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CLINICAL REPORT
Epidemiology of Depression in Patients with Psoriasis: A Nationwide
Population-based Cross-sectional Study
Stephen Chu-Sung HU 1–4 , Gwo-Shing CHEN 1,2 and Hung-Pin TU 5
1
Department of Dermatology, College of Medicine, Kaohsiung Medical University, 2 Department of Dermatology, Kaohsiung Medical University
Hospital, 3 Department of Medical Research, Kaohsiung Medical University Hospital, 4 Translational Research Center, Kaohsiung Medical
University Hospital, Kaohsiung Medical University, and 5 Department of Public Health and Environmental Medicine, School of Medicine, College
of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
The epidemiology of depression in patients with psori-
asis has not been well defined in the Asian population.
This study evaluated the epidemiological features of,
and risk factors for, depression among patients with
psoriasis in Taiwan. A nationwide population-based
cross-sectional study was undertaken using the Natio-
nal Health Insurance Research Database. This study
included 17,086 patients with psoriasis and 1,607,242
patients from the general population. The prevalence
of depression in patients with psoriasis was 11.52%,
while the prevalence of depression in the general po-
pulation was 7.73% (prevalence ratio 1.49, 95% con-
fidence interval 1.43–1.55). Multivariable analysis
showed that, in patients with psoriasis, risk factors
associated with depression were: age 20–50 years,
female sex, low income, and major comorbid diseases,
including liver cirrhosis, renal disease, cardiovascular
disease and cerebrovascular disease. Therefore, the
prevalence of depression is higher in patients with
psoriasis, particularly in young and middle-aged wo-
men with low income and major comorbidities.
Key words: psoriasis; depression; prevalence; cross-sectional
study.
Accepted Feb 7, 2019; E-published Feb 8, 2019
Acta Derm Venereol 2019; 99: 530–538.
Corr: Hung-Pin Tu, Department of Public Health and Environmental Medi-
cine, School of Medicine, College of Medicine, Kaohsiung Medical Universi-
ty, 100 Shih-Chuan 1 st Road, Kaohsiung 807, Taiwan. E-mail: p915013@
kmu.edu.tw
P
soriasis is a common disease with a worldwide pre-
valence of approximately 2%. Patients with psoriatic
skin disease usually present with erythematous plaques
with silver scales on the skin, while patients with pso-
riatic arthritis present with joint pain and deformities
(1–3). The disease has been shown to have detrimental
effects on patients’ functional abilities and quality of life
(4–9). Recent studies have also shown that psoriasis is
not only a disease that affects the skin and joints, but that
it may be associated with various systemic inflammatory
and cardiometabolic diseases, including diabetes (10),
hypertension (11), hyperlipidaemia (12), obesity (13),
metabolic syndrome (14), myocardial infarction (15) and
cerebrovascular disease (16). Therefore, psoriasis is now
regarded as a systemic chronic inflammatory disease.
doi: 10.2340/00015555-3145
Acta Derm Venereol 2019; 99: 530–538
SIGNIFICANCE
This nationwide population-based cross-sectional study
demonstrates that the prevalence of depression is higher
in patients with psoriasis compared with non-psoriasis pa-
tients in the Taiwanese general population. In patients with
psoriasis, risk factors associated with increased prevalence
of depression include: age 20–50 years, female sex, lower
income, and comorbid diseases, including liver cirrhosis,
renal disease, cardiovascular disease and cerebrovascu-
lar disease. Therefore, clinicians should be vigilant for in-
creased prevalence of depression in patients with psoriasis,
especially those with the aforementioned risk factors. In
addition, more clinical effort should be focused on the pre-
vention and treatment of this serious psychiatric disorder
in patients with psoriasis.
Depression is a common and serious psychiatric dis-
order, characterized by low mood and loss of interest in
activities (17, 18). It is an important cause of functional
disability and impaired quality of life (19, 20), and may
have major socioeconomic consequences (21). Severe
forms of depression may lead to suicidal ideations. In
patients with psoriasis, depression may also be asso-
ciated with poor adherence to treatment (22), which
may negatively impact clinical outcomes. Therefore,
in patients with concurrent psoriasis and depression, it
is important to treat both diseases in order to optimize
clinical outcomes.
Although previous studies have shown an association
between psoriasis and depression (23), these studies have
produced heterogeneous results, with the prevalence of
depression in patients with psoriasis ranging from 6% to
62% (23–25). Moreover, many of these studies were per-
formed in single tertiary centres (with a limited number
of patients), and lack a non-psoriasis control group (26).
Furthermore, the prevalence and epidemiological features
of depression in patients with psoriasis have not been well
defined in the East Asian population and, in particular,
similar studies have not been performed in Taiwan. The
epidemiology of depression is likely to be different in the
Taiwanese and Han Chinese population, compared with
Western countries, due to differences in genetic, cultural
and lifestyle factors, higher degree of social support, and
lower rate of divorce and family breakdown.
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Journal Compilation © 2019 Acta Dermato-Venereologica.