Abstract
This case-control study uses population-based data to examine the association of psoriasis with mental health disorders, and to identify trends in their rates of occurrence and times to onset after diagnosis of psoriasis.
Psoriasis is a chronic inflammatory skin disorder that affects 3% of the white population in the United States and is known to decrease patients’ health-related quality of life.1 There have been many studies demonstrating that patients with psoriasis have more depressive symptoms and mental health comorbidities than healthy controls.1,2,3 However, there have been few studies on how long it takes for these mental health comorbidities to appear after the diagnosis of psoriasis.
Methods
We obtained population-based data (n = 1 116 789) from South Korea’s Health Insurance Research and Assessment Agency from 2002 to 2013. The patients with mental disorders and psoriasis were identified using the following diagnostic codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10): psoriasis (L40), depressive episode (F32), other anxiety disorders (F41), acute stress reaction (F43), somatoform disorders (F45), other neurotic disorders (F48), and nonorganic sleep disorders (F51).
We estimated the prevalence and sex- and age-adjusted odds ratios of mental health disorders in patients with psoriasis using logistic regression. The parameters for the sequential pattern mining were based on the values of the probability of occurrence and the time to onset of mental disorders after the diagnosis of psoriasis using the SAS Enterprise Miner version 13.2 (SAS Institute). The study design was approved by the Ethics Committee of Seoul St Mary’s Hospital, the Catholic University of Korea, and followed all relevant principles of the Declaration of Helsinki. Informed consent was waived owing to the nature of the study.
Results
The final study population included 12 762 patients with psoriasis. The risk of depressive episodes, anxiety disorders, somatoform disorders, neurotic disorders, and nonorganic sleep disorders were 2.19, 2.92, 2.62, 2.66, and 2.58 times higher in patients with psoriasis than in control patients, which were slightly attenuated after adjusting for covariates (Table 1).
Table 1. Three-Year Risk of Mental Disorder in Patients With Psoriasis.
| Mental Disorder | Odds Ratio (95% CI) | |
|---|---|---|
| Age- and Sex-Adjusted Model | Adjusted for Comorbid Diseasesa | |
| Depressive episode | ||
| Control | 1 [Reference] | |
| Patients with psoriasis | 2.19 (1.97-2.44) | 1.99 (1.79-2.22) |
| Anxiety disorders | ||
| Control | 1 [Reference] | |
| Patients with psoriasis | 2.92 (2.67-3.20) | 2.649 (2.42-2.91) |
| Acute stress reaction | ||
| Control | 1 [Reference] | |
| Patients with psoriasis | 1.25 (0.99-1.58) | 1.207 (0.96-1.52) |
| Somatoform disorders | ||
| Control | 1 [Reference] | |
| Patients with psoriasis | 2.62 (2.24-3.08) | 2.347 (1.999-2.76) |
| Neurotic disorders | ||
| Control | 1 [Reference] | |
| Patients with psoriasis | 2.66 (2.29-3.09) | 2.417 (2.29-3.09) |
| Nonorganic sleep disorders | ||
| Control | 1 [Reference] | |
| Patients with psoriasis | 2.58 (2.27-2.93) | 2.292 (2.02-2.60) |
Adjusted for coronary heart disease, cerebrovascular disease, diabetes mellitus, and hyperlipidemia.
The probabilities of the occurrence of depressive episodes, anxiety disorders, somatoform disorders, neurotic disorders. and nonorganic sleep disorders after the diagnosis of psoriasis were 0.12%, 0.14%, 0.13%, 0.16%, and 0.05%, respectively; the times to onset were 196.7, 86.1, 86.3, 224.2, and 94.2 days, respectively (Table 2). In men, somatoform disorders and neurotic disorders were the most common. Additionally, for men, it took 80.4 days and 280.4 days to develop somatoform disorders and neurotic disorders, respectively. In women, depressive episodes were the most common, with a 0.18% probability of occurrence and a mean time to onset of 267.9 days. On average, it took 53.0 days for women patients with psoriasis to develop anxiety disorders.
Table 2. Risk and Time to Onset of Mental Health Disorders in 12 762 Men and Women With Psoriasis.
| Mental Disorder | Men | Women | Total | |||
|---|---|---|---|---|---|---|
| Probability of Occurrence, % | Time to Onset, d | Probability of Occurrence, % | Time to Onset, d | Probability of Occurrence, % | Time to Onset, d | |
| Anxiety disorders | 0.14 | 112.6 | 0.14 | 53.0 | 0.14 | 86.1 |
| Acute stress reaction | 0.03 | 24.0 | 0.04 | 98.5 | 0.03 | 61.3 |
| Depressive episode | 0.07 | 54.4 | 0.18 | 267.9 | 0.12 | 196.7 |
| Neurotic episode | 0.16 | 280.4 | 0.16 | 155.4 | 0.16 | 224.2 |
| Nonorganic sleep disorders | 0.01 | 43.0 | 0.09 | 104.4 | 0.05 | 94.2 |
| Somatoform disorders | 0.16 | 80.4 | 0.09 | 99.2 | 0.13 | 86.3 |
Discussion
This study investigated the risk and time to onset of mental health disorders in patients with psoriasis. Similar to previous studies, the risk of mental health disorders in patients with psoriasis was higher than in controls.1,2,3 Recent studies have suggested that the helper T cell type 17 (TH17) axis might play a role in neuroimmune interactions, including anxiety disorders and depression.4,5,6 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.
In patients with psoriasis, mental health disorders were shown to occur within 2 or 3 months of diagnosis. Men tended to have a shorter time to onset for most mental health disorders than women, except for neurotic disorders and anxiety disorders. Therefore, when patients are diagnosed with psoriasis, multidisciplinary teams consisting of dermatologists and psychiatrists should be involved in the early stages of treatment.
The limitation of our study is that we could not measure the actual disease duration between psoriasis and the mental health disorders. However, our study was strengthened by the use of standardized, large-population data to identify an association between psoriasis and mental health disorders.
The present results demonstrate that psoriasis is associated with a higher risk for developing mental health disorders; therefore, dermatologists should play a role in detecting mental health disorders in patients with psoriasis, and in assembling a multidisciplinary team of medical professionals to treat these patients.
References
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