Open AccessArticle The Impact of Disease-Related Fear and Internalized Stigma on Quality of Life in Patients with Scabies: A Cross-Sectional Study by Nurperihan Tosun Nurperihan Tosun SciProfiles Scilit Preprints.org Google Scholar 1, Mustafa Tosun Mustafa Tosun SciProfiles Scilit Preprints.org Google Scholar 2,*, Sermed Doğan Sermed Doğan SciProfiles Scilit Preprints.org Google Scholar 3 and Mustafa Younis Mustafa Younis SciProfiles Scilit Preprints.org Google Scholar 4 1 Department of Health Management, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas 58140, Türkiye 2 Department of Dermatology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas 58140, Türkiye 3 Department of Health Institutions Management, Vocational School of Social Sciences, Kayseri University, Kayseri 38030, Türkiye 4 Department of Health Policy and Management, Jackson State University, Jackson, MS 39217, USA * Author to whom correspondence should be addressed. Healthcare 2026, 14(11), 1575; https://doi.org/10.3390/healthcare14111575 (registering DOI) Submission received: 8 March 2026 / Revised: 30 May 2026 / Accepted: 1 June 2026 / Published: 4 June 2026 Abstract Background/Objectives: Scabies is a contagious dermatological infestation that can cause not only physical symptoms but also considerable psychosocial burden. This study aimed to investigate the relationships between fear of scabies, internalized stigma, and dermatology-related quality of life in patients with scabies. Methods: This cross-sectional study included 131 patients diagnosed with scabies in a dermatology outpatient clinic. Data were collected using a structured questionnaire including sociodemographic and clinical characteristics, the Fear of Scabies Scale (FSS), the Internalized Stigma Scale (ISS), and the Dermatology Life Quality Index (DLQI). Correlation and regression analyses were conducted to examine the associations between fear of scabies, internalized stigma, and quality of life. Results: The mean DLQI score was 15.82 ± 5.69, indicating a considerable impairment in dermatology-related quality of life. Fear of scabies showed a weak but significant positive correlation with DLQI scores (r = 0.326, p 0.05). Similarly, no significant correlations were observed between FSS and the subdimensions of the ISS. A moderate positive and statistically significant correlation was found between DLQI and ISS (r = 0.484, p < 0.01). In addition, DLQI demonstrated moderate positive correlations with the alienation (r = 0.527, p < 0.01) and perceived discrimination (r = 0.574, p < 0.01) subscales of the ISS. A strong positive correlation was observed between DLQI and the social withdrawal subscale (r = 0.622, p < 0.01). Furthermore, DLQI showed a weak but significant positive correlation with the stereotype endorsement subscale (r = 0.255, p < 0.01). The Type I error rate was taken into account in the context of multiple correlation analysis. In this regard, a Benjamini–Hochberg False Discovery Rate (FDR) correction was applied, and it was determined that the correlations found to be statistically significant retained their significance. The correlation results among the variables are presented in Table 2. 3.3. Findings Related to Linear Regression Analyses The relationships between FSS, ISS, and DLQI were examined using simple linear regression analysis. According to the results, a positive relationship was observed between FSS and DLQI (β = 0.326). FSS was significantly associated with DLQI ( p < 0.001), and FSS explained approximately 10% of the variance in DLQI. Similarly, a positive relationship was found between ISS and DLQI (β = 0.484). ISS was significantly associated with DLQI ( p < 0.001), explaining approximately 23% of the variance in DLQI. Therefore, the regression models examining the associations of FSS and ISS on DLQI were found to be statistically significant. In addition, according to the results of the multiple linear regression analysis, both FSS (β = 0.294) and ISS (β = 0.464) were significantly and positively associated with DLQI. These findings indicate that fear of the disease and internalized stigma together show a stronger association with quality of life. The results of the analyses are presented in Table 3. Results of the regression analysis examining the associations between ISS subdimensions on DLQI are presented in Table 4. According to the findings, the ISS subdimensions of alienation (β = 0.527), stereotype endorsement (β = 0.255), perceived discrimination (β = 0.574), and social withdrawal (β = 0.622) demonstrated significant positive associations with DLQI. Among these dimensions, social withdrawal showed the strongest association with quality of life impairment. In terms of explained variance, alienation accounted for 22% of the variance in DLQI, stereotype endorsement explained 6%, perceived discrimination explained 33%, and social withdrawal explained 38% of the variance. In contrast, the stigma resistance subdimension was not significantly associated with DLQI. The results regarding the demographic (age, gender, marital status, education level, and place of residence) and clinical characteristics (duration of symptoms, nocturnal pruritus, skin lesions, and regional involvement) of the patients are presented in Table 5. According to the linear regression analysis, gender was significantly associated with fear of scabies (β = −0.224, p < 0.05). This finding indicates that men’s levels of fear of scabies are lower than those of female participants. In contrast, education level (β = 0.468, p < 0.001), duration of symptoms (β = 0.708, p < 0.001), nocturnal pruritus (β = 0.408, p < 0.05), skin lesions (β = 0.263, p < 0.05), and regional involvement (β = 0.073, p < 0.05) were positively associated with fear of scabies. Age, marital status, and place of residence were not significantly associated with fear of scabies. The results of the multiple regression analysis of the DLQI in relation to other clinical variables are presented in Table 6. According to the analysis results, among the variables included in the model, only the treatment response was significantly associated with quality of life (β = −0.708, p < 0.001). This finding indicates that individuals who responded positively to treatment had lower DLQI scores. No significant associations were observed between the other variables and quality of life. 4. Discussion Scabies is increasingly recognized not only as a dermatological infestation but also as a disease associated with significant psychosocial consequences. In this study, we examined the relationships between disease-related fear, internalized stigma, and dermatology-specific quality of life in patients with scabies. Our findings indicate that both fear of scabies and internalized stigma are significantly associated with impaired quality of life. These results demonstrate that the burden of scabies is not limited to physical symptoms but also encompasses important psychological and social dimensions [ 16, 36]. Correlation analyses have shown that both fear of scabies and internalized stigma are significantly associated with dermatology-specific quality of life. However, the strength of these relationships varies. Internalized stigma showed a stronger relationship with DLQI scores, while fear related to the disease showed a weaker relationship. This suggests that psychosocial mechanisms related to stigma may show a stronger association with patients’ well-being than disease-related fear [ 16]. However, these associations should be interpreted with caution, as not all potential clinical confounding variables were simultaneously included in the regression models. Therefore, the observed associations do not necessarily indicate independent relationships between fear of scabies, internalized stigma, and dermatology-specific quality of life. Regression analyses further supported these findings. Internalized stigma demonstrated a stronger association with impaired quality of life, whereas fear of scabies showed a comparatively lower explanatory contribution. When both variables are included in the model together, they explain a larger portion of the variance in quality of life. These findings suggest that psychosocial processes, particularly internalized stigma, may play an important role in the burden associated with scabies. This study also demonstrates that internalized stigma is a multidimensional construct that affects quality of life in various ways. Among the subdimensions of stigma, social withdrawal showed the strongest correlation with DLQI scores. Patients who avoid social interactions due to shame, fear of judgment, or concern about transmitting their illness to others may receive less social support and experience greater psychological distress. It has been previously reported that social avoidance due to stigma in dermatological diseases significantly impairs quality of life [ 16, 18]. In addition to social withdrawal, alienation and perceived discrimination have also shown a significant relationship with deterioration in quality of life. Alienation refers to the individual feeling different from others or socially isolated due to their illness. In the context of scabies, visible skin lesions and the contagious nature of the disease can lead patients to feel socially excluded. Similarly, perceived discrimination refers to an individual’s belief that they will be treated negatively by others due to their illness, which can increase psychological distress. Studies in dermatology also show that perceived discrimination in visible skin diseases is an important mechanism in the decline of quality of life [ 38, 39]. The stereotype confirmation dimension has also been found to be related to quality of life, but the strength of this relationship is lower than that of other dimensions. This suggests that some patients may internalize the societal misconception that scabies is associated with poor hygiene or adverse living conditions. Internalizing such stereotypes can lead to feelings of shame and self-blame, negatively affecting psychological well-being [ 36]. Interestingly, despite the relatively low overall level of scabies fear in our sample according to the Scabies Fear Scale scoring criteria, the deterioration in quality of life is quite pronounced. This suggests that psychosocial factors such as stigmatization and social reactions may play a greater role than disease fear in determining patients’ well-being. Certain clinical factors have also been found to be associated with increased fear of scabies. In particular, prolonged symptom duration showed the strongest association with fear levels. Persistent itching and visible lesions may cause patients to experience uncertainty about recovery and increased anxiety levels. Similarly, nocturnal pruritus and visible skin lesions have also been found to be associated with fear levels. It has been previously reported that prolonged symptoms in dermatological diseases increase psychological burden and reduce quality of life [ 26]. The finding that educational level is positively correlated with fear suggests that individuals with higher educational levels may be more aware of the contagiousness of the disease and its social consequences. From a public health perspective, these findings are quite significant given the global burden of scabies. Classified by the World Health Organization as a neglected tropical disease, scabies affects more than 200 million people worldwide at any given time. Beyond its dermatological symptoms, the disease can lead to significant psychosocial consequences such as stigmatization, social exclusion, and psychological distress. These psychosocial effects may be associated with an increased overall burden of the disease [ 5, 36]. From a clinical perspective, these findings indicate that psychosocial aspects should also be considered in the management of scabies. The recent increase in scabies incidence reported in several countries following the COVID-19 pandemic may be associated with disruptions in healthcare access, increased household transmission, and treatment-related challenges. In addition, “pseudoresistance,” which may result from inadequate treatment duration, poor adherence, or incorrect application of therapy, has been suggested as a possible contributing factor to the persistence and spread of the disease [ 6, 12]. These factors may also contribute to increased psychosocial burden, disease-related fear, and concerns about contagion among affected individuals. Dermatologists and other healthcare professionals should be aware that patients may experience stigmatization, shame, and social withdrawal due to the disease. Therefore, providing appropriate counseling to patients, emphasizing that scabies is a treatable disease, and providing accurate information about disease transmission can play an important role in reducing psychological distress and improving patient outcomes. Overall, the findings of this study suggest that scabies should be considered not only as a parasitic skin infestation but also as a disease with significant psychological and social consequences. Therefore, effective management strategies should not be limited to pharmacological treatment alone but should also include approaches such as patient education, reduction in stigma, and psychosocial support. One strength of the present study is that it simultaneously evaluates disease-related fear and internalized stigma in relation to dermatology-specific quality of life in patients with scabies, which has rarely been addressed in the previous literature. Our study has several limitations. First, its cross-sectional design does not allow causal inferences regarding the relationships between disease-related fear, internalized stigma, and quality of life. Second, the study was conducted at a single center with a relatively modest sample size, which may limit the generalizability of the findings to other populations and healthcare settings. The predominance of male participants may also have influenced the representativeness of the psychosocial findings. Third, psychological variables were assessed using self-report questionnaires, which may be subject to response bias. Although the ISS has been used in various medical conditions, it was originally developed for psychiatric populations, which may limit its construct validity in dermatological conditions such as scabies. In addition, the stigma resistance subdimension demonstrated relatively low internal consistency, and findings related to this subscale should therefore be interpreted cautiously. Although individuals with known psychiatric disorders were excluded, other psychological factors such as anxiety and stress were not directly evaluated. Furthermore, not all potential clinical confounding variables were simultaneously included in the regression models evaluating DLQI. Another limitation is that no validated objective scabies severity scoring system was used, limiting interpretation of the relationship between clinical disease burden, psychological distress, and quality of life. Information regarding reasons for not receiving treatment or whether patients had received adequate treatment and hygiene instructions was also not systematically assessed. Finally, symptom duration was based on patient self-report and may partly reflect persistent post-scabetic pruritus rather than ongoing active infestation in some patients. Multicenter longitudinal studies are needed to better clarify the psychosocial burden of scabies and to develop interventions aimed at improving patient well-being. 5. Conclusions The results of our study suggest that scabies is associated with significant psychosocial consequences beyond its dermatological manifestations. Fear related to the disease and internalized stigma were identified as important factors associated with impaired dermatology-specific quality of life. However, these findings should be interpreted with caution given the cross-sectional design of the study and the fact that not all potential clinical confounding variables were simultaneously included in the regression models. Mechanisms related to stigma, particularly social withdrawal, play a significant role in shaping patients’ well-being. Although the overall level of fear of scabies is relatively low, the disease has a marked negative impact on quality of life. This finding suggests that psychosocial factors such as stigma and social reactions are closely associated with the overall burden of disease. These findings highlight the need for a comprehensive approach to scabies management that includes not only pharmacological treatment but also patient education, reduction in stigma, and psychosocial support. Larger, multicenter studies will contribute to a better understanding of the psychosocial effects of scabies and the development of patient-centered management strategies. Author Contributions Conceptualization, N.T. and S.D.; methodology, M.T. and N.T.; software, S.D.; validation, N.T., M.Y. and M.T.; formal analysis, S.D.; investigation, M.T.; resources, M.T.; data curation, N.T.; writing—original draft preparation, N.T. and S.D.; writing—review and editing, N.T.; visualization, M.T.; supervision, N.T.; project administration, N.T.; funding acquisition, M.Y. All authors have read and agreed to the published version of the manuscript. Funding This research received no external funding. Institutional Review Board Statement The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Sivas Cumhuriyet University (approval number: 668028, date: 23 January 2026). Informed Consent Statement Informed consent was obtained from all subjects involved in the study. Data Availability Statement In accordance with institutional ethical considerations and patient confidentiality requirements, the data are not publicly available. However, anonymized data can be made available from the corresponding author upon reasonable request for academic and scientific purposes. Conflicts of Interest The authors declare no conflicts of interest. 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Cureus 2024, 16, e60731. [ Google Scholar] [ CrossRef] Table 1. Examination of the sociodemographic and clinical characteristics of scabies patients and their disease fear scores. Table 1. Examination of the sociodemographic and clinical characteristics of scabies patients and their disease fear scores. Variables n (%) or Mean ± SD (Min–Max) ( n = 131) Median FSS p Age 35.87 ± 15.58 (20–72) Gender 0.039 Female 47 (35.9%) 34.0 Male 84 (64.1%) 29.0 Working status 0.001 No 68 (51.9%) 33.0 Yes 63 (48.1%) 28.0 Marital status 0.560 Single 63 (48.1%) 30.0 Married 68 (51.9%) 30.5 Education level 0.010 Primary education 6 (4.6%) - Secondary education 20 (15.3%) 33.0 High school 79 (60.3%) 30.0 Higher education 26 (19.8%) 27.0 Smoking status 0.403 Smoker 55 (42.0%) 32.0 Non-smoker 76 (58.0%) 30.0 Alcohol status 0.005 Drinking 20 (15.3%) 33.0 does not drink 111 (84.7%) 30.0 Place of residence 0.021 Home 125 (95.4%) 30.0 Dormitory 6 (4.6%) - Are there any other patients with scabies? 0.154 No 91 (69.5%) 31.0 Yes 40 (30.5%) 29.0 Duration of symptoms 80.53 ± 76.75 (20–365) FSS 29.68 ± 5.82 (12–40) ISS 58.61 ± 14.58 (38–102) DLQI 15.82 ± 5.69 (7–26) Abbreviations: FSS, Fear of Scabies Scale; ISS, Internalized Stigma Scale; DLQI, Dermatology Life Quality Index; SD, Standard Deviation. Table 2. Arithmetic mean, standard deviation, and correlation results for variables. Table 2. Arithmetic mean, standard deviation, and correlation results for variables. Mean SD 1 2 3 4 5 6 7 8 FSS 2.79 0.58 (0.78) DLQI 1.44 0.52 0.326 (0.84) ISS 2.02 0.50 0.069 0.484 (0.94) Alienation 2.06 0.57 0.098 0.527 0.966 (0.75) Stereotype endorsement 1.94 0.58 0.126 0.255 0.894 0.857 (0.81) Perceived discrimination 1.87 0.69 −0.100 0.574 0.872 0.823 0.670 (0.83) Social withdrawal 1.94 0.59 0.160 0.622 0.928 0.932 0.780 0.826 (0.87) Stigma resistance 2.34 0.52 −0.024 0.021 0.536 0.416 0.389 0.323 0.316 (0.51) Abbreviations: FSS, Fear of Scabies Scale; DLQI, Dermatology Life Quality Index; ISS, Internalized Stigma Scale; SD, Standard Deviation. Table 3. Associations of fear of scabies and internalized stigma with quality of life. Table 3. Associations of fear of scabies and internalized stigma with quality of life. Non-Standardized Coefficients Standardized Coefficients t p Durbin-Watson Beta Std. Error Beta Model 1 Constant 0.578 0.224 2.580 0.011 2.012 FSS 0.290 0.074 0.326 3.916 <0.001 R = 0.326 R 2 = 0.106 Adjusted R 2 = 0.099 F = 15.332 Dependent Variable: DLQI Model 2 Constant 0.431 0.165 2.605 0.010 1.982 ISS 0.499 0.079 0.484 6.283 <0.001 R = 0.484 R 2 = 0.234 Adjusted R 2 = 0.228 F = 39.481 Dependent Variable: DLQI Model 3 Constant −0.304 0.240 −1.265 0.208 2.031 FSS 0.262 0.065 0.294 4.026 <0.001 ISS 0.478 0.075 0.464 6.351 <0.001 R = 0.566 R 2 = 0.320 Adjusted R 2 = 0.310 F = 30.170 Dependent Variable: DLQI Abbreviations: FSS, Fear of Scabies Scale; DLQI, Dermatology Life Quality Index; ISS, Internalized Stigma Scale. Table 4. Associations between the subdimensions of the internalized stigma scale and quality of life. Table 4. Associations between the subdimensions of the internalized stigma scale and quality of life. Non-Standardized Coefficients Standardized Coefficients t p Durbin-Watson Beta Std. Error Beta Model 1 Constant 0.449 0.146 3.079 0.003 2.015 Alienation 0.480 0.068 0.527 7.037 <0.001 R = 0.527 R 2 = 0.277 Adjusted R 2 = 0.272 F = 49.515 Dependent Variable: DLQI Model 2 Constant 0.995 0.155 6.435 <0.001 1.950 Stereotype endorsement 0.228 0.076 0.255 2.991 0.003 R = 0.255 R 2 = 0.065 Adjusted R 2 = 0.058 F = 8.948 Dependent Variable: DLQI Model 3 Constant 0.632 0.108 5.867 <0.001 1.967 Perceived discrimination 0.431 0.054 0.574 7.968 <0.001 R = 0.574 R 2 = 0.330 Adjusted R 2 = 0.325 F = 63.493 Dependent Variable: DLQI Model 4 Constant 0.381 0.123 3.102 0.002 2.136 Social withdrawal 0.547 0.061 0.622 9.013 <0.001 R = 0.622 R 2 = 0.386 Adjusted R 2 = 0.382 F = 81.233 Dependent Variable: DLQI Model 5 Constant 1.390 0.211 6.574 <0.001 2.049 Stigma resistance 0.021 0.088 0.021 0.236 0.813 R = 0.021 R 2 = 0.000 Adjusted R 2 = −0.007 F = 0.056 Dependent Variable: DLQI Abbreviations: DLQI, Dermatology Life Quality Index. Table 5. Predictors of fear of scabies among patients with scabies. Table 5. Predictors of fear of scabies among patients with scabies. Model β 95% CI p Constant - 2.040 to 2.967 0.001 Age 0.116 −0.006 to 0.016 0.413 Gender −0.224 −0.475 to −0.066 0.010 Marital status 0.203 −0.044 to 0.515 0.098 Education level 0.468 0.202 to 0.583 <0.001 Place of residence 0.001 −0.477 to 0.482 0.991 Duration of symptoms 0.708 0.003 to 0.008 <0.001 Nocturnal pruritus 0.408 0.232 to 1.602 0.009 Skin lesions 0.263 0.057 to 0.235 0.002 Regional involvement 0.073 0.023 to 0.123 0.005 Table 6. Clinical predictors of DLQI in patients with scabies. Table 6. Clinical predictors of DLQI in patients with scabies. Model β 95% CI p Constant - 0.589 to 2.589 0.002 Duration of symptoms 0.206 −0.001 to 0.004 0.309 Nocturnal pruritus −0.014 −0.830 to 0.775 0.945 Skin lesions −0.127 −0.153 to 0.029 0.179 Response to treatment −0.708 −1.060 to −0.587 <0.001 Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. Share and Cite MDPI and ACS Style Tosun, N.; Tosun, M.; Doğan, S.; Younis, M. The Impact of Disease-Related Fear and Internalized Stigma on Quality of Life in Patients with Scabies: A Cross-Sectional Study. Healthcare 2026, 14, 1575. https://doi.org/10.3390/healthcare14111575 AMA Style Tosun N, Tosun M, Doğan S, Younis M. The Impact of Disease-Related Fear and Internalized Stigma on Quality of Life in Patients with Scabies: A Cross-Sectional Study. Healthcare. 2026; 14(11):1575. https://doi.org/10.3390/healthcare14111575 Chicago/Turabian Style Tosun, Nurperihan, Mustafa Tosun, Sermed Doğan, and Mustafa Younis. 2026. "The Impact of Disease-Related Fear and Internalized Stigma on Quality of Life in Patients with Scabies: A Cross-Sectional Study" Healthcare 14, no. 11: 1575. https://doi.org/10.3390/healthcare14111575 APA Style Tosun, N., Tosun, M., Doğan, S., & Younis, M. (2026). The Impact of Disease-Related Fear and Internalized Stigma on Quality of Life in Patients with Scabies: A Cross-Sectional Study. 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The Impact of Disease-Related Fear and Internalized Stigma on Quality of Life in Patients with Scabies: A Cross-Sectional Study
