime population studies on life events. The most experienced life events were loss of health and separation. At least one strainful life event prior to the AA onset was reported by 82% of patients. The highest strainful ratings were found in the Family and Personal categories of SRRS, such as Major change in health of a family member and Major personal injury or illness. A comparison between SRRS life events and strain ratings showed that 60% of the life events were rated higher and 35% were rated lower than the standard SRRS readjustment weight order. Conclusion: This study provides support for an inquiry into any strainful life event preceding AA onset in newly diagnosed patients with AA. Categories of highly strainful events and the importance of subjective strain are identified in patients with AA. This implies the need to address strain, which seems to be important for strain reduction thereby decreasing the burden among patients with AA. Plain Language Summary: Life Events and Strain before Alopecia Areata Onset Patients with the hair loss disease alopecia areata (AA), often associates its onset with the experience of life events, but scientific studies show conflicting results. We wanted to know more about life events for two years preceding AA onset, and to know more about how patients perceived different types of life events, both minor and major events such as changing to a new school, leaving home or the death or illness of a family member. With this purpose, we examined life events reported by 100 patients with AA two years before the AA onset and asked them about their perceived strain in terms of whether the event was desirable or not, expected or not, or controllable or not. We also asked them about their AA illness, their social life, and symptoms of depression and anxiety. Our results show that patients with AA experienced a high number of personal and familiar life events perceived as strainful before AA onset. Dermatologists and medical staff need to be observant of the strain these patients may have. Asking about previous life events when seeing these patients may reduce the strain and hence the burden of disease. Keywords: alopecia areata, life events, social readjustment rating scale, psychodermatology, strain, stressors