World's largest study on facial scarring and mental health published

Scar Free researchers from Swansea University used health records from over 170,000 people to measure how many people with scars on their face struggle with mental health problems - and what factors make anxiety and depression more or less likely.

The study, “Assessing the burden oF Facial scarring and associated mEntal health Conditions to identify patients at greatesT risk” - known as AFFECT - was funded by The Scar Free Foundation and Health and Care Research Wales. The respected psychiatry journal, BJPsychOpen, accepted the headline research of the AFFECT study for publication in Autumn 2023.

The team, lead by Professor Iain Whitaker used an anonymised databank called SAIL as the basis for their analysis. Using health data from Wales, they found 179,079 people with facial scars. These records were matched by socio-economic status, age of facial scarring, and sex to the same number of people without scars.

The GP records of these matched pairs were compared to figure out how many people with facial scars and without facial scars were treated for anxiety and depression.

They found that people with facial scars are more likely to suffer from anxiety and depression compared to the wider population.

The research showed that there are some key factors that influence how often people with facial scars experience these common mental health issues:

• Anxiety and depression are most prevalent among people whose scars came from self-harm, assault, or traumatic injuries like burns.
• People whose scars came from congenital conditions are the least likely to be treated for anxiety and depression.
• Women, people with a history of poor mental health, and people experiencing deprivation are also at a higher risk.

We are proud to have funded this project alongside H&CRW. Millions of the people in the UK live with scars, but the impact of scarring on our mental health is understudied and often dismissed. This study is one step towards getting people living with facial scarring the support they need to feel happy, healthy, and confident.

Professor Iain Whitaker, Lead Investigator on the AFFECT Study said:

“I’ve been a plastic surgeon for 20 years, and I see a huge number of patients that need to have cancers on their face removed, or who have facial injuries. Every surgery leaves a scar but currently, there is an absence of psychological support for patients.

It’s important to me as a doctor that I know the repercussions of treatment on my patients beyond the immediate physical effects. I want to give my patients better information and a better patient experience. I hope this research leads to a more robust system of mental health support for patients with facial scars.”

Dr Jaco Nel, Scar Free Ambassador and sepsis survivor said:

“From my own experience as both a psychiatrist and someone living with scars, I know there's very little psychological support built in to help people with scarring, especially in the early days. I survived sepsis, but the consequences of my illness were life-changing. I lost both of my legs and several fingers and had extensive scarring to my face.

Although it was a challenge to adapt to my physical disabilities, I found the psychological scars had, and still have, an enduring effect. I suffered from depression and PTSD.

I felt self-conscious about my facial disfigurement. Your face is what people recognise; it tells how you feel, what you are thinking, who you are as a person. Mine was suddenly foreign, unrecognisable, even ugly. I was aware of staring eyes. Someone once said to me in a restaurant how brave I was to be out and about.

This study shows how important it is for patients to be offered good psychological support throughout their journey. The illness or event that leads to a facial scar is often fleeting, but our scars will be with us forever.

I am no longer ashamed of my scars; I use them to tell my story, hoping to help others overcome their struggles with physical and mental health. But it’s been a long and difficult journey to get to that point. I hope studies like this spur change so that in the future, people living with facial scars can live their lives without shame or anxiety.

The AFFECT study is just one of the projects funded by The Scar Free Foundation in Swansea University. Learn more about our other research projects: