A mixed methods survey of social anxiety, anxiety, depression, and wig use in alopecia

Background: Hair, for many, is a central aspect of appearance, and hair loss can have a negative impact on self-esteem and body image. The current study aimed to examine levels of psychosocial distress reported by people with alopecia, and associations with wig use. The study also sought to report on experiences of wearing wigs in social situations. Method: A cross sectional survey comprised of standardised measures of social anxiety, anxiety and depression and survey questions to measure the use of wigs was completed by participants living with alopecia (N = 338). Correlations and t-tests were used to examine the relationship between wearing wigs and psychosocial distress. Open ended questions enabled participants to comment on their experiences of wearing wigs and were analysed using qualitative content analysis. Findings: Clinically significant levels of social anxiety (47.5%), anxiety (35.5%) and depression (27.5%) were reported with 66.3% reporting they would not feel confident leaving the house without a wig. Participants who reported worries about not wearing a wig reported significantly higher levels of depression, t(103) = 3.40, p = <.001, anxiety, t(109) = 4.80, p = <.001, and social anxiety, t(294), = 3.89, p = <.001. Wearing wigs appeared to increase social confidence; however, for some participants fears of wigs being noticed was reported which led to increased anxiety in social situations. Discussion: The relationship between wearing a wig and social confidence is complex. The psychosocial impact of hair loss needs to be considered when making decisions regarding funding for wig provision.