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Patients with psoriasis are at an increased risk of both anxiety and depression, likely because of the stress of the disease.¹

A team, led by Gloria-Beatrice Wintermann, Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, examined the impact of disease severity, health-related quality of life, and psychosocial stress on anxiety/depression for patients with moderate to severe psoriasis.

Mental Health and Psoriasis

Mental comorbidities are common among patients with psoriasis, may additionally affect the therapy outcome. However, it is not currently whether the disease severity, psychosocial stress, or health-related quality of life are factors for the manifestation of anxiety or depression and vice versa in patients with psoriasis.

“The interplay between these variables during the dermatological treatment of psoriasis remains to be elucidated in order to initiate appropriate psychological interventions and to identify patients at risk for comorbid anxiety/depression,” the authors wrote.

The Study

In the prospective cohort study, the investigators examined patients with psoriasis during dermatological treatment before and about 3 months following the beginning of a new treatment episode. Most cases were by means of systemic therapy.

The investigators analyzed the data using Bivariate Larent Change Score Models and mediator analyses. They utilized patient-reported outcome measures to assess patients, including Hospital Anxiety and Depression Scale/HADS, Perceived Stress Scale/PSS, Childhood Trauma Questionnaire/CTQ, Dermatology Life Quality Index-DLQI, Body Surface Area-BSA at both study timepoints.

The study included patients with psoriasis with a median age of 53.7 years and a median BSA of 18.0. Patients with complete data on HADS and DLQI were included in the study.

Results

The results show a higher anxiety/depression at the first assessment was linked to a lower improvement in psoriasis severity in the course of the dermatological treatment (γBSA = 0.50, P <0.001).

After analyzing subgroups of patients with psoriasis with low/high CTQ scores, anxiety/depression at the first time point had no impact on the change in psoriasis severity.

However, only by tendency, in CTQ subgroups, those with higher psoriasis severity was associated with a higher improvement in anxiety/depression at the second timepoint (low/high CTQ, γHADS = −0.16/−0.15, P = 0.08).

There was also an improvement in the health-related quality life that was positively associated with an improvement in anxiety/depression (Pearson's r = 0.49, P = 0.02). with a reduction of acute psychosocial stress as the decisive factor, mediating the association (β = 0.20; t [2,60] = 1.87; P = 0.07, 95% confidence interval [CI], −0.01 to 0.41).

“The results allude, that the initial severity of anxiety/depression may presumably have an impact on the treatment outcome in the total group,” the authors wrote. “In contrast, analyzing subgroups of patients with high/low childhood trauma, the impact of the initial disease severity on the course of anxiety/depression after a switch to a new dermatological treatment could not be conclusively ruled out.”

One of the limitations of the is that the latent change score modelling had a small sample size.

“A common aetiopathological mechanism for psoriasis and anxiety/depression might be assumed with impact of dermatological treatment on both,” the authors wrote. “The change in perceived stress seems to play an important role in the manifestation of anxiety/depression, substantiating the need for adequate stress management in patients with increased psychosocial stress during their dermatological treatment.”

References:

Wintermann, G., Bierling, A. L., Peters, E. M., Abraham, S., Beissert, S., & Weidner, K. (2023). Psychosocial stress affects the change of mental distress under dermatological treatment—a prospective cohort study in patients with psoriasis. Stress and Health. https://doi.org/10.1002/smi.3263