Acta Dermato-Venereologica 99-4CompleteContent | Page 15

CLINICAL REPORT 417 Patients with Moderate to Severe Psoriasis Associate with Higher Risk of Depression and Anxiety Symptoms: Results of a Multivariate Study of 300 Spanish Individuals with Psoriasis Maria José TRIBÓ 1 , Marta TURROJA 1 , Gemma CASTAÑO-VINYALS 2–5 , Antonio BULBENA 6 , Elena ROS 7 , Pablo GARCÍA- MARTÍNEZ 1 , Francisco TAUSK 8 , Marc SAGRISTÀ 1 , Ramon M. PUJOL 1 , Marta FERRAN 1 and Fernando GALLARDO 1 Department of Dermatology and 6 Department of Psychiatry, Parc de Salut Mar, 2 ISGlobal, 3 IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra (UPF), Barcelona, 5 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, 7 Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Spain, and 8 Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA 1 4 Psoriasis is a chronic skin disease associated with con- siderable physical and psychological comorbidities. Stress and emotional disturbances have been impli- cated in both triggering the onset and exacerbation of psoriasis. In order to determine the level of perceived stress and mood alterations in patients with psoriasis and their association with disease severity, 300 indi- viduals completed diverse validated questionnaires as- sessing stress and psychological mood. Evaluation of perception of disease was also measured. A significant association between psoriasis severity and mood, emo- tional disturbances and an impact on assessments of the quality of life were observed. Particularly, Montgo- mery-Asberg Depression Rating Scale, Hamilton Rating Scale and Hospital Anxiety and Depression Scale for Depression detected a significant risk for depression in relation to the disease severity. The association bet- ween depression features, anxiety and perceived stress with psoriasis severity is important and can influence the appropriate management of psoriasis. Key words: psoriasis; anxiety; depression; stress; mood; quality of life. Accepted Jan 7, 2019; E-published Jan 9, 2019 Acta Derm Venereol 2019; 99: 417–422. Corr: Fernando Gallardo, MD, Department of Dermatology, Parc de Salut Mar, Passeig Maritim, 25-29, ES-08003 Barcelona, Spain. E-mail: fgal- [email protected] P soriasis affects about 2.3% of the Spanish popula- tion. An increasing prevalence has been detected, probably due to a higher awareness and earlier diagnosis, rather than an increment of the total number of cases (1, 2). Individuals are likely to present differing levels of disease severity throughout their lifetime, experiencing ‘spontaneous’ remissions and flare-ups during the disease course. The pathogenesis of psoriasis is not fully under- stood but includes hereditary and environmental factors. Psoriasis is considered to be a psycho-physiological disease, a dermatological condition which evolution may be influenced by psychological aspects. Patients often point out stress as an exacerbating factor. Some studies SIGNIFICANCE Population-based studies indicate that psoriasis associates a greater risk of comorbidities that alter mood, such as anxiety and, above all, depression. We applied a complete panel of validated questionnaires to perform a full psycho- pathological exploration according to the DSM-V classifica- tion of psychiatric diseases in 300 psoriatic patients. A do- se-response association with depression and anxiety (the more severe psoriatic patients have more risk of having depression or anxiety) was observed. The Montgomery- Asberg Depression Rating, Hamilton Rating for Depression, Hospital Anxiety and Depression scales (for depression), and State Anxiety Inventory (for anxiety) seem to better detect such mood comorbidities in psoriatic patients. support the fact that stress may play a relevant role in the onset and course of psoriasis in comparison with other conditions, such as urticaria or atopic dermatitis (3, 4). Relationships between emotional stress and psoriasis se- verity have been reported and a conclusive link between skin symptoms and mood was demonstrated (5). More- over, large-scale studies have evaluated the association between depression, anxiety and suicidal ideation with psoriasis. A significantly higher prevalence of psycholo- gical and psychiatric disorders in patients suffering from psoriasis has been reported (6–8). The present study aims to assess the impact of psycho- social events or mood disorders on the psoriatic population and to explore their link to the quality of life (QoL) and health status related to skin disease severity. To accom- plish this, both stress level (secondary to recent-previous life events) and current psychological co-morbidities were measured among psoriatic individuals with different levels of skin disease severity using a complete set of validated questionnaires. In contrast to other studies, a large number of cases were evaluated, using an efficient methodology to record stressful life events and psychological mood variables. The impact of the stress level on the severity of psoriasis, considering both the physician and the patient’s points of view was also assessed. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3114 Acta Derm Venereol 2019; 99: 417–422