Psoriasis Negatively Impacts Adolescent Mental Health, Particularly for Those with Joint Pain

Credit: Pexels

Adolescent mental health struggles are associated with psoriasis, according to new findings from the Danish National Birth Cohort (DNBC), and the link is more apparent among those reporting joint pain as opposed to only a diagnosis.¹

These conclusions were the results of new research designed to ascertain whether or not there had been a difference observed in adolescents’ self-reported mental health with and without psoriasis. The investigators, led by Sandra L. Brandi of Copenhagen University Hospital – Herlev and Gentofte in Denmark, utilized data drawn from the 18-year follow-up of the DNBC.

Brandi et al. noted that while there had been qualitative research on adolescents’ struggles with psoriasis and related issues, comparisons had not been widely-available among these studies to psoriasis-free peers.²

“The aim of this study was to establish whether there is a difference in self-reported mental health between adolescents with and without psoriasis using data from the 18-year follow-up of the Danish National Birth Cohort (DNBC),” Brandi and colleagues wrote.

Background and Methods

As mentioned previously, the research team drew their data from the Danish National Birth Cohort. The DNBC is a population-based study which enrolled close to 100,000 pregnant females in the timeframe between 1996 - 2002, further utilizing follow-ups subsequently carried out on both mothers and their offspring.

A recent phase of this research took place from March 2016 - January 2022, and it involved recruiting subjects from the cohort who had reached the age of 18 and 3 months to participate in a questionnaire done online. The research team’s survey explored several different elements of health and health-related life quality, including inquiries regarding psoriasis and mental well-being.

The team focused in their analysis on adolescents who had given responses to questions about psoriasis during the 18-year follow-up period, with the their questionnaire having included evaluations of subjects’ overall perception of health, their mental well-being assessed through the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), their satisfaction with life, their behavioral issues assessed through the Strengths and Difficulties Questionnaire (SDQ), and their feelings of loneliness.

The categorizations for participants’ self-rated health questions were separated by the investigators into 'good' or 'poor' health, while satisfaction scores related to life in general required a rating above 6 to suggest higher satisfaction. Subject scores in mental well-being which were between 7 - 20 were determined by the team to be 'low,' and those over 20 were deemed 'moderate/high.’

There were other elements considered by the research team as potential confounding variables such as body mass index (BMI), maternal level of education, sex, autoimmune conditions, and household income. Various sources were used by the team to gather these data, some of which included Denmark’s Civil Registration System, the Danish National Patient Register, and Statistics Denmark.

Findings

Overall, 44,838 participants were included by the investigators, among which about 2.6% reported the presence of psoriasis. Adolescents with diagnoses of psoriasis were reported by the team as having a heightened risk with various correlations such as higher rates of depressive symptoms (odds ratio [OR] 1.38; confidence interval [CI] 1.19–1.58) as well as panic/agoraphobia, with the team noting greater odds observed in both females (OR 1.60; CI 1.33–1.92) and males (OR 1.72; CI 1.33–2.19).

Despite these findings, the investigators noted that such links weakened when considering only those cases diagnosed by a doctor. The link between poor mental health and cases of psoriasis was, however, particularly pronounced among adolescents with additional reports of joint pain experiences.

“Our results must be interpreted within the context of several limitations, including the nature of self-reported data and cross-sectional design…” they wrote. “Thus, adolescents with poor mental health may be at greater risk of developing psoriasis and without temporal ordering we can only speculate about the directionality.”

References

1. ^{Brandi SL, Skov L, Strandberg-Larsen K, Zachariae C, Cederkvist L, Groot J, Nybo Andersen AM. Psoriasis and mental health in adolescents: A cross-sectional study within the Danish National Birth Cohort. J Affect Disord. 2024 May 3;358:318-325. doi: 10.1016/j.jad.2024.05.009. Epub ahead of print. PMID: 38703911.}
2. ^{C.J. Golics, M.K.A. Basra, A.Y. Finlay, M.S. Salek; Adolescents with Skin Disease Have Specific Quality of Life Issues. Dermatology 1 April 2009; 218 (4): 357–366. https://doi.org/10.1159/000205524.}