Functional Impairment Increases Depression Risk in Psoriasis, Psoriatic Arthritis

Nils Venhoff, MD
Credit: University of Freiburg

Data from a survey of patients with psoriatic disease is shedding light on the impact of psoriasis and psoriatic arthritis (PsA) on quality of life and depressive symptoms.

A survey of 300 people receiving care at dermatology and rheumatology outpatient clinics, results provide evidence of the relationship between functional impairment and risk of depressive symptoms in patients with psoriatic disease, with depressive symptoms presented in more than 50% of those with psoriasis and more than 60% of those with PsA.¹

“We were able to show that depressive symptoms are predicted by functional impairment, axial complaints, diagnosis of psoriatic arthritis, and number of joint regions with complaints,” wrote investigators.¹ “We furthermore showed that functional impairment, quality of life, and depressive symptoms are mutually interdependent, necessitating early diagnosis and initiation of anti-inflammatory therapy to avoid long-term damage, disability, and mental health complications.”

Psoriatic disease, like many chronic conditions, is associated with an increased risk of depressive symptoms in addition to the inherent impact on quality of life. In a study published in 2015, the presence of anxiety/depression was associated with a 61% increase in risk of mortality relative to their counterparts without anxiety/depression.^2,3

The current study was led by Nils Venhoff, MD, senior consultant in the Department of Rheumatology and Clinical Immunology of the University of Freiburg in Germany, along with a team of investigators from other institutions in Europe with the intent of evaluating burden of disease, functional capacity, quality of life, and depressive symptoms and identify factors predicting functional impairment and depression in patients with psoriatic disease. With this in mind, investigators designed their study as a cross-sectional survey of patients presenting to the University of Freiburg’s outpatient rheumatology or dermatology clinics.¹

A total of 300 patients were included in the study, with 150 patients from the dermatology clinic and 150 from the rheumatology clinic. Among the cohort, 111 patients had psoriasis and 189 had PsA. The overall cohort had a mean age at assessment of 54.3 years, a mean disease duration of 15.4 years, and 54% were male.¹

Participants completed questionnaire-based assessments of arthritis, functional status, quality of life, and depressive symptoms. For the purpose of analysis, investigators also performed a retrospective review of medical chart data. Of note the Psoriasis Epidemiology Screening Tool, Functional Questionnaire Hannover, World Health Organization Quality of Life Brief Version, and Patient Health Questionnaire 9 were used to assess arthritis, functional status, quality of life, and depressive symptoms, respectively.

Investigators pointed out elevated levels of disease burden were observed among study participants despite receiving treatment, with joint pain in multiple regions reported by 111 patients with psoriasis and 189 with PsA. Investigators noted differences in frequency and distribution patterns of symptoms were observed among those with PsA and psoriasis. Investigators also pointed out functional impairment in everyday life was independently associated with diagnosis of PsA (Odds Ratio [OR], 9.56; 95% Confidence Interval [CI], 1.96-46.73; P=.005), depressive symptoms (OR, 5.44; 95% CI, 2.22-13.33; P <.001), and age (OR, 1.04; 95% CI, 1.00-1.08; P=.033).¹

Further analysis indicated mild depressive symptoms were demonstrated in 54% and 69% of patients with psoriasis and PsA, respectively. Using logistic regression, investigators identified independent associations between depressive symptoms and increased likelihood of functional impairment (OR, 4.50; 95% CI, 1.64-12.35; P=.003), axial complaints (OR, 2.80; 95% CI, 1.11-7.08; P=.030), diagnosis of PsA (OR, 2.69; 95% CI, 1.02-7.11; P=.046), and number of joint regions with complaints (OR, 1.10; 95% CI, 1.01-1.20; P=.032).¹

“The data presented in this manuscript furthermore indicate that depression is underdiagnosed and undertreated in patients with psoriatic disease, with possible negative effects on quality of life, disease activity, and therapy adherence,” investigators added.¹ “Patients with psoriatic disease should thus be screened for depressive symptoms and access to mental health services should be improved to facilitate early diagnosis and concomitant therapy of depression.”

References:

1. Frede N, Hiestand S, Schauer F, et al. Psoriasis and Psoriatic Arthritis Have a Major Impact on Quality of Life and Depressive Symptoms: A Cross-Sectional Study of 300 Patients [published online ahead of print, 2023 Oct 15]. Rheumatol Ther. 2023;10.1007/s40744-023-00602-9. doi:10.1007/s40744-023-00602-9
2. Sahi FM, Masood A, Danawar NA, Mekaiel A, Malik BH. Association Between Psoriasis and Depression: A Traditional Review. Cureus. 2020;12(8):e9708. Published 2020 Aug 13. doi:10.7759/cureus.9708
3. Pratt LA, Druss BG, Manderscheid RW, Walker ER. Excess mortality due to depression and anxiety in the United States: results from a nationally representative survey. Gen Hosp Psychiatry. 2016;39:39-45. doi:10.1016/j.genhosppsych.2015.12.003