Gender differences in the association between adverse childhood experiences and early onset psoriasis

Abstract

Psoriasis, a chronic autoimmune skin disease, arises from both genetic predisposition and environmental factors, including Adverse Childhood Experiences (ACEs). This cross-sectional study investigated the association between ACEs, family history, and early-onset psoriasis (≤ 18 years), with particular attention to gender differences. Among 102 psoriasis patients (54 early-onset, 48 late-onset), the early-onset group demonstrated a higher proportion of females, greater prevalence of parental psoriasis, and elevated anxiety levels compared to the late-onset group. However, multivariable regression analysis revealed that parental psoriasis was not significantly associated with early-onset psoriasis. Exposure to three or more ACEs significantly associated with early-onset psoriasis (adjusted OR = 2.61, p = 0.014), with specific associations observed for emotional neglect, domestic violence, and loneliness. Gender-stratified analysis showed a stronger association in females (adjusted OR = 6.609, p = 0.016) than in males (adjusted OR = 2.494, p = 0.115), though no significant gender-ACEs interaction was detected (p = 0.289). These findings demonstrate a gender differences, dose-response relationship between ACEs and early-onset psoriasis, highlighting the potential value of early psychological interventions for at-risk individuals, particularly females with high ACE exposure.

Introduction

Psoriasis, a chronic and recurrent autoimmune skin disease requiring lifelong management, exhibits varying prevalence across regions, from 0.14% in East Asia, and approximately 0.47% in China¹, to 1.92% in Western Europe, with higher rates observed in high-income countries². While the precise etiology remains elusive, a complex interplay of genetic, environmental, and immune factors is implicated³. Clinically, psoriasis vulgaris, the most common phenotype, is often categorized into early-onset (≤ 40 years) and late-onset (> 40 years) subtypes⁴, with early-onset frequently associated with the HLA-Cw*06 allele³.

Beyond genetic predispositions, the role of environmental stressors, particularly Adverse Childhood Experiences (ACEs), in the development and exacerbation of psoriasis is increasingly recognized⁵. Childhood trauma has been found to increase the risk of psychological disorders⁶, unhealthy life style⁷, and autoimmune disease⁸. Notably, the accumulation of ACEs has been associated with earlier onset of various chronic diseases⁹. However, the specific relationship between ACEs and the onset of psoriasis, especially in its early-onset form, remains poorly understood.

It is worth noting that the existing ACEs questionnaire was not developed based on investigations within the psoriasis population or tailored to individuals living in China. Our prior interviews with Chinese psoriasis patients revealed that certain ACEs manifest uniquely in China. For instance, many described being raised primarily by grandparents during early childhood, only to transition abruptly to their parents’ household at school age. Others reported being sent to live with relatives/others for schooling while separated from parents. When standardized ACE instruments fail to capture such culturally specific adversities, critical childhood stressors may remain undetected.

Furthermore, family history is a well-established risk factor for psoriasis¹⁰ and early onset of psoriasis¹¹, while research has explored the genetic contribution of parental psoriasis, the potential psychosocial impact on offspring remains largely uninvestigated. This gap is significant, as family history likely reflects not only genetic predispositions but also shared environmental influences. Parents with psoriasis may experience heightened psychological stress¹², which could impact their parenting styles and potentially increase the risk of intergenerational adversity. Therefore, understanding the psychosocial dimensions of parental psoriasis is crucial for a comprehensive understanding of psoriasis in offspring.

Given the well-documented influence of gender differences on immune responses¹³ and stress reactivity¹⁴,which can lead to distinct manifestations of similar pathologies, it is reasonable to hypothesize that the impact of ACEs on the onset of psoriasis may vary between males and females.

In this case, 86 psoriasis patients were pre-interviewed to add and optimize 7 questions to the original ACE 10 questions, which is used over the past 20 years, a large body of research has accumulated linking this scale to many health outcomes in diverse populations around the world¹⁵. Furthermore, this study aims to investigate the impact of ACEs and family history on early-onset psoriasis (≤ 18 years), while controlling for HLA-Cw*06 and other relevant factors. Specifically, we will examine whether the association between ACEs and early-onset psoriasis differs between males and females.

Results

Basic information

A comparative analysis of demographic, clinical, and psychosocial characteristics between two groups based on the onset age of psoriasis (≤ 18 years vs. >18 years). The group with onset ≤ 18 years (n = 54) was younger (median age 33.0 vs. 43.0, p < 0.001), had a higher proportion of females (55.6% vs. 35.4%, p = 0.042), and more frequently reported a family history of the psoriasis (48.2% vs. 27.1%, p = 0.029). Anxiety levels were significantly higher in the ≤ 18 years group (median 8.0 vs. 6.0, p = 0.011), while other clinical measures like PASI, depression, and quality of life scores showed no significant differences. HLA-Cw*06 allele frequency and positivity did not differ significantly between groups. Overall, the ≤ 18 years group exhibited distinct psychosocial and demographic profiles compared to the > 18 years group (Table 1).

Table 1. Comparison of demographic, clinical, and psychosocial characteristics between early onset (≤ 18 years) and late onset (age > 18) of psoriasis.

		Onset age n (%)		p value	Effect size
		≤ 18 years (54)	> 18 years (48)	X2/t/MannWhitney	Phi/Cramer V/Cohen’s d
Age	Median (P25, P75)	33.0(28.5,43.3)	43.0(37.0,52.8)	0.000***	0.95
Gender	Male	24(44.4)	31(64.6)	0.042*	0.202
	Female	30(55.6)	17(35.4)
Ethics	Han	34(63.0)	27(56.3)	0.788	0.068
	Mongolian	19(35.2)	20(41.7)
	Others	1(1.9)	1(2.1)
Education	Low	18(33.3)	24(50.0)	0.088	0.169
	High	36(66.7)	24(50.0)
Family history	No	28(51.9)	35(72.9)	0.029*	0.216
	Yes	26(48.2)	13(27.1)
First degree family history	No	28(51.85)	37(77.08)	0.008**	0.262
	Yes	26(48.15)	11(22.92)
Parents with psoriasis	No	28(51.85)	38(79.17)	0.004**	0.285
	Yes	26(48.15)	10(20.83)
Marriage status	Single	25(46.3)	5(10.4)	0.001**	0.402
	Married	28(51.9)	41(85.4)
	Divorced	1(1.9)	1(2.1)
	Widow	0(0.0)	1(2.1)
Smoking status	No	35(64.8)	24(50.0)	0.318	0.15
	Yes	7(13.0)	9(18.8)
	No more smoking	12(22.2)	15(31.3)
BMI	M ± SD	24.2 ± 4.0	24.4 ± 2.7	0.732	0.067
HLA-Cw*06 allele frequency	No	4(7.4)	7(14.6)	0.335	0.146
	Heterozygote	45(83.3)	39(81.3)
	Homozygote	5(9.3)	2(4.17)
HLA-Cw*06 positivity	Negative	4(7.4)	7(14.6)	0.244	0.115
	Positive	50(92.6)	41(85.4)
PASI	Median (P25, P75)	6.9(3.9,11.1)	7.4(4.3,11.2)	0.725	0.07
Depression	Median (P25, P75)	6.0(3.0,9.0)	5.0(2.0,9.0)	0.336	0.377
Anxiety	Median (P25, P75)	8.0(4.0,11.0)	6.0(2.3,8.0)	0.011*	0.728
PDI	Median (P25, P75)	19.0(14.0,28.0)	17.0(13.0,25.5)	0.438	0.342
DLQI	Median (P25, P75)	15.0(9.0,19.0)	14.0(9.0,18.0)	0.313	0.354
PLSI	M ± SD	22.2 ± 7.6	21.2 ± 6.9	0.482	0.143

BMI body mass index; * p < 0.05 ** p < 0.01 *** p < 0.001.

The factors associated with early (≤ 18 years) onset psoriasis

The logistic regression analysis identified several factors associated with early-onset psoriasis (age ≤ 18 years). Gender (OR = 3.669, 95% CI: 1.232–10.926, p = 0.02), ACE accumulation (OR = 2.297, 95% CI: 1.050–5.027, p = 0.037), marriage status (OR = 0.138, 95% CI: 0.028–0.672, p = 0.014), and smoking status (OR = 0.494, 95% CI: 0.255–0.957, p = 0.037) showed significant associations. However, parental psoriasis (OR = 2.833, p = 0.063) showed no significant association with early-onset psoriasis (Table 2).

Table 2. Logistic regression analysis of factors associated with early onset (age ≤ 18 years or > 18 years).

	B	SE	OR	OR 95% CI	p
Age	-0.052	0.028	0.95	0.899 ~ 1.003	0.063
Gender	1.3	0.557	3.669	1.232 ~ 10.926	0.02*
Ethics	-0.114	0.507	0.892	0.330 ~ 2.409	0.822
Education (Low and high)	0.64	0.531	1.897	0.670 ~ 5.370	0.228
Marriage state	-1.978	0.807	0.138	0.028 ~ 0.672	0.014*
BMI	0.171	0.092	1.186	0.991 ~ 1.420	0.063
Smoking status	-0.706	0.338	0.494	0.255 ~ 0.957	0.037*
HLA-Cw*06	0.354	0.776	1.425	0.311 ~ 6.520	0.648
ACE accumulations	0.832	0.4	2.297	1.050 ~ 5.027	0.037*
Parent with psoriasis	1.041	0.56	2.833	0.945 ~ 8.497	0.063

Relationship of aces and early onset of psoriasis, and the gender differences

Table 3 revealed significantly higher rates of high-dose ACE exposure (≥ 3 ACEs) in early-onset psoriasis (age ≤ 18) compared to late-onset cases. Notably, specific ACE subtypes showed significant differences in domestic violence (27.8% vs. 4.2%, p = 0.001) and loneliness (31.5% vs. 2.1%, p < 0.001). Logistic regression demonstrated dose-dependent associations, with both ACE number (AOR = 1.47, p = 0.020) and accumulation (AOR = 2.62, p = 0.014) significantly associated with early onset. Three ACE subtypes showed particularly strong adjusted associations: emotional neglect (AOR = 15.36, p = 0.043), parental domestic violence (AOR = 13.43, p = 0.005), and loneliness (AOR = 15.88, p = 0.013). The subgroup analysis revealed that in females, ACE dose respond demonstrated a stronger association with early-onset psoriasis (adjusted OR = 6.609, p = 0.016) than in males (adjusted OR = 2.494, p = 0.115). However, the gender-ACEs accumulation interaction was not statistically significant (p = 0.289) (Table 4).

Table 3. Comparison of aces between early onset (age ≤ 18 years) and late onset (> 18 years) of psoriasis.

		Onset age n (%)		p value	Effect size
		≤ 18 years (54)	> 18 years (48)	X2 test	Phi/Cramer V/Cohen’s d
ACE number	0	22(40.7)	26(54.2)	0.064	0.38
	1	11(20.4)	12(25.0)
	2	5(9.3)	8(16.7)
	3	6(11.1)	0(0.0)
	4	5(9.3)	0(0.0)
	5	1(1.9)	1(2.1)
	6	1(1.9)	1(2.1)
	7	2(3.7)	0(0.0)
	8	1(1.9)	0(0.0)
ACEs yes or no	No	22(40.7)	26(54.2)	0.175	0.134
	Yes	32(59.3)	22(45.8)
ACEs accumulation	No	20(37.0)	26(54.2)	0.009**	0.303
	1 ~ 2	18(33.3)	19(39.6)
	>=3	16(29.6)	3(6.6)
ACE subtypes	Physical Abuse	4(7.4)	1(2.1)	0.433	0.123
	Emotional Abuse	1(1.6)	0(0.0)	1	0.094
	Sexual Abuse	3(5.6)	0(0.0)	0.284	0.164
	Emotional Neglect	8(14.8)	1(2.1)	0.056	0.224
	Physical Neglect	2(3.7)	2(4.2)	0.696	0.012
	Parental Death or Separation	7(13.0)	8(16.7)	0.598	0.052
	Domestic Violence	15(27.8)	2(4.2)	0.001**	0.316
	Family Substance Use	6(11.1)	4(8.3)	0.891	0.047
	Family Mental Illness	3(5.6)	1(2.1)	0.696	0.089
	Family Incarceration	0(0.0)	2(4.2)	0.219	0.15
	Bullying	8(14.8)	4(8.3)	0.311	0.1
	Community Violence	1(1.9)	3(6.3)	0.528	0.113
	Collective Violence	1(1.9)	0(0.0)	1	0.094
	Foster care	8(14.8)	4(8.3)	0.311	0.1
	Change of Primary Caregiver	3(5.6)	4(8.3)	0.872	0.055
	Child Labor	4(7.4)	2(4.2)	0.785	0.069
	Loneliness	17(31.5)	1(2.1)	0.000***	0.385

Table 4. Logistic regression analysis of the association between aces and early onset of psoriasis (age ≤ 18 years or > 18 years) and subgroup analysis by gender, crude and adjusted ORs and their 95% CIs.

	OR	95% CI	p	Adjusted OR	95% CI	p
ACE17 numbers	1.39	1.058 ~ 1.826	0.018*	1.47	1.064 ~ 2.030	0.020*
0
1
2
3
4
5
6
7
8
10
ACE yes or no	1.719	0.784 ~ 3.771	0.176	2.192	0.773 ~ 6.211	0.14
no
yes
ACE accumulations	2.13	1.216 ~ 3.729	0.008**	2.618	1.220 ~ 5.622	0.014*
0
1 ~ 2
≥ 3
Emotional Neglect	8.174	0.983 ~ 67.977	0.052	15.36	1.087 ~ 217.125	0.043*
Domestic Violence	8.846	1.904 ~ 41.093	0.005**	13.429	2.213 ~ 81.499	0.005**
Loneliness	21.595	2.746 ~ 169.817	0.004**	15.878	1.808 ~ 139.431	0.013*
Subgroup analysis by Gender (adjusted p for interaction = 0.289)
Female	3.859	1.355 ~ 10.988	0.011*	6.609	1.412 ~ 30.940	0.016*
Male	1.657	0.791 ~ 3.473	0.181	2.494	0.800 ~ 7.779	0.115

* p < 0.05, **p < 0.01, *** p < 0.001, adjusted for the gender, age, ethics, marriage status, BMI, Education (non- university and university), smoking status and HLA-Cw*06 positivity.

Discussion

This study demonstrated that individuals with early-onset psoriasis (≤ 18 years) exhibited distinct demographic and psychosocial characteristics compared to those with later-onset disease. Specifically, early-onset psoriasis showed a higher proportion of female patients, higher parentals psoriasis and elevated anxiety levels. However, after multivariable regression analysis parental psoriasis showed no significant association with early-onset psoriasis. Notably, we observed a dose-response relationship between ACEs and early-onset psoriasis, with subtypes including emotional neglect, domestic violence, and loneliness showing significant associations. Subgroup analysis revealed that females with higher cumulative ACE exposure had a significant association with early-onset psoriasis than males, highlighting important gender differences - though no significant gender-ACEs interaction was detected. These findings underscore the significant role of early-life stressors in psoriasis pathophysiology and emphasize the need for targeted psychosocial interventions, particularly for vulnerable female populations.

In our study, a clear dose-response relationship was observed especially in the early-onset group (≤ 18 years of age). For individuals with early-onset of psoriasis, particularly those whose condition continues to flare up, can be a heightened risk of severe morbidity¹⁶. Children with psoriasis are twice as likely to have comorbidities as those without psoriasis¹⁷, including metabolic syndrome (obesity, hyperlipidemia, hypertension, and diabetes mellitus), psoriatic arthritis, and cardiovascular disease¹⁸. Early onset of psoriasis also causes psychological distress, leading to a higher risk of depression and anxiety¹⁹. And negative impact in the quality of life of children, adolescents and their families, even in the presence of mild disease¹⁹. ACEs may serve as a common trigger for a range of psoriasis and co-occurring psychiatric disorders, with studies indicating that high levels of ACE exposure are associated with chronic diseases²⁰ and mental health problems^21,22 in adolescents. Among younger respondents, those reporting high dose ACEs faced a two to four times higher risk for each chronic condition and poor health status compared to those reporting no ACEs²⁰. Moreover, the toxic stress from ACEs can dysregulate the body’s stress system, with cumulative exposure leading to low cortisol levels during adolescence²³. This dysregulation is also observed in patients with psoriasis, where both glucocorticoid secretion and receptor expression are suppressed in psoriatic lesions²⁴, and lower peripheral cortisol level compare to control^25,26. Consequently, early identification and intervention of ACEs are crucial in mitigating adverse clinical outcomes in these patients.

ACEs are associated with autoimmune diseases²⁷, and research indicates gender differences in these associations²⁸. Women with recent myocardial infarction (MI) and higher ACE exposure report greater psychological distress and poorer disease-specific health status, whereas similar associations are not observed in men²⁹. Long-term cognitive effects of ACEs, showing greater dementia risk in women³⁰. Women exposed to ACEs are more likely to develop depression, anxiety³¹. Men with ACE exposure tend to engage in risk-taking behaviors, leading to violent behavior³². Gender-specific biological mechanisms¹³, such as hormonal regulation³³ and stress response³⁴, influence how ACEs impact mental and physical health differently. ACEs may manifest as distinct health issues across genders, necessitating tailored interventions: emotional-focused approaches for women and behavioral strategies for men show greater clinical relevance. Studies suggest that gender differences in stress response, hormonal regulation, and coping mechanisms contribute to varying health outcomes.

Strength and limitation

Strength

1. New insight: There were significant associations between high dose ACEs and psoriasis earl onset. Specially, Emotional neglect, domestic violence and loneliness. The study controlled for HLA-Cw*06 positivity and other factors.

2. Subgroup analysis revealed gender differences: women exposed to higher cumulative ACE levels showed a significant association with early-onset psoriasis (age ≤ 18 years), whereas men did not.

3. The ACEs17 Questionnaire conducted by structured interviews with psoriasis patients provides reliable data on the role of childhood trauma.

Limitation

1. The study did not distinguish between parental death and divorce in the ACEs 17 Questionnaire. These experiences should be distinguished in future studies.

2. This study involved a limited number of psoriasis patients. Given the national and geographic variations in psoriasis-related ACEs, future research should include longitudinal, larger and more diverse psoriasis populations across multiple countries.

3. ACEs questionaries provide retrospective data that may introduce some recall bias.

Conclusion

Our study highlights a potential relationship between adverse childhood experiences (ACEs) and early-onset psoriasis, with notable gender differences observed. Future research should prioritize longitudinal studies to investigate causal relationships and evaluate the effectiveness of early psychosocial interventions in alleviating the burden of psoriasis and its associated comorbidities.

Materials and methods

Study design

The first aim of this study was to examine and compare demographic and psoriasis-related characteristics between patients with early-onset (≤ 18 years) and late-onset (> 18 years) psoriasis. Second, to determine the association between ACEs and early-onset psoriasis, controlling for potential confounding factors, including HLA-Cw06 genotype. To conduct subgroup analyses and interaction testing to assess gender-specific differences in the relationship between ACEs and early-onset psoriasis. Thirdly, to compare between with and without parental psoriasis and the occurrence of ACEs in offspring.

Interview psoriasis patients for adapting aces 17

Structured interviews were conducted with 86 patients with psoriasis who visited the Department of Psychosomatic Medicine, Inner Mongolia International Mongolian Hospital, from May 2018 to December 2020. The patients were interviewed for 3 h, including family history of psoriasis, self-reported triggers of psoriasis, perceptions of psoriasis, medical history, caregivers’ personalities, relationships with caregivers, siblings, and friends, marital status and childhood and adult experiences.

ACEs were assessed through 17 questions, including the original 10 ACEs questions (supplement Table 1). These assessed child abuse (emotional, physical, and sexual abuse), child neglect (emotional and physical neglect), and family dysfunction (loss of a family member, domestic violence, parental alcohol or drug abuse, parental mental illness or suicidal intention, and parental criminal records). Seven additional questions were included, covering three types of community violence (bullying, community violence, and collective violence) and four other factors (placement in foster care, change of primary caregiver, child labor, and loneliness).

The internal consistency reliability of the 17-item ACEs questionnaire was acceptable, with a Cronbach’s Alpha of 0.698. The Kaiser-Meyer-Olkin (KMO) test result was 0.704 (Bartlett’s Test χ2 = 1282.737, p < 0.01), indicating that the adequacy of the model was acceptable.

Setting and participants

The study included 102 patients with psoriasis vulgaris, aged between 18 and 65 years, who met the following criteria: they were diagnosis with psoriasis vulgaris, not pregnant, had no other serious complications, and provided peripheral blood samples. These patients had been treated at the Department of Psychosomatic Medicine of the Inner Mongolia International Mongolian Hospital between March 2018 and March 2022. A retrospective survey was conducted from August 1 to August 20, 2022, during which the patients completed the ACE-17 item questionnaire via an online survey platform (Survey Star; Changsha Ranxing Science and Technology).

Sample size, based on previous interview for 86 patients, we have found the psoriasis had more than 3 childhood adversity is much higher prevalence (30.2%) in the group of onset age ≤ 18, rarely in the group of > 18 years (8.1%), to detect significant differences with 80% power at significance level 0.05 (two-sided). Based on calculation prevalence of traumatic events reported case more than 3 were 30% vs. 8% of the control. With a ratio cases: controls of 1: 1, analysis showed that at least 46 psoriasis patients with age > 18 and 46 age ≤ 18 were needed.

Ethic

This study was conducted in accordance with the ethical principles outlined in the Nuremberg Code and the Declaration of Helsinki. Ethical approval was granted by the Institutional Review Board (IRB) of the International Mongolian Medicine Hospital of Inner Mongolia (Approval No.: B2018-002).

Prior to this study, written informed consent was obtained from all participants explicitly allowing the use of their biological samples for future scientific research. Therefore, in accordance with applicable regulations regarding the secondary use of pre-collected anonymized samples, the Ethics Committee approved a waiver of the additional informed consent requirement for this study. All data and samples were handled in strict compliance with patient confidentiality and data protection guidelines.

Measures

We collected sociodemographic data (gender, age, ethnicity, marital status, weight, height, smoking status, and education) and psoriasis-related characteristics (age at onset, duration of disease, family history, stress response, and ACEs prior to the onset of psoriasis). Psoriasis Area and Severity Index (PASI) scores, The Hospital Anxiety and Depression Scale (HADS) and blood samples were also collected. Stress responders were defined as patients who self-reported that psychological stress triggered or worsened their psoriasis.

Psoriasis area and severity index (PASI). A representative area of psoriasis is selected for each body region. The intensity of redness, thickness, and scaling of the psoriasis is assessed as none (0), mild (1), moderate (2), severe (3), or very severe (4). The percentage area affected by psoriasis is evaluated in the four regions of the body. In each region, the area is expressed as nil (0), 1–9% (score 1), 10–29% (score 2), 30–49% (score 3), 50–69% (score 4), 70–89% (score 5) or 90–100% (score 6).

The Hospital Anxiety and Depression Scale (HADS) A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of a hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder.

HLA-Cw*06 genotyping

Genomic DNA was extracted from whole blood. The presence of the HLA-Cw*06 allele was determined using PCR (primer forward, 5’-TTG AGG ATT CTC CAC TCC CCT GAG-3’; reverse, 5’- CTG TGC CTG GCG CTT GTA CTT-3’), followed by SmaI restriction enzyme digestion and agarose gel electrophoresis. The 618 bp PCR product was cleaved to fragments of 348 and 270 bp in non-Cw6 individuals, whereas carriage resulted in fragments of 348, 270, 196 and 74 bp in heterozygous individuals and 348, 196 and 74 bp in the homozygous state^35,36.

Statistics analysis

The ACEs17 questionnaire was analyzed using internal consistency reliability and exploratory factor analysis. In descriptive statistics, qualitative variables were expressed as counts (percentages) and compared using the Chi2 test or the Fisher exact test, as appropriate. In the chi-square test, a variety of indicators can be used to indicate the effect size; in the case of a 2*2 table, it is recommended that the Phi indicator be used, and in the case of a m*n (m not equal to n) table, the Cramer V indicator is recommended. When considered normally distributed, quantitative variables were either expressed as mean (± standard deviation) and compared using two independent samples t-tests, or when unequal variances were used, corrected t-tests were used, and effect sizes were calculated using Cohen’s d. For abnormally distributed data and ranked data summarized at median and quartiles [median (P25, P75)], the Mann-Whitney U test was used. Comparisons were made and the effect size Cohen’s d was calculated using the online tool https://www.psychometrica.de/effect_size.html. P values were considered significant when they were less than 0.05, at which point larger effect sizes indicated a larger magnitude of difference, and the thresholds for distinguishing between small, medium, and large effect sizes in the usual case were respectively: 0.20, 0.50, and 0.80. Crude and adjusted ratios (ORs) and 95% confidence intervals (CIs) were calculated for different childhood traumas and subgroup analysis using logistic regression. Adjusted ORs were adjusted for age, gender, ethnicity, and level of education (high - low), smoking status, and body mass index. And further generalized linear model analyzed the relationship of early onset of psoriasis and Anxiety symptoms. All study analysis used SPSS24.0 and SPSSAU online analytic software (SPSS cloud 4th generation statistical analysis software, QingSi Technology Ltd 2016–2025 All Right Reserved. https://spssau.net/).

Acknowledgements

This study was supported by Inner Mongolia Major Project 2017 (NMGZDZX2017), the National Natural Science Foundation of China [Grant No. 82071517, U21A20364, 31771217], and the Scientific Foundation of Institute of Psychology, Chinese Academy of Sciences (No. E2CX4115CX).

Author contributions

Conceptualization: SA, NH, WWW; Formal Analysis: SA, HX; Investigation: SA, YFB, NB, AB, WS, NX, NT; Resource: YFB, NB, AB, NH; Supervision; WWW, NH; Writing- original draft: SA, HX, WWW; Writing-review and editing: WWW, NH.

Data availability

Sarnai Arlud should be contacted if someone wants to request the data from this study.

Declarations

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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