Psoriasis may have effects that are more than skin deep.
Compared with controls, psoriasis patients had a 39 percent increase in the risk of a clinical diagnosis of depression, a 31 percent increase in the risk of anxiety and a 44 percent increase in the risk of suicidality.
“Our results suggest that patients with psoriasis are at increased risk for the development of depression, anxiety, and suicidality. On the basis of these data and the prevalence of psoriasis we estimate that in the UK there are over 10,400 diagnoses of depression, 7,100 diagnoses of anxiety, and 350 diagnoses of suicidality attributable to psoriasis each year,” according to Dr. Shanu Kohli Kurd, MD, and colleagues at the University of Pennsylvania.
Psoriasis, a chronic itchy or painful skin rash, affects up to three percent of the population, and even more individuals may be undiagnosed. Psoriasis can decrease quality of life, and when severe can be associated with other medical conditions. According to Kurd, psoriasis has been linked to mental health issues, but a clear association has not been carefully documented by research.
To determine how often depression, anxiety, and suicidality occurred in patients with psoriasis compared with the general population, Kurd and his team used data from the General Practice Research Database in the U.K., an electronic medical record of more than eight million people containing records from 1987 to 2002. Included in the data were 146,042 patients with mild psoriasis, 3,956 with psoriasis severe enough to require systemic therapy, and 766,950 people without psoriasis.
The researchers assessed the frequency of depression in terms of “person-years of follow-up,” which is a measure of the total of number of years of depression in the group. When they compared the rates numbers of “person-years” spent in depression of the patients with psoriasis to those without, they found that those with psoriasis were 1.39 times more likely to be depressed. The hazard ratios for those with psoriasis for anxiety was 1.31, and 1.44 for suicidal thinking. For more severe cases of psoriasis, the risk for suicidality was even higher.
The researchers found that younger patients appeared to have a significantly higher risk of the three diagnoses than older patients. Also, men appear to be at higher risk than women for a diagnosis of depression if they have severe psoriasis.
Kurd’s research is important in that this is the first large-scale trial that clearly documents the magnitude of mental health risks associated with psoriasis, and the nature of the psychiatric diagnoses that may accompany both mild and severe skin disease.
Clinicians may become aware of these issues and newer targeted interventions may be developed for these groups of individuals.
Dr. Kurd’s results can be seen in the August issue of the Archives of Dermatology.
Source: Archives of Dermatology