Mental Health Disorders Are More Prevalent in Psoriasis Patients

MAY 15, 2019
Kevin Kunzmann
depression, psoriasisPsoriasis is associated with a greater patient development risk for mental health disorders, according to findings from a nationally-based South Korea study that links 2 varied specialties of care.

A team of investigators from Seoul St. Mary’s Hospital in South Korea used population-based data including 1 million-plus patients over a decade to evidence a two-fold-plus greater risk of depressive episodes, anxiety disorders, somatoform disorders, neurotic disorders, and nonorganic sleep disorders in patients with psoriasis, versus patients without the condition.

Led by Chul Hwan Bang, MD, the team sought to assess the average length of time for each of a half-dozen mental health comorbidities to manifest in patients post-psoriasis diagnosis. They used data from 1,116,789 patients from the South Korea Health Insurance Research and Assessment Agency, from 2002-2013.

They identified patients with mental disorders and psoriasis using diagnostic codes for psoriasis, depressive episode, acute stress reaction, somatoform disorders, nonorganic sleep disorders, other anxiety disorders, and other neurotic disorders. Sex- and age-adjusted odds ratios and overall prevalence were estimated for mental health disorders in patients with psoriasis.

Overall, 12,762 patients were found to have been diagnosed with psoriasis. Among mental health disorders—after slight attenuation for covariate adjustment—anxiety disorders were the most likely to develop in psoriasis patients (2.92) than control patients. Somatoform (2.62), neurotic (2.66), and nonorganic sleep disorders (2.58) each had a 2.5-fold greater risk of development in psoriasis patients than control patients.

Among depressive episodes; anxiety disorders; somatoform disorders; neurotic disorders; and nonorganic sleep disorders, diagnoses took on average 196.7; 86.1;  86.3; 224.2;and 94.2 days, respectively. Among men, comorbid somatoform and neurotic disorders were most common, and took 80.4 and 280.4 days on average to develop, respectively. Among women, depressive episodes were most common, and took an average 267.9 days to develop.

Female patients with psoriasis developed anxiety disorders within an average of 53 days.

Bang and colleagues noted that previous investigations into the high prevalence of mental health disorders in psoriasis patients has pointed to a similar neuroimmune interaction—the helper T cell type 17 (TH17) axis could play a role in conditions including anxiety disorder and depression.

“Because psoriasis is a typical TH17-related chronic disease, the prevalence of mental health disorders in patients with psoriasis may be higher than in healthy control individuals,” they wrote.

In an essay accompanying the study, April W. Armstrong, MD, MPH, of the Department of Dermatology at the Keck School of Medicine, University of Southern California, and Associate Editor of JAMA Dermatology, noted that patients with psoriasis have been previously shown to have a 33% greater chance of attempting suicide—and a 20% greater change of committing suicide—than those without. The rate is even greater in young patients, and those with a more severe form of psoriasis.

“Is the development of depression and bipolar disorder simply a consequence of having psoriasis?” Armstrong prosed. “Or are there mechanistic underpinnings that help explain the observed association between these mental disorders and psoriasis?”

Regardless of the driving factor—be it TH17 or not—other assessments show successful treatment of psoriasis is associated with reduced depressive signs and symptoms. As such, Armtstrong calls for early, appropriate care of skin diseases for the sake of decrease mental health comorbidity risk.

“Even in our fast-paced clinics, screening for mental disorders in high-risk populations can be worthwhile,” she wrote.

The study, “Association of Psoriasis With Mental Health Disorders in South Korea,” was published online in JAMA Dermatology.

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