Serious mental illnesses increased in psoriasis patients
MedWire News: Patients with psoriasis have an increased risk for clinical depression, anxiety, and suicidal behavior, including ideation and attempt, compared with the general population, study findings indicate.
Shanu Kohli Kurd and colleagues, from the University of Pennsylvania in Philadelphia, estimate that in the UK, in excess of 10,400 diagnoses of depression, 7100 diagnoses of anxiety, and 350 diagnoses of suicidality are attributable to psoriasis annually..
"It is important to identify these psychiatric disorders because they represent substantial morbidity that can be improved with a variety of pharmacological and nonpharmalogical approaches," the researchers note in the Archives of Dermatology.
For their study, the team analyzed the risk for depression, anxiety, and suicidality in 3956 patients with severe psoriasis, defined as having a diagnostic code for psoriasis and a code indicating systemic treatment modality, 146,042 patients with mild psoriasis, who were not receiving systemic treatment, and 766,950 people without psoriasis.
Most of the severe psoriasis patients were taking methotrexate, for which the researchers believe there is no evidence of an association with depression, anxiety, or suicidality, as far as they are aware.
The rates of depression, anxiety, and suicidality were higher in psoriasis patients than controls prior to study entry. And after entry, psoriasis patients were 1.39 times more likely to receive a general practitioner clinical diagnosis of depression than controls, and 1.31 and 1.44 times more likely to receive a clinical diagnosis of anxiety and suicidality, respectively.
The risk for depression was significantly higher in patients with severe compared with mild psoriasis (hazard ratio [HR]=1.72 vs 1.38). The same was true for suicidality, although the difference was not significant (HR=1.51 vs 1.44), but the risk for anxiety was similar in patients with mild and severe psoriasis (HR=1.31 and 1.29, respectively).
The researchers also report that among patients with severe psoriasis, the risk for a clinical diagnosis of depression was higher among men than women, and the risk for depression, anxiety, and suicidality were all greater among younger (20 years old) than older (40-60 years old) patients.
The absolute risks for a diagnosis of depression, anxiety, or suicidality attributable to psoriasis, after adjusting for age and gender ,were 11.8, 8.1, and 0.4 per 1000 person-years, respectively. The attributable risks were similar between mild and severe psoriasis patients, with the exception of that for depression, which was higher among severe psoriasis patients, at 25.5 per 1000 person-years compared with 11.5 per 1000 person years for those with mild depression.
The team concludes that "future studies are necessary to determine the mechanisms by which psoriasis is associated with depression, anxiety, and suicidality as well as approaches to prevent such adverse outcomes in patients with psoriasis."
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By Lucy Piper