1182 INVESTIGATIVE REPORT
ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Determinants of Psychosocial Health in Psoriatic Patients: A Multinational Study
Karolina LESNER 1, Adam REICH 1, Jacek C. SZEPIETOWSKI 1, Florence J. DALGARD 2, Uwe GIELER 3, Lucia TOMAS- ARAGONES 4, Lars LIEN 5, Francoise POOT 6, Gregor B. JEMEC 7, Laurent MISERY 8, Csanád SZABÓ 9, Dennis LINDER 10, Francesca SAMPOGNA 11, Andrea W. M. EVERS 12, Jon Anders HALVORSEN 13, Flora BALIEVA 14, Andrey LVOV 15, Servando E. MARRON 16, İlknur K. ALTUNAY 17, Andrew Y. FINLAY 18, Sam S. SALEK 19 and Jörg KUPFER 20
1
Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, 2 National Center for Dual Diagnosis, Innlandet Hospital Trust, Brumundal, Norway, 3 Department of Dermatology, Justus Liebig University, Giessen, Germany, 4 Department of Psychology, University of Zaragoza, Zaragoza, Spain, 5 Department of Public Health, Hedmark University College, Elverum, Norway, 6 Department of Dermatology, ULB-Erasme Hospital, Brussels, Belgium, 7 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,
8
Department of Dermatology, University Hospital of Brest, Brest, France, 9 Department of Dermatology, University of Szeged, Szeged, Hungary,
10
Section of Biostatistics, University of Oslo, Oslo, Norway, 11 Clinical Epidemiology Unit, Istituto Dermopatico dell’ Immacolata, Rome, Italy,
12
Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands, 13 Department of Dermatology, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, 14 Department of Dermatology, Stavanger University Hospital, Stavanger, Norway,
15
Department of Clinical Derm atology and Cosmetology, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia, 16 Department of Dermatology, Alcaniz Hospital, Alcaniz, Spain, 17 Department of Dermatology, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey, 18 Department of Dermatology, Cardiff University School of Medicine, Cardiff, 19 School of Life and Medical Sciences, University of Hertfordshire, Hatfield, and Institute for Medicines Development, Cardiff, UK, and 20 Institute of Medical Psychology, Justus Liebig University, Giessen, Germany
There are limited data on the differences in the impact of psoriasis between various countries with respect to quality of life( QoL). The aim of this study was to explore the psychosocial health of patients with psoriasis in different European countries. A total of 682 patients were recruited in 13 European countries. All patients completed a questionnaire regarding sociodemographic information, negative life events, suicidal ideation and satisfaction with their dermatologist. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale( HADS), and QoL with the Dermatology Life Quality Index( DLQI) and EuroQoL( EQ-5D). The lowest anxiety and depression scoring was noted in patients from Denmark, the lowest level of impairment in QoL in subjects from Spain, and the highest level of impairment in QoL in patients from Italy. The most relevant parameters influencing patients’ well-being were severity of pruritus and satisfaction with their dermatologist. The level of anxiety and depression symptoms correlated significantly with suicidal ideation.
Key words: psoriasis; quality of life; depression; anxiety; selfesteem.
Accepted Aug 9, 2017; Epub ahead of print Aug 10, 2017 Acta Derm Venereol 2017; 97: 1182 – 1188.
Corr: Jacek Szepietowski, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chałubińskiego 1, PL-50-368 Wroclaw, Poland. E-mail: jacek. szepietowski @ umed. wroc. pl
Psoriasis is a common chronic inflammatory skin disorder with a substantial emotional impact on patients. Prevalence studies have shown uniformly high rates of psychopathology among people with psoriasis( 1 – 4). For instance, anxiety symptoms were found much more commonly in patients with psoriasis compared with controls, with an adjusted odds ratio( OR) of 2.91( 95 % confidence interval( 95 % CI) 2.01 – 4.21) for anxiety disorders in subjects with psoriasis( 4). People with psoriasis were also more likely to be clinically depressed( 1). Of note, psychological factors, such as stress, anxiety and depressed mood, may influence the course of the disease and, along with the impact of psoriatic symptoms, impair patients’ quality of life( QoL). Importantly, the impact of psoriasis on health-related QoL( HRQoL) seems to be as great as that of other major medical conditions, such as cancer, heart failure, diabetes and depression( 3). Moreover, there was a significant association between having psoriasis and having suicidal thoughts: 67.6 % of subjects with psoriasis reported suicidal ideation because of their skin problem( 4). Depression in psoriasis might also be linked with higher cardiovascular morbidity and mortality, as it may play a role in promoting subclinical atherosclerosis beyond traditional cardiovascular risk factors. It was shown that depression might be associated with increased vascular inflammation and formation of coronary plaques( 5, 6). Therefore, it could be recommended that patients with psoriasis should be systematically screened to identify clinically important levels of depression and anxiety that may be missed while assessing HRQoL alone( 7).
It is not known whether depression level and other psychopathological symptoms in psoriasis correlate with disease severity, as current data are contradictory. Some authors have suggested that social stigmatization, high stress levels, physical limitations, depression, employment problems and other psychosocial co-morbidities experienced by patients with psoriasis are not always proportional to, or predicted by, other measurements of disease severity, such as body surface area involvement or plaque severity( 2). However, other researchers report that the severity of psoriasis has a significant impact on the wellbeing of affected individuals, as the burden of overall medical comorbidities increases with disease severity in the psoriatic population, and severe psoriasis doi: 10.2340 / 00015555-2760 Acta Derm Venereol 2017; 97: 1182 – 1188
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica.