Association Between the Mental Health of Patients With Psoriasis and Their Satisfaction With Physicians

Charlotte Read; April W Armstrong

doi:10.1001/jamadermatol.2020.1054

. 2020 May 6;156(7):1–9. doi: 10.1001/jamadermatol.2020.1054

Association Between the Mental Health of Patients With Psoriasis and Their Satisfaction With Physicians

Charlotte Read ^1,², April W Armstrong ^1,^✉

¹Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles

²Department of Medicine, Imperial College London, London, United Kingdom

Accepted for Publication: March 10, 2020.

^✉

Corresponding Author: April W. Armstrong, MD, MPH, Department of Dermatology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, KAM B6, Los Angeles, CA 90089 (armstrongpublication@gmail.com).

Published Online: May 6, 2020. doi:10.1001/jamadermatol.2020.1054

Author Contributions: Drs Read and Armstrong had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Both authors.

Critical revision of the manuscript for important intellectual content: Both authors.

Statistical analysis: Read.

Administrative, technical, or material support: Armstrong.

Supervision: Armstrong.

Conflict of Interest Disclosures: Dr Read reported receiving grants from the National Psoriasis Foundation (NPF) during the conduct of the study. Dr Armstrong reported receiving grants and personal fees from Abbvie, Bristol-Myers Squibb, Dermavant, Eli Lilly, Janssen Pharmaceuticals Inc, Leo Pharma, Novartis Pharmaceuticals Corp, Regeneron Pharmaceuticals, and UCB Pharma; personal fees from Boehringer Ingelheim, Genentech, Merck, Modernizing Medicine, Ortho Dermatologics, Pfizer Inc, Sanofi Genzyme, and Celgene; and grants from Dermira and Kyowa Hakko Kirin outside the submitted work.

Funding/Support: This study was funded by the NPF/USA.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: This study was conducted with publicly available, deidentified data from the Agency for Health Care Research and Quality’s Medical Expenditure Panel Survey.

^✉

Corresponding author.

PMCID: PMC7203668 PMID: 32374350

Key Points

Question

Is the mental health of patients with psoriasis associated with their satisfaction with physicians?

Findings

This analysis of the medical records of 652 US adult patients with psoriasis (weighted total, 8 876 767 patients) found that patients with symptoms of psychological distress and depression reported lower satisfaction with their physicians than patients with no or fewer such symptoms.

Meaning

Because patients’ baseline mental health may be associated with their perception of the physician, clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities.

Abstract

Importance

How patients’ mental health is associated with their satisfaction with physicians is rarely studied among adults with skin conditions.

Objective

To examine the association between mental health comorbidities in patients with psoriasis and their satisfaction with physicians.

Design, Setting, and Participants

This retrospective survey analysis used 14 years of nationally representative longitudinal data on adults in the United States with psoriasis from the 2004-2017 Medical Expenditure Panel Survey. Statistical analysis was performed from October 1, 2018, to December 1, 2019. Mental health comorbidities were measured by performance on the Kessler 6-Item Psychological Distress Scale (score range, 0-24, where a score ≥13 is considered an indicator of a serious mental illness and significant psychological distress) and the Patient Health Questionnaire 2 (score range, 0-6, where a score ≥3 is considered a positive screening result for a depressive disorder).

Main Outcomes and Measures

Patient satisfaction with physician, measured by the patient-physician communication composite score.

Results

A weighted total of 8 876 767 US adults with psoriasis (unweighted total, 652 patients) (weighted; 54% women; mean [SEM] age, 52.1 [0.7] years) were analyzed; 27% of adults had moderate or severe symptoms of psychological distress, and 21% had moderate or severe symptoms of depression. Patients with moderate or severe psychological distress symptoms were less satisfied with their clinicians compared with those with no or mild psychological distress symptoms (mean Kessler 6-Item Psychological Distress Scale scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 13.0-13.4]; and severe symptoms, 13.1 [95% CI, 12.5-13.7]; P < .001). In addition, compared with patients with no or mild psychological distress symptoms, patients with moderate psychological distress symptoms were 2.8 times more likely to report low patient satisfaction (adjusted odds ratio, 2.8 [95% CI, 1.5-4.9]; P = .001), and patients with severe psychological distress symptoms were 2.3 times more likely to report low patient satisfaction (adjusted odds ratio, 2.3 [95% CI, 1.1-4.7]; P = .03). Furthermore, patients with moderate or severe depression symptoms were less satisfied with their clinicians compared with those with no or mild depression symptoms (mean Patient Health Questionnaire 2 scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 12.9-13.6]; and severe symptoms, 13.0 [95% CI, 12.6-13.4]; P = .002). In addition, compared with patients with no or mild depression symptoms, patients with moderate depression symptoms were 4.6 times more likely to report low patient satisfaction (adjusted odds ratio, 4.6 [95% CI, 2.1-10.0]; P < .001).

Conclusions and Relevance

This study suggests that patients with greater psychological distress and depression report lower satisfaction with their clinicians than those without such mental health symptoms. Clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities. Evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.

This survey study uses data from the Medical Expenditure Panel Survey to examine the association between mental health comorbidities in patients with psoriasis and their satisfaction with physicians.

Introduction

Patients evaluate dermatologists and other dermatology clinicians on how well we communicate about their skin diseases and treatment plans. In the field of dermatology, dermatologists and dermatology clinicians generally receive high patient satisfaction ratings.^1,2,3,4 However, dermatologists sometimes receive disparate evaluations by different patients. Why do some patients rate their dermatology clinicians poorly when most other patients rate the same clinicians highly?

Traditional factors relevant to dermatology patients’ satisfaction with health care professionals include confidence in the clinician, provision of individualized care, and the quality of information provided.^{5,6,7,8,9,10,11,12,13,14,15} However, to our knowledge, the association between a patient’s baseline psychological state and his or her perception of the quality of patient-clinician interactions is unknown. So, are unhappy patients more likely than happy patients to rate lower patient satisfaction with their clinicians regardless of the actual quality of patient-clinician interactions? Understanding whether mental health comorbidities may be associated with patient satisfaction is important because greater patient satisfaction is associated with better practice and better patient outcomes.^{2,16,17,18,19,20}

A critical knowledge gap exists in this area. Addressing this knowledge gap enables dermatology clinicians to be more cognizant of the psychological factors that may be associated with patient satisfaction. In addition, addressing this knowledge gap will be foundational to improve our approaches to increase patient satisfaction, from enhancing communication styles to directly addressing patients’ underlying psychological state.

This study aims to evaluate whether an association exists between a patient’s psychological state and the perception of patient-clinician encounters using nationally representative data collected with validated instruments. We chose to examine this question for patients with psoriasis owing to the chronicity of psoriasis, the varied psychological and mood states among patients with psoriasis, and the overall large disease burden.^21,22,23

Methods

Data Source and Study Population

This retrospective survey analysis used longitudinal data from the 2004-2017 Household Component of the Medical Expenditure Panel Survey (MEPS). The MEPS is a publicly available database that uses a stratified, multistaged probability design to provide a nationally representative, noninstitutionalized sample of US adults that is followed up for approximately 2 consecutive years.²⁴ The survey collects deidentified information on health care use, health care expenditures, and sociodemographic characteristics as well as physical and mental health comorbidities. This study was determined to be exempt by the University of Southern California Institutional Review Board because the MEPS comprises deidentified, publicly available data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

The study population included all adults (≥18 years) alive during the calendar year who reported a diagnosis of psoriasis, reported patient satisfaction with their clinician, and completed the Kessler 6-Item Psychological Distress Scale (K6) and/or the Patient Health Questionnaire 2 (PHQ2). We used the Medical Conditions data file to identify patients who had a diagnosis of psoriasis identified by the International Classification of Diseases, Ninth Revision (ICD-9) code 696 or the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code L40. The MEPS database had been used previously to evaluate patients with psoriasis.^25,26 We used the Full-Year Consolidated data file to obtain mental health comorbidity and patient satisfaction data. For analysis, we included patients who had complete data on demographic and clinical characteristics of interest.

Variables

Dependent Variable (Patient Satisfaction)

The dependent variable was patient satisfaction as measured by the patient-physician communication composite score, a validated instrument that assesses a patient’s perception of the quality of patient-clinician communication.^27,28 This measure collects patients’ responses to the following 4 patient-clinician communication domains: (1) listening carefully to patients, (2) explaining diagnoses and management in ways patients could understand, (3) showing respect for patients’ perspective, and (4) spending enough time with patients. Patients’ responses were scored using a 4-point Likert scale (1-4, where 1 indicates never and 4 indicates always). Global scores range from 4 to 16. Based on existing literature, the patient-physician composite scores were categorized into the following 3 groups: (1) low patient satisfaction (patient-physician composite score, 4-9), (2) medium patient satisfaction (patient-physician composite score, 10-15), and (3) high patient satisfaction (patient-physician composite score, 16).^{29,30,31,32,33}

Independent Variable (Mental Health Comorbidities)

The independent variable (indicator) was mental health comorbidities as measured by the presence of psychological distress or depression symptoms. We favored the use of K6 and PHQ2 rather than ICD codes for anxiety and depression because the K6 and PHQ2 provided granular information regarding patients’ mental health symptoms and pertain only to patients exhibiting symptoms.

The K6 scale is a validated 6-item measure of psychological distress. It evaluates aspects of nervousness, hopelessness, restlessness, depression, apathy, and worthlessness during a 30-day reference period.^34,35 Each item is scored on a 5-point Likert scale (0-5, where 0 indicates none of the time and 4 indicates all of the time). Global scores range from 0 to 24; a score of 13 or more is considered an indicator of a serious mental illness and significant psychological distress.³⁴ A validation study of mental health comorbidity measures in the MEPS database demonstrated that all K6 items loaded strongly on the mental health factor using factor analysis.³⁶ The K6 scores were categorized into the following 3 groups: no or mild psychological distress symptoms (K6 score, 0 to <5), moderate psychological distress symptoms (K6 score, 5 to <13), and severe psychological distress symptoms (K6 score, 13-24).³⁷

The PHQ2 is a validated 2-item screening measure for depression.^38,39 Responders are asked to report whether, during the past 2 weeks, they have been “feeling down, depressed, or hopeless” or have “little interest or pleasure in doing things.” Each item is scored on a 4-point Likert scale (0-3, where 0 indicates not at all and 3 indicates nearly every day). Global scores range from 0 to 6; a score of 3 or more is considered a positive screening result for a depressive disorder (sensitivity, 94%; specificity, 75%).³⁹ The PHQ2 scores were categorized into the following 3 groups: no or mild depression symptoms (PHQ2 score, <1.5), moderate depression symptoms (PHQ2 sore, ≥1.5 to <3), and severe depression symptoms (PHQ2 score, 3-6).^39,40

Covariates

We adjusted for potential demographic confounders, including age, sex (self-reported as female or male), race, ethnicity (Hispanic or non-Hispanic), marital status, employment status (employed or unemployed), educational level, poverty level category, the year the survey was conducted, and whether the patient and clinician speak the same language.^{41,42,43,44,45,46} We also adjusted for potential clinical confounders, including cognitive limitations, social limitations, and comorbidities. Cognitive limitations were defined as confusion or memory loss, problems making decisions, or the requirement of supervision for safety. Social limitations were defined as any social, recreational, or family activity limitations secondary to mental or physical impairments. Comorbidities were assessed using the Charlson Comorbidity Index, excluding depression from the index owing to its collinearity with mental health comorbidity measures.⁴⁷ The Charlson Comorbidity Index is a validated method of the estimated risk of mortality from comorbid disease and has been adapted for use with 3-digit ICD-9 codes.^47,48,49,50 Its use in the MEPS is well described.^51,52,53,54

Statistical Analysis

Statistical analysis was performed from October 1, 2018, to December 1, 2019. We conducted separate analyses for each mental health comorbidity measure (K6 and PHQ2). We performed a descriptive analysis of age, sex, race, ethnicity, marital status, employment status, educational level, poverty level category, cognitive limitations, social limitations, and year the survey was conducted and calculated the Charlson Comorbidity Index. We evaluated differences in sociodemographic and clinical factors between patients with varying severities of mental health symptoms using χ² analyses for categorical variables and analysis of variance for continuous data.

To determine whether differences exist in patient satisfaction among patients with varying severities of mental health symptoms, we performed a univariate analysis using analysis of variance. Multivariate logistic regression models were used to evaluate the outcome of patient satisfaction, which was a binomial variable.

To obtain nationally representative population sums, we applied person-level sampling weights and a variance estimation stratum. P ≤ .05 was established a priori as statistically significant for unadjusted comparisons. To address multiple hypothesis testing, P ≤ .004 was established using the Bonferroni correction (α/number of tested variables = 0.05/13 = 0.004) as statistically significant for adjusted comparisons. For all statistical analyses of the MEPS survey data, we applied the appropriate survey commands using STATA, version 13.0 (StataCorp LLC).

Results

Study Population Characteristics

Among a weighted total of 13 965 002 US adults with psoriasis (unweighted, 1385 US adults with psoriasis) who reported mental health comorbidities during a 14-year period from the 2004-2017 MEPS database, approximately 36% were excluded from the analysis owing to missing data. A comparison of sociodemographic and clinical characteristics of the original population with incomplete data and the analyzed population with complete data showed overall similar population-level characteristics and are detailed in eTables 1 and 2 in the Supplement.

A weighted total of 8 876 767 patients (unweighted, 652 patients) were included in the analysis. The mean (SEM) age was 52.1 (0.7) years. Women comprised 54% of the population, and men comprised 46% of the population. The mean patient satisfaction score was 14.0 (95% CI, 13.8-14.2).

Kessler 6-Item Psychological Distress Scale

Regarding psychological distress, 73% of patients had no or mild symptoms, 22% had moderate symptoms, and 5% had severe symptoms (Table 1). The mean patient satisfaction score was 14.3 (95% CI, 14.2-14.4) for patients with no or mild psychological distress symptoms, 13.2 (95% CI, 13.0-13.4) for patients with moderate psychological distress symptoms, and 13.1 (95% CI, 12.5-13.7) for patients with severe psychological distress symptoms (P < .001) (Figure). Unadjusted logistic regression found that, compared with patients with no or mild psychological distress symptoms, patients with moderate psychological distress symptoms were 3.0 times more likely to report low patient satisfaction with their clinician (odds ratio [OR], 3.0 [95% CI, 1.7-5.4]; P < .001).

Table 1. Sociodemographic and Clinical Characteristics of US Adult Patients With Psoriasis by Severity of Mental Health Symptoms From the Medical Expenditure Panel Survey.

Characteristic	Severity of psychological distress symptoms, No. (%) (weighted; unweighted)^a			P value	Severity of depression symptoms, No. (%) (weighted; unweighted)^a			P value
Characteristic	No or mild (n = 6 457 943; n = 476)	Moderate (n = 1 926 000; n = 143)	Severe (n = 492 824; n = 33)	P value	No or mild (n = 6 995 345; n = 515)	Moderate (n = 1 180 290; n = 85)	Severe (n = 701 132; n = 52)	P value
Age, mean (SEM), y	52.3 (0.7)	51.1 (1.6)	53.2 (1.7)	.66^b	51.6 (0.6)	53.0 (2.4)	55.5 (2.0)	.31^b
Female sex	3 484 884 (54)	1 010 161 (52)	261 888 (53)	.93^c	3 821 056 (55)	536 694 (45)	399 183 (57)	.26^c
Unemployed^d	1 895 066 (29)	870 031 (45)	333 336 (68)	<.001^c	2 080 057 (30)	541 398 (46)	476 979 (68)	<.001^c
Race
White	5 508 714 (85)	1 731 590 (90)	455 232 (92)	.10^c	6 023 511 (86)	1 026 737 (87)	645 288 (92)	.20^c
Black	602 434 (9)	140 770 (7)	5998 (1)		621 780 (9)	97 925 (8)	29 497 (4)
Asian, Native Hawaiian, or Pacific Islander	212 742 (3)	53 640 (3)	13 457 (3)		222 261 (3)	51 071(4)	6506 (1)
American Indian or Alaska Native	49 876 (1)	NA	18 137 (4)		48 172 (1)	NA	19 841(3)
Multiple races reported	84 177 (1)	NA	NA		79 620(1)	4557 (0)	NA
Hispanic ethnicity	418 437 (6)	200 191 (10)	75 590 (15)	.003^c	494 679 (7)	91 248 (8)	108 291 (15)	.008^c
Marital status
Married	4 408 550 (68)	989 657 (51)	270 191 (55)	<.001^c	4 651 698 (66)	659 655 (56)	357 045 (51)	.07^c
Widowed	422 956 (7)	182 333 (9)	26 370 (5)		500 312 (7)	76 713 (6)	54 635 (8)
Divorced	608 207 (9)	324 877 (17)	108 192 (22)		680 632 (10)	197754 (17)	162 890 (23)
Separated	53 326 (1)	11 554 (1)	2242 (0)		51 276 (1)	5518 (0)	10 328 (1)
Never married	964 904 (15)	417 580 (22)	85 829 (17)		1 111 427 (16)	240 651 (20)	116 234 (17)
Cognitive limitations^d	149 006 (2)	207 153 (11)	233 725 (47)	<.001^c	150 519 (2)	180 921 (15)	258 444 (37)	<.001^c
Social limitations^d	282 459 (4)	208 523 (11)	143 857 (29)	<.001^c	340 893 (5)	100 032 (8)	193 913 (28)	<.001^c
Educational level^d
<High school	776 461 (12)	210 139 (11)	111 110 (23)	.01^c	788 051 (11)	143 185 (12)	166 474 (24)	.04^c
High school	1 582 922 (25)	638 629 (33)	174 734 (35)		1 780 020 (25)	406 549 (34)	209 715 (30)
≥1 y College	4 098 560 (63)	1 077 232 (56)	206 981 (42)		4 427 274 (63)	630 556 (53)	324 943 (46)
Poverty level category^e
Poor	240 914 (4)	212 121 (11)	79 484 (16)	<.001^c	248 797 (4)	155 336 (13)	128 385 (18)	<.001^c
Near poor	135 597 (2)	28 364 (1)	36 061 (7)		143 559 (2)	18 173 (2)	38 291 (5)
Low income	372 572 (6)	256 547 (13)	155 018 (31)		502 379 (7)	109 470 (9)	172 287 (25)
Middle income	1 779 467 (28)	435 570 (23)	121 213 (25)		1 891 113 (27)	235 356 (20)	209 780 (30)
High income	3 929 393 (61)	993 399 (52)	101 049 (21)		4 209 497 (60)	661 955 (56)	152 389 (22)
Clinician and patient do not speak same language	40 656 (1)	27 987 (1)	21 351 (4)	.002^c	55 829 (1)	3732 (0)	30 432 (4)	<.001^c
CCI, mean (95% CI)	0.892 (0.834-0.950)	0.891 (0.715-1.066)	0.930 (0.790-1.069)	.63^b	0.878 (0.823-0.933)	0.960 (0.671-1.243)	0.941 (0.826-1.055)	.92^b
Patient satisfaction
High	2 830 519 (44)	557 137 (29)	143 530 (29)	<.001^c	2 940 241 (42)	392 240 (33)	198 705 (28)	<.001^c
Medium	3 423 830 (53)	1 196 459 (62)	317 748 (65)		3 828 757 (55)	656 220 (56)	453 060 (65)
Low	203 594 (3)	172 403 (9)	31 546 (6)		226 347 (3)	131 831 (11)	49 366 (7)

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Abbreviations: CCI, Charlson Comorbidity Index; NA, not applicable.

^{^a}

Percentages of weighted population.

^{^b}

Analysis of variance of differences between adult patients with psoriasis who reported no or mild psychological distress or depressive symptoms, moderate psychological distress or depressive symptoms, or severe psychological distress or depressive symptoms.

^{^c}

Using the χ² test of differences between adult patients with psoriasis who reported no or mild psychological distress or depressive symptoms, moderate psychological distress or depressive symptoms, or severe psychological distress or depressive symptoms.

^{^d}

Thirty-six percent of original study population had incomplete data pertaining to mental health comorbidities, patient satisfaction, employment status, cognitive limitations, social limitations, year, and educational level and were excluded from analysis (eTables 1 and 2 in the Supplement).

^{^e}

Poverty level category was measured as percentage of federal poverty level: poor (≤100% of federal poverty level), near poor (100% to <125%), low income (125% to <200%), middle income (200% to <400%), and high income (≥400%).

Figure. — Patient satisfaction as measured by the patient-provider communication composite score. The vertical lines indicate 95% CIs.

^aP = .002.

^bP < .001.

Multivariate logistic regression adjusting for sociodemographic and clinical characteristics found that, compared with patients with no or mild psychological distress symptoms, patients with moderate psychological distress symptoms were 2.8 times more likely to report low patient satisfaction with their clinician (adjusted OR [AOR], 2.8 [95% CI, 1.5-4.9]; P = .001), and patients with severe psychological distress symptoms were 2.3 times more likely to report low patient satisfaction with their clinicians (AOR, 2.3 [95% CI, 1.1-4.7]; P = .03) (Table 2).

Table 2. Adjusted Multivariate Logistic Regression Analyses of the Association Between Mental Health Comorbidity Symptoms and Patient Satisfaction Among Adults With Psoriasis From the Medical Expenditure Panel Survey^a.

Independent variable	Low patient satisfaction as dependent variable
	Psychological distress symptoms		Depression symptoms
	AOR (95% CI)^b	P value	AOR (95% CI)^b	P value
Mental health symptom severity
No or mild	1 [Reference]	NA	1 [Reference]	NA
Moderate	2.8 (1.5-4.9)	.001	4.6 (2.1-10)	<.001
Severe	2.3 (1.1-4.7)	.03	1.8 (1.0-3.4)	.06
Age	0.97 (0.95-0.99)	.004	0.96 (0.95-0.98)	<.001
Sex
Male	1 [Reference]	NA	1 [Reference]	NA
Female	1.4 (0.6-3.0)	.45	1.4 (0.7-3.6)	.36
Race
White	1 [Reference]	NA	1 [Reference]	NA
Black	NA	.005	NA	.002
American Indian or Alaska Native	NA	NA	NA	NA
Asian, Native Hawaiian, or Pacific Islander	0.7 (0.2-2.1)	.49	0.6 (0.2-2.2)	.40
Multiple races	5.2 (1.8-15.0)	.003	4.0 (1.5-11)	.007
Ethnicity
Non-Hispanic	1 [Reference]	NA	1 [Reference]	NA
Hispanic	0.6 (0.2-1.7)	.32	0.6 (0.2-1.7)	.30
Marital status
Married	1 [Reference]	NA	1 [Reference]	NA
Widowed	4.3 (2.4-7.6)	<.001	4.3 (2.2-8.6)	<.001
Divorced	0.9 (0.2-3.3)	.86	0.8 (0.2-2.9)	.78
Separated	3.4 (1.4-8.3)	.007	4.0 (1.9-8.5)	.001
Never married	0.8 (0.3-2.1)	.58	0.7 (0.3-1.9)	.50
Employment status
Employed	1 [Reference]	NA	1 [Reference]	NA
Unemployed	0.6 (0.3-1.1)	.09	0.5 (0.2-1.0)	.06
Educational level
<High school	1 [Reference]	NA	1 [Reference]	NA
High school	0.2 (0.1-0.6)	.002	0.2 (0.1-0.4)	<.001
≥1 y College	0.2 (0.1-0.5)	<.001	0.2 (0.1-0.4)	<.001
Poverty level category
High income	1 [Reference]	NA	1 [Reference]	NA
Middle income	1.0 (0.4-2.9)	.97	1.2 (0.4-3.1)	.74
Low income	1.3 (0.8-2.3)	.32	1.6 (1.0-2.4)	.048
Near poor	1.2 (0.2-10.0)	.83	1.3 (0.1-12.0)	.81
Poor	3.1 (1.0-9.9)	.06	3.1 (1.1-9.3)	.04
Cognitive limitations
No	1 [Reference]	NA	1 [Reference]	NA
Yes	0.8 (0.3-2.2)	.63	0.8 (0.3-2.2)	.70
Social limitations
No	1 [Reference]	NA	1 [Reference]	NA
Yes	0.6 (0.2-1.4)	.22	0.4 (0.2-1.2)	.10
Patient and clinician language barrier
No	1 [Reference]	NA	1 [Reference]	NA
Yes	NA	NA	NA	NA
Charlson Comorbidity Index	1.4 (0.8-2.4)	.20	1.3 (0.9-1.9)	.19
Year
2004	1 [Reference]	NA	1 [Reference]	NA
2005	NA	NA	NA	NA
2006	14.5 (7.4-29.0)	<.001	19.7 (10.5-36.9)	<.001
2007	12.7 (7.0-23.0)	<.001	16.5 (7.5-36.3)	<.001
2008	10.8 (1.9-62.0)	.009	12.8 (2.0-80.9)	.007
2009	1.9 (1.1-3.4)	.03	2.4 (1.3-4.6)	.009
2010	1.9 (0.2-17.0)	.56	2.5 (0.3-23.5)	.43
2011	13.1 (3.8-45.0)	<.001	15 (4.9-46.6)	<.001
2012	NA	NA	NA	NA
2013	0.6 (0.2-1.6)	.32	0.8 (0.2-1.6)	.28
2014	NA	NA	NA	NA
2015	9.5 (3.0-29.0)	<.001	8.7 (2.7-29.0)	.001
2016	13 (5.7-31.0)	<.001	14.0 (5.7-33.0)	<.001
2017	18 (8.6-38.0)	<.001	21.0 (9.8-45)	<.001
2018	NA	NA	NA	NA
Constant	0.2 (0.02-2.0)	.16	0.4 (0.04-3.0)	.34

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Abbreviations: AOR, adjusted odds ratio; NA, not applicable.

^{^a}

The following covariates were excluded from logistic regression analyses owing to collinearity: black and American Indian or Alaska Native race; presence of a language barrier; and years 2005, 2014, and 2018. In addition, data from 2012 were excluded owing to limited sample size.

^{^b}

Expected odds that low patient satisfaction is reported.

Patient Health Questionnaire 2

Regarding depression, 79% had no or mild symptoms, 13% had moderate symptoms, and 8% had severe symptoms (Table 1). The mean patient satisfaction score was 14.3 (95% CI, 14.2-14.4) for patients with no or mild depression symptoms, 13.2 (95% CI, 12.9-13.6) for patients with moderate depression symptoms, and 13.0 (95% CI, 12.6-13.4) (P = .002) for patients with severe depression symptoms (Figure).

Unadjusted logistic regression found that, compared with patients with no or mild depression symptoms, patients with moderate depression symptoms were 3.8 times more likely to report low patient satisfaction with their clinician (OR, 3.8 [95% CI, 1.8-7.9]; P = .001), and patients with severe depression symptoms were 2.3 times more likely to report low patient satisfaction with their clinician (OR, 2.3 [95% CI, 1.2-4.2]; P = .009). Multivariate logistic regression adjusting for sociodemographic and clinical characteristics found that, compared with patients with no or mild depression symptoms, patients with moderate depression symptoms were 4.6 times more likely to report low patient satisfaction with their clinician (AOR, 4.6 [95% CI, 2.1-10.0]; P < .001) (Table 2).

Discussion

This study examined a critical gap in the association between the mental health of patients with psoriasis and their perception of the quality of patient-clinician interactions. Based on this nationally representative population of adults with psoriasis spanning 14 years, compared with patients with no mental health symptoms, patients with psychological distress and depressive symptoms are more likely to report lower satisfaction with their physicians.

Specifically, patients with moderate or severe psychological distress and patients with moderate depression symptoms were more likely to report low patient satisfaction with clinicians regardless of sociodemographic factors or comorbidities. Therefore, it is possible that patients’ mental health status may be associated with their perception of the quality of interactions with health care professionals. However, further research is necessary to confirm the directionality of the findings.

These findings are informative for the following reasons. Even if clinicians delivered consistent high-quality care, some patients may perceive such care to be inferior owing, at least in part, to their baseline mental health status. For example, a patient who has depressive symptoms at baseline is more likely than another patient without depressive symptoms to rate a clinician poorly. Prior research in other chronic diseases may provide a rationale for this observation.^55,56,57,58 In some patients, the “pervasiveness” of mental health illness, defined as a general negative outlook on life, may predispose them to be particularly sensitive to the suboptimal components of the patient-clinician interaction.⁵⁹ In addition, cognitive impairments associated with mental health illnesses can be associated with a patient’s ability to engage with the clinician or comprehend or recall information from the encounter.^60,61,62

Our findings corroborate and extend those from studies of other chronic diseases.^63,64 For example, for patients with chronic coronary disease, depressive symptoms were strongly associated with a negative perception of their clinicians.⁶⁴ Furthermore, patients with depressive symptoms are also more likely to report overall dissatisfaction with other aspects of health care delivery regardless of disease severity or comorbidities.^63,64,65,66

Recognizing the association between a patient’s baseline mental health status and a patient’s satisfaction is critical in caring for patients with psoriasis because one-third of patients with psoriasis present with symptoms of depression and anxiety.^67,68,69 Improving the patient experience among those with mental health comorbidities is important because increased patient satisfaction may be associated with greater treatment adherence and better health outcomes.^{2,16,17,18,19,20}

When caring for patients with mental health symptoms, dermatology clinicians may need to be more adaptive in their communication style.^20,70,71 Because depressed patients can be more sensitive to negative communication, the clinician needs to be more conscious about using a positive and supportive communication style. In addition, clinicians need to provide context when discussing the effectiveness and the potential adverse effects of treatment such that patients can evaluate the treatments accurately.

Furthermore, these study findings are especially relevant when we evaluate clinicians based on the results of patient satisfaction surveys. Patient surveys with small sample sizes, nonrandom sampling, or low response rates need to be interpreted with skepticism and caution. Also, comparing a clinician’s performance based solely on patient satisfaction is problematic because different physicians may treat different patient populations with varying baseline mental health status.

Limitations

This study has some limitations, and our findings need to be interpreted in the context of the study design. The MEPS database does not collect data on physicians’ perceptions of the quality of an encounter, thereby limiting a comparison of patient and clinician perceptions. In addition, the MEPS does not capture other factors that may be associated with the mental health status of patients with psoriasis and their satisfaction with their clinician, such as psoriasis disease severity and treatment responses. Because the MEPS methods enable the calculation of national estimates, the study findings are generalizable to patients with psoriasis in the United States. The findings are mostly, but not entirely, generalizable to dermatology clinicians in the United States because the MEPS does not specify whether clinicians caring for patients with psoriasis were dermatologists. However, based on other national studies, most psoriasis clinicians are dermatologists.^72,73

Conclusions

Our study found that psychological distress and depression symptoms were associated with lower patient satisfaction with clinicians among adults with psoriasis. A patient’s baseline mental health, at least in part, is associated with their perception of the health care professional. It is important for clinicians to be adaptable and supportive in their communication style in caring for these patients. It is also important to recognize that evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.

Supplement.

eTable 1. Comparison of Sociodemographic and Clinical Characteristics of Adults With Psoriasis Reporting Psychological Distress Symptoms With Complete vs Incomplete Data From the MEPS

eTable 2. Comparison of Sociodemographic and Clinical Characteristics of Adults With Psoriasis Reporting Depression Symptoms With Complete vs Incomplete Data From the MEPS

Click here for additional data file.^{(160.8KB, pdf)}

References

1.Augustin M, Eissing L, Elsner P, et al. Perception and image of dermatology in the German general population 2002-2014. J Eur Acad Dermatol Venereol. 2017;31(12):2124-2130. doi: 10.1111/jdv.14476 [DOI] [PubMed] [Google Scholar]
2.Poulos GA, Brodell RT, Mostow EN. Improving quality and patient satisfaction in dermatology office practice. Arch Dermatol. 2008;144(2):263-265. doi: 10.1001/archdermatol.2007.58 [DOI] [PubMed] [Google Scholar]
3.Camacho FT, Balkrishnan R, Khanna V, et al. How happy are dermatologists’ patients? a review of a study examining patients’ perceptions of dermatology practices. Dermatologist. 2013;21(4):38-42. [Google Scholar]
4.Richard MA, Joly P, Roy Geffroy B, Taïeb C. Public perception of dermatologists in France: results from a population-based national survey. J Eur Acad Dermatol Venereol. 2019;33(8):1610-1615. doi: 10.1111/jdv.15541 [DOI] [PubMed] [Google Scholar]
5.Coast J, Horrocks S. Developing attributes and levels for discrete choice experiments using qualitative methods. J Health Serv Res Policy. 2007;12(1):25-30. doi: 10.1258/135581907779497602 [DOI] [PubMed] [Google Scholar]
6.Noerreslet M, Jemec GBE, Traulsen JM. Involuntary autonomy: patients’ perceptions of physicians, conventional medicines and risks in the management of atopic dermatitis. Soc Sci Med. 2009;69(9):1409-1415. doi: 10.1016/j.socscimed.2009.08.036 [DOI] [PubMed] [Google Scholar]
7.Gibbons C, Singh S, Gibbons B, et al. Using qualitative methods to understand factors contributing to patient satisfaction among dermatology patients: a systematic review. J Dermatolog Treat. 2018;29(3):290-294. doi: 10.1080/09546634.2017.1364688 [DOI] [PubMed] [Google Scholar]
8.van Scheppingen C, Lettinga AT, Duipmans JC, Maathuis CGB, Jonkman MF. Main problems experienced by children with epidermolysis bullosa: a qualitative study with semi-structured interviews. Acta Derm Venereol. 2008;88(2):143-150. doi: 10.2340/00015555-0376 [DOI] [PubMed] [Google Scholar]
9.Magin PJ, Adams J, Heading GS, Pond CD. Patients with skin disease and their relationships with their doctors: a qualitative study of patients with acne, psoriasis and eczema. Med J Aust. 2009;190(2):62-64. doi: 10.5694/j.1326-5377.2009.tb02276.x [DOI] [PubMed] [Google Scholar]
10.Collins K, Walters S, Bowns I. Patient satisfaction with teledermatology: quantitative and qualitative results from a randomized controlled trial. J Telemed Telecare. 2004;10(1):29-33. doi: 10.1258/135763304322764167 [DOI] [PubMed] [Google Scholar]
11.Andreassen HK. What does an email address add?—doing health and technology at home. Soc Sci Med. 2011;72(4):521-528. doi: 10.1016/j.socscimed.2010.11.026 [DOI] [PubMed] [Google Scholar]
12.Ersser SJ, Surridge H, Wiles A. What criteria do patients use when judging the effectiveness of psoriasis management? J Eval Clin Pract. 2002;8(4):367-376. doi: 10.1046/j.1365-2753.2002.00372.x [DOI] [PubMed] [Google Scholar]
13.Nelson PA, Barker Z, Griffiths CE, Cordingley L, Chew-Graham CA; IMPACT Team . “On the surface”: a qualitative study of GPs’ and patients’ perspectives on psoriasis. BMC Fam Pract. 2013;14:158. doi: 10.1186/1471-2296-14-158 [DOI] [PMC free article] [PubMed] [Google Scholar]
14.Waernulf L, Moberg C, Henriksson EW, Evengard B, Nyberg F. Patients’ views on care and treatment after phototherapy for psoriasis and atopic eczema including a gender perspective. J Dermatolog Treat. 2008;19(4):233-240. doi: 10.1080/09546630801955127 [DOI] [PubMed] [Google Scholar]
15.Halldin CB, Gonzalez H, Wennberg AM, Lepp M. Patients’ experiences of pain and pain relief during photodynamic therapy on actinic keratoses: an interview study. Acta Derm Venereol. 2013;93(4):433-437. doi: 10.2340/00015555-1500 [DOI] [PubMed] [Google Scholar]
16.Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3)(suppl):S110-S127. doi: 10.1097/00005650-198903001-00010 [DOI] [PubMed] [Google Scholar]
17.Stelfox HT, Gandhi TK, Orav EJ, Gustafson ML. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118(10):1126-1133. doi: 10.1016/j.amjmed.2005.01.060 [DOI] [PubMed] [Google Scholar]
18.Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570. doi: 10.1136/bmjopen-2012-001570 [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Dubina MI, O’Neill JL, Feldman SR. Effect of patient satisfaction on outcomes of care. Expert Rev Pharmacoecon Outcomes Res. 2009;9(5):393-395. doi: 10.1586/erp.09.45 [DOI] [PubMed] [Google Scholar]
20.Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423-1433. [PMC free article] [PubMed] [Google Scholar]
21.Hayes J, Koo J. Psoriasis: depression, anxiety, smoking, and drinking habits. Dermatol Ther. 2010;23(2):174-180. doi: 10.1111/j.1529-8019.2010.01312.x [DOI] [PubMed] [Google Scholar]
22.Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010;146(8):891-895. doi: 10.1001/archdermatol.2010.186 [DOI] [PMC free article] [PubMed] [Google Scholar]
23.Liang SE, Cohen JM, Ho RS. Psoriasis and suicidality: a review of the literature. Dermatol Ther. 2019;32(1):e12771. doi: 10.1111/dth.12771 [DOI] [PubMed] [Google Scholar]
24.Cohen JW, Cohen SB, Banthin JS. The Medical Expenditure Panel Survey: a national information resource to support healthcare cost research and inform policy and practice. Med Care. 2009;47(7)(suppl 1):S44-S50. doi: 10.1097/MLR.0b013e3181a23e3a [DOI] [PubMed] [Google Scholar]
25.Fischer AH, Shin DB, Gelfand JM, Takeshita J. Health care utilization for psoriasis in the United States differs by race: an analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol. 2018;78(1):200-203. doi: 10.1016/j.jaad.2017.07.052 [DOI] [PMC free article] [PubMed] [Google Scholar]
26.Salame N, Ehsani-Chimeh N, Armstrong AW. Comparison of mental health outcomes among adults with psoriasis on biologic versus oral therapies: a population-based study. J Dermatolog Treat. 2019;30(2):135-140. doi: 10.1080/09546634.2018.1476654 [DOI] [PubMed] [Google Scholar]
27.McGee J, Kanouse DE, Sofaer S, Hargraves JL, Hoy E, Kleimann S; Consumer Assessment of Health Plans Study . Making survey results easy to report to consumers: how reporting needs guided survey design in CAHPS. Med Care. 1999;37(3)(suppl):MS32-MS40. doi: 10.1097/00005650-199903001-00004 [DOI] [PubMed] [Google Scholar]
28.Hargraves JL, Hays RD, Cleary PD. Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 adult core survey. Health Serv Res. 2003;38(6, pt 1):1509-1527. doi: 10.1111/j.1475-6773.2003.00190.x [DOI] [PMC free article] [PubMed] [Google Scholar]
29.Okunrintemi V, Spatz ES, Di Capua P, et al. Patient-provider communication and health outcomes among individuals with atherosclerotic cardiovascular disease in the United States: Medical Expenditure Panel Survey 2010 to 2013. Circ Cardiovasc Qual Outcomes. 2017;10(4):e003635. doi: 10.1161/CIRCOUTCOMES.117.003635 [DOI] [PubMed] [Google Scholar]
30.Rutten LJF, Augustson E, Wanke K. Factors associated with patients’ perceptions of health care providers’ communication behavior. J Health Commun. 2006;11(suppl 1):135-146. doi: 10.1080/10810730600639596 [DOI] [PubMed] [Google Scholar]
31.Ok H, Marks R, Allegrante JP. Perceptions of health care provider communication activity among American cancer survivors and adults without cancer histories: an analysis of the 2003 Health Information Trends Survey (HINTS) data. J Health Commun. 2008;13(7):637-653. doi: 10.1080/10810730802412172 [DOI] [PubMed] [Google Scholar]
32.Calo WA, Ortiz AP, Colon-Lopez V, Krasny S, Tortolero-Luna G. Factors associated with perceived patient-provider communication quality among Puerto Ricans. J Health Care Poor Underserved. 2014;25(2):491-502. doi: 10.1353/hpu.2014.0074 [DOI] [PMC free article] [PubMed] [Google Scholar]
33.Cerier E, Beal EW, Chakedis J, et al. Patient-provider relationships and health outcomes among hepatopancreatobiliary patients. J Surg Res. 2018;228:290-298. doi: 10.1016/j.jss.2018.03.026 [DOI] [PubMed] [Google Scholar]
34.Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184-189. doi: 10.1001/archpsyc.60.2.184 [DOI] [PubMed] [Google Scholar]
35.Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959-976. doi: 10.1017/S0033291702006074 [DOI] [PubMed] [Google Scholar]
36.Fleishman JA, Zuvekas SH. Global self-rated mental health: associations with other mental health measures and with role functioning. Med Care. 2007;45(7):602-609. doi: 10.1097/MLR.0b013e31803bb4b0 [DOI] [PubMed] [Google Scholar]
37.Prochaska JJ, Sung HY, Max W, Shi Y, Ong M. Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int J Methods Psychiatr Res. 2012;21(2):88-97. doi: 10.1002/mpr.1349 [DOI] [PMC free article] [PubMed] [Google Scholar]
38.Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58(2):163-171. doi: 10.1016/j.jpsychores.2004.09.006 [DOI] [PubMed] [Google Scholar]
39.Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284-1292. doi: 10.1097/01.MLR.0000093487.78664.3C [DOI] [PubMed] [Google Scholar]
40.Read C, Armstrong AW. Do mental health comorbidities influence patient satisfaction? a population study among U.S adults with psoriasis. J Invest Dermatol. 2019;139(5)(suppl):S36. doi: 10.1016/j.jid.2019.03.285 [DOI] [Google Scholar]
41.Dreger S, Buck C, Bolte G. Material, psychosocial and sociodemographic determinants are associated with positive mental health in Europe: a cross-sectional study. BMJ Open. 2014;4(5):e005095. doi: 10.1136/bmjopen-2014-005095 [DOI] [PMC free article] [PubMed] [Google Scholar]
42.Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. JAMA. 2002;288(12):1475-1483. doi: 10.1001/jama.288.12.1475 [DOI] [PubMed] [Google Scholar]
43.Tefft N. Mental health and employment: the SAD story. Econ Hum Biol. 2012;10(3):242-255. doi: 10.1016/j.ehb.2011.08.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
44.Meyer OL, Castro-Schilo L, Aguilar-Gaxiola S. Determinants of mental health and self-rated health: a model of socioeconomic status, neighborhood safety, and physical activity. Am J Public Health. 2014;104(9):1734-1741. doi: 10.2105/AJPH.2014.302003 [DOI] [PMC free article] [PubMed] [Google Scholar]
45.Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8-19. doi: 10.1001/archpsyc.1994.03950010008002 [DOI] [PubMed] [Google Scholar]
46.Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. The Free Press; 1991:17. [Google Scholar]
47.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383. doi: 10.1016/0021-9681(87)90171-8 [DOI] [PubMed] [Google Scholar]
48.D’Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the Charlson Comorbidity Index with administrative data bases. J Clin Epidemiol. 1996;49(12):1429-1433. doi: 10.1016/S0895-4356(96)00271-5 [DOI] [PubMed] [Google Scholar]
49.D’Hoore W, Sicotte C, Tilquin C. Risk adjustment in outcome assessment: the Charlson Comorbidity Index. Methods Inf Med. 1993;32(5):382-387. doi: 10.1055/s-0038-1634956 [DOI] [PubMed] [Google Scholar]
50.de Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity: a critical review of available methods. J Clin Epidemiol. 2003;56(3):221-229. doi: 10.1016/S0895-4356(02)00585-1 [DOI] [PubMed] [Google Scholar]
51.Okunrintemi V, Benson EA, Tibuakuu M, et al. Trends and costs associated with suboptimal physical activity among US women with cardiovascular disease. JAMA Netw Open. 2019;2(4):e191977. doi: 10.1001/jamanetworkopen.2019.1977 [DOI] [PMC free article] [PubMed] [Google Scholar]
52.Tripathi R, Knusel KD, Ezaldein HH, Honaker JS, Bordeaux JS, Scott JF. Incremental health care expenditure of chronic cutaneous ulcers in the United States. JAMA Dermatol. 2019;155(6):694-699. doi: 10.1001/jamadermatol.2018.5942 [DOI] [PMC free article] [PubMed] [Google Scholar]
53.Kulkarni AS, Balkrishnan R, Richmond D, Pearce DJ, Feldman SR. Medication-related factors affecting health care outcomes and costs for patients with psoriasis in the United States. J Am Acad Dermatol. 2005;52(1):27-31. doi: 10.1016/j.jaad.2004.08.004 [DOI] [PubMed] [Google Scholar]
54.Caulley L, Thavorn K, Rudmik L, Cameron C, Kilty SJ. Direct costs of adult chronic rhinosinusitis by using 4 methods of estimation: results of the US Medical Expenditure Panel Survey. J Allergy Clin Immunol. 2015;136(6):1517-1522. doi: 10.1016/j.jaci.2015.08.037 [DOI] [PubMed] [Google Scholar]
55.Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74(3):295-301. doi: 10.1016/j.pec.2008.11.015 [DOI] [PubMed] [Google Scholar]
56.Jackson JL. Communication about symptoms in primary care: impact on patient outcomes. J Altern Complement Med. 2005;11(suppl 1):S51-S56. doi: 10.1089/acm.2005.11.s-51 [DOI] [PubMed] [Google Scholar]
57.Epstein RM, Street RL Jr Patient-centered communication in cancer care: promoting healing and reducing suffering. National Cancer Institute; 2007. NIH Publication 07-6225. Accessed January 19, 2020. https://cancercontrol.cancer.gov/brp/docs/pcc_monograph.pdf
58.Arora NK. Interacting with cancer patients: the significance of physicians’ communication behavior. Soc Sci Med. 2003;57(5):791-806. doi: 10.1016/S0277-9536(02)00449-5 [DOI] [PubMed] [Google Scholar]
59.Roter D, Hall J. Doctors Talking With Patients/Patients Talking With Doctors: Improving Communication in Medical Visits. 2nd ed Praeger; 2006. [Google Scholar]
60.Tyng CM, Amin HU, Saad MNM, Malik AS. The influences of emotion on learning and memory. Front Psychol. 2017;8:1454. doi: 10.3389/fpsyg.2017.01454 [DOI] [PMC free article] [PubMed] [Google Scholar]
61.Kadam UT, Croft P, McLeod J, Hutchinson M. A qualitative study of patients’ views on anxiety and depression. Br J Gen Pract. 2001;51(466):375-380. [PMC free article] [PubMed] [Google Scholar]
62.Swenson SL, Rose M, Vittinghoff E, Stewart A, Schillinger D. The influence of depressive symptoms on clinician-patient communication among patients with type 2 diabetes. Med Care. 2008;46(3):257-265. doi: 10.1097/MLR.0b013e31816080e9 [DOI] [PubMed] [Google Scholar]
63.Ye J, Shim R. Perceptions of health care communication: examining the role of patients’ psychological distress. J Natl Med Assoc. 2010;102(12):1237-1242. doi: 10.1016/S0027-9684(15)30779-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
64.Schenker Y, Stewart A, Na B, Whooley MA. Depressive symptoms and perceived doctor-patient communication in the Heart and Soul Study. J Gen Intern Med. 2009;24(5):550-556. doi: 10.1007/s11606-009-0937-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
65.Tyser AR, Gaffney CJ, Zhang C, Presson AP. The association of patient satisfaction with pain, anxiety, and self-reported physical function. J Bone Joint Surg Am. 2018;100(21):1811-1818. doi: 10.2106/JBJS.17.00372 [DOI] [PMC free article] [PubMed] [Google Scholar]
66.Clignet F, Houtjes W, van Straten A, Cuijpers P, van Meijel B. Unmet care needs, care provision and patient satisfaction in patients with a late life depression: a cross-sectional study. Aging Ment Health. 2019;23(4):491-497. doi: 10.1080/13607863.2018.1426716 [DOI] [PubMed] [Google Scholar]
67.Dalgard FJ, Gieler U, Tomas-Aragones L, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135(4):984-991. doi: 10.1038/jid.2014.530 [DOI] [PMC free article] [PubMed] [Google Scholar]
68.Dowlatshahi EA, Wakkee M, Arends LR, Nijsten T. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J Invest Dermatol. 2014;134(6):1542-1551. doi: 10.1038/jid.2013.508 [DOI] [PubMed] [Google Scholar]
69.Fleming P, Bai JW, Pratt M, Sibbald C, Lynde C, Gulliver WP. The prevalence of anxiety in patients with psoriasis: a systematic review of observational studies and clinical trials. J Eur Acad Dermatol Venereol. 2017;31(5):798-807. doi: 10.1111/jdv.13891 [DOI] [PubMed] [Google Scholar]
70.Bultman DC, Svarstad BL. Effects of physician communication style on client medication beliefs and adherence with antidepressant treatment. Patient Educ Couns. 2000;40(2):173-185. doi: 10.1016/S0738-3991(99)00083-X [DOI] [PubMed] [Google Scholar]
71.Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43. doi: 10.1043/toj-09-0040.1 [DOI] [PMC free article] [PubMed] [Google Scholar]
72.Bhutani T, Wong JW, Bebo BF, Armstrong AW. Access to health care in patients with psoriasis and psoriatic arthritis: data from National Psoriasis Foundation survey panels. JAMA Dermatol. 2013;149(6):717-721. doi: 10.1001/jamadermatol.2013.133 [DOI] [PubMed] [Google Scholar]
73.Pearce DJ, Stealey KH, Balkrishnan R, Fleischer AB Jr, Feldman SR. Psoriasis treatment in the United States at the end of the 20th century. Int J Dermatol. 2006;45(4):370-374. doi: 10.1111/j.1365-4632.2006.02532.x [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement.

eTable 1. Comparison of Sociodemographic and Clinical Characteristics of Adults With Psoriasis Reporting Psychological Distress Symptoms With Complete vs Incomplete Data From the MEPS

eTable 2. Comparison of Sociodemographic and Clinical Characteristics of Adults With Psoriasis Reporting Depression Symptoms With Complete vs Incomplete Data From the MEPS

Click here for additional data file.^{(160.8KB, pdf)}

[doi200021r1] 1.Augustin M, Eissing L, Elsner P, et al. Perception and image of dermatology in the German general population 2002-2014. J Eur Acad Dermatol Venereol. 2017;31(12):2124-2130. doi: 10.1111/jdv.14476 [DOI] [PubMed] [Google Scholar]

[doi200021r2] 2.Poulos GA, Brodell RT, Mostow EN. Improving quality and patient satisfaction in dermatology office practice. Arch Dermatol. 2008;144(2):263-265. doi: 10.1001/archdermatol.2007.58 [DOI] [PubMed] [Google Scholar]

[doi200021r3] 3.Camacho FT, Balkrishnan R, Khanna V, et al. How happy are dermatologists’ patients? a review of a study examining patients’ perceptions of dermatology practices. Dermatologist. 2013;21(4):38-42. [Google Scholar]

[doi200021r4] 4.Richard MA, Joly P, Roy Geffroy B, Taïeb C. Public perception of dermatologists in France: results from a population-based national survey. J Eur Acad Dermatol Venereol. 2019;33(8):1610-1615. doi: 10.1111/jdv.15541 [DOI] [PubMed] [Google Scholar]

[doi200021r5] 5.Coast J, Horrocks S. Developing attributes and levels for discrete choice experiments using qualitative methods. J Health Serv Res Policy. 2007;12(1):25-30. doi: 10.1258/135581907779497602 [DOI] [PubMed] [Google Scholar]

[doi200021r6] 6.Noerreslet M, Jemec GBE, Traulsen JM. Involuntary autonomy: patients’ perceptions of physicians, conventional medicines and risks in the management of atopic dermatitis. Soc Sci Med. 2009;69(9):1409-1415. doi: 10.1016/j.socscimed.2009.08.036 [DOI] [PubMed] [Google Scholar]

[doi200021r7] 7.Gibbons C, Singh S, Gibbons B, et al. Using qualitative methods to understand factors contributing to patient satisfaction among dermatology patients: a systematic review. J Dermatolog Treat. 2018;29(3):290-294. doi: 10.1080/09546634.2017.1364688 [DOI] [PubMed] [Google Scholar]

[doi200021r8] 8.van Scheppingen C, Lettinga AT, Duipmans JC, Maathuis CGB, Jonkman MF. Main problems experienced by children with epidermolysis bullosa: a qualitative study with semi-structured interviews. Acta Derm Venereol. 2008;88(2):143-150. doi: 10.2340/00015555-0376 [DOI] [PubMed] [Google Scholar]

[doi200021r9] 9.Magin PJ, Adams J, Heading GS, Pond CD. Patients with skin disease and their relationships with their doctors: a qualitative study of patients with acne, psoriasis and eczema. Med J Aust. 2009;190(2):62-64. doi: 10.5694/j.1326-5377.2009.tb02276.x [DOI] [PubMed] [Google Scholar]

[doi200021r10] 10.Collins K, Walters S, Bowns I. Patient satisfaction with teledermatology: quantitative and qualitative results from a randomized controlled trial. J Telemed Telecare. 2004;10(1):29-33. doi: 10.1258/135763304322764167 [DOI] [PubMed] [Google Scholar]

[doi200021r11] 11.Andreassen HK. What does an email address add?—doing health and technology at home. Soc Sci Med. 2011;72(4):521-528. doi: 10.1016/j.socscimed.2010.11.026 [DOI] [PubMed] [Google Scholar]

[doi200021r12] 12.Ersser SJ, Surridge H, Wiles A. What criteria do patients use when judging the effectiveness of psoriasis management? J Eval Clin Pract. 2002;8(4):367-376. doi: 10.1046/j.1365-2753.2002.00372.x [DOI] [PubMed] [Google Scholar]

[doi200021r13] 13.Nelson PA, Barker Z, Griffiths CE, Cordingley L, Chew-Graham CA; IMPACT Team . “On the surface”: a qualitative study of GPs’ and patients’ perspectives on psoriasis. BMC Fam Pract. 2013;14:158. doi: 10.1186/1471-2296-14-158 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r14] 14.Waernulf L, Moberg C, Henriksson EW, Evengard B, Nyberg F. Patients’ views on care and treatment after phototherapy for psoriasis and atopic eczema including a gender perspective. J Dermatolog Treat. 2008;19(4):233-240. doi: 10.1080/09546630801955127 [DOI] [PubMed] [Google Scholar]

[doi200021r15] 15.Halldin CB, Gonzalez H, Wennberg AM, Lepp M. Patients’ experiences of pain and pain relief during photodynamic therapy on actinic keratoses: an interview study. Acta Derm Venereol. 2013;93(4):433-437. doi: 10.2340/00015555-1500 [DOI] [PubMed] [Google Scholar]

[doi200021r16] 16.Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3)(suppl):S110-S127. doi: 10.1097/00005650-198903001-00010 [DOI] [PubMed] [Google Scholar]

[doi200021r17] 17.Stelfox HT, Gandhi TK, Orav EJ, Gustafson ML. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118(10):1126-1133. doi: 10.1016/j.amjmed.2005.01.060 [DOI] [PubMed] [Google Scholar]

[doi200021r18] 18.Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570. doi: 10.1136/bmjopen-2012-001570 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r19] 19.Dubina MI, O’Neill JL, Feldman SR. Effect of patient satisfaction on outcomes of care. Expert Rev Pharmacoecon Outcomes Res. 2009;9(5):393-395. doi: 10.1586/erp.09.45 [DOI] [PubMed] [Google Scholar]

[doi200021r20] 20.Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423-1433. [PMC free article] [PubMed] [Google Scholar]

[doi200021r21] 21.Hayes J, Koo J. Psoriasis: depression, anxiety, smoking, and drinking habits. Dermatol Ther. 2010;23(2):174-180. doi: 10.1111/j.1529-8019.2010.01312.x [DOI] [PubMed] [Google Scholar]

[doi200021r22] 22.Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010;146(8):891-895. doi: 10.1001/archdermatol.2010.186 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r23] 23.Liang SE, Cohen JM, Ho RS. Psoriasis and suicidality: a review of the literature. Dermatol Ther. 2019;32(1):e12771. doi: 10.1111/dth.12771 [DOI] [PubMed] [Google Scholar]

[doi200021r24] 24.Cohen JW, Cohen SB, Banthin JS. The Medical Expenditure Panel Survey: a national information resource to support healthcare cost research and inform policy and practice. Med Care. 2009;47(7)(suppl 1):S44-S50. doi: 10.1097/MLR.0b013e3181a23e3a [DOI] [PubMed] [Google Scholar]

[doi200021r25] 25.Fischer AH, Shin DB, Gelfand JM, Takeshita J. Health care utilization for psoriasis in the United States differs by race: an analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol. 2018;78(1):200-203. doi: 10.1016/j.jaad.2017.07.052 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r26] 26.Salame N, Ehsani-Chimeh N, Armstrong AW. Comparison of mental health outcomes among adults with psoriasis on biologic versus oral therapies: a population-based study. J Dermatolog Treat. 2019;30(2):135-140. doi: 10.1080/09546634.2018.1476654 [DOI] [PubMed] [Google Scholar]

[doi200021r27] 27.McGee J, Kanouse DE, Sofaer S, Hargraves JL, Hoy E, Kleimann S; Consumer Assessment of Health Plans Study . Making survey results easy to report to consumers: how reporting needs guided survey design in CAHPS. Med Care. 1999;37(3)(suppl):MS32-MS40. doi: 10.1097/00005650-199903001-00004 [DOI] [PubMed] [Google Scholar]

[doi200021r28] 28.Hargraves JL, Hays RD, Cleary PD. Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 adult core survey. Health Serv Res. 2003;38(6, pt 1):1509-1527. doi: 10.1111/j.1475-6773.2003.00190.x [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r29] 29.Okunrintemi V, Spatz ES, Di Capua P, et al. Patient-provider communication and health outcomes among individuals with atherosclerotic cardiovascular disease in the United States: Medical Expenditure Panel Survey 2010 to 2013. Circ Cardiovasc Qual Outcomes. 2017;10(4):e003635. doi: 10.1161/CIRCOUTCOMES.117.003635 [DOI] [PubMed] [Google Scholar]

[doi200021r30] 30.Rutten LJF, Augustson E, Wanke K. Factors associated with patients’ perceptions of health care providers’ communication behavior. J Health Commun. 2006;11(suppl 1):135-146. doi: 10.1080/10810730600639596 [DOI] [PubMed] [Google Scholar]

[doi200021r31] 31.Ok H, Marks R, Allegrante JP. Perceptions of health care provider communication activity among American cancer survivors and adults without cancer histories: an analysis of the 2003 Health Information Trends Survey (HINTS) data. J Health Commun. 2008;13(7):637-653. doi: 10.1080/10810730802412172 [DOI] [PubMed] [Google Scholar]

[doi200021r32] 32.Calo WA, Ortiz AP, Colon-Lopez V, Krasny S, Tortolero-Luna G. Factors associated with perceived patient-provider communication quality among Puerto Ricans. J Health Care Poor Underserved. 2014;25(2):491-502. doi: 10.1353/hpu.2014.0074 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r33] 33.Cerier E, Beal EW, Chakedis J, et al. Patient-provider relationships and health outcomes among hepatopancreatobiliary patients. J Surg Res. 2018;228:290-298. doi: 10.1016/j.jss.2018.03.026 [DOI] [PubMed] [Google Scholar]

[doi200021r34] 34.Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184-189. doi: 10.1001/archpsyc.60.2.184 [DOI] [PubMed] [Google Scholar]

[doi200021r35] 35.Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959-976. doi: 10.1017/S0033291702006074 [DOI] [PubMed] [Google Scholar]

[doi200021r36] 36.Fleishman JA, Zuvekas SH. Global self-rated mental health: associations with other mental health measures and with role functioning. Med Care. 2007;45(7):602-609. doi: 10.1097/MLR.0b013e31803bb4b0 [DOI] [PubMed] [Google Scholar]

[doi200021r37] 37.Prochaska JJ, Sung HY, Max W, Shi Y, Ong M. Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int J Methods Psychiatr Res. 2012;21(2):88-97. doi: 10.1002/mpr.1349 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r38] 38.Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58(2):163-171. doi: 10.1016/j.jpsychores.2004.09.006 [DOI] [PubMed] [Google Scholar]

[doi200021r39] 39.Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284-1292. doi: 10.1097/01.MLR.0000093487.78664.3C [DOI] [PubMed] [Google Scholar]

[doi200021r40] 40.Read C, Armstrong AW. Do mental health comorbidities influence patient satisfaction? a population study among U.S adults with psoriasis. J Invest Dermatol. 2019;139(5)(suppl):S36. doi: 10.1016/j.jid.2019.03.285 [DOI] [Google Scholar]

[doi200021r41] 41.Dreger S, Buck C, Bolte G. Material, psychosocial and sociodemographic determinants are associated with positive mental health in Europe: a cross-sectional study. BMJ Open. 2014;4(5):e005095. doi: 10.1136/bmjopen-2014-005095 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r42] 42.Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. JAMA. 2002;288(12):1475-1483. doi: 10.1001/jama.288.12.1475 [DOI] [PubMed] [Google Scholar]

[doi200021r43] 43.Tefft N. Mental health and employment: the SAD story. Econ Hum Biol. 2012;10(3):242-255. doi: 10.1016/j.ehb.2011.08.006 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r44] 44.Meyer OL, Castro-Schilo L, Aguilar-Gaxiola S. Determinants of mental health and self-rated health: a model of socioeconomic status, neighborhood safety, and physical activity. Am J Public Health. 2014;104(9):1734-1741. doi: 10.2105/AJPH.2014.302003 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r45] 45.Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8-19. doi: 10.1001/archpsyc.1994.03950010008002 [DOI] [PubMed] [Google Scholar]

[doi200021r46] 46.Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. The Free Press; 1991:17. [Google Scholar]

[doi200021r47] 47.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383. doi: 10.1016/0021-9681(87)90171-8 [DOI] [PubMed] [Google Scholar]

[doi200021r48] 48.D’Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the Charlson Comorbidity Index with administrative data bases. J Clin Epidemiol. 1996;49(12):1429-1433. doi: 10.1016/S0895-4356(96)00271-5 [DOI] [PubMed] [Google Scholar]

[doi200021r49] 49.D’Hoore W, Sicotte C, Tilquin C. Risk adjustment in outcome assessment: the Charlson Comorbidity Index. Methods Inf Med. 1993;32(5):382-387. doi: 10.1055/s-0038-1634956 [DOI] [PubMed] [Google Scholar]

[doi200021r50] 50.de Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity: a critical review of available methods. J Clin Epidemiol. 2003;56(3):221-229. doi: 10.1016/S0895-4356(02)00585-1 [DOI] [PubMed] [Google Scholar]

[doi200021r51] 51.Okunrintemi V, Benson EA, Tibuakuu M, et al. Trends and costs associated with suboptimal physical activity among US women with cardiovascular disease. JAMA Netw Open. 2019;2(4):e191977. doi: 10.1001/jamanetworkopen.2019.1977 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r52] 52.Tripathi R, Knusel KD, Ezaldein HH, Honaker JS, Bordeaux JS, Scott JF. Incremental health care expenditure of chronic cutaneous ulcers in the United States. JAMA Dermatol. 2019;155(6):694-699. doi: 10.1001/jamadermatol.2018.5942 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r53] 53.Kulkarni AS, Balkrishnan R, Richmond D, Pearce DJ, Feldman SR. Medication-related factors affecting health care outcomes and costs for patients with psoriasis in the United States. J Am Acad Dermatol. 2005;52(1):27-31. doi: 10.1016/j.jaad.2004.08.004 [DOI] [PubMed] [Google Scholar]

[doi200021r54] 54.Caulley L, Thavorn K, Rudmik L, Cameron C, Kilty SJ. Direct costs of adult chronic rhinosinusitis by using 4 methods of estimation: results of the US Medical Expenditure Panel Survey. J Allergy Clin Immunol. 2015;136(6):1517-1522. doi: 10.1016/j.jaci.2015.08.037 [DOI] [PubMed] [Google Scholar]

[doi200021r55] 55.Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74(3):295-301. doi: 10.1016/j.pec.2008.11.015 [DOI] [PubMed] [Google Scholar]

[doi200021r56] 56.Jackson JL. Communication about symptoms in primary care: impact on patient outcomes. J Altern Complement Med. 2005;11(suppl 1):S51-S56. doi: 10.1089/acm.2005.11.s-51 [DOI] [PubMed] [Google Scholar]

[doi200021r57] 57.Epstein RM, Street RL Jr Patient-centered communication in cancer care: promoting healing and reducing suffering. National Cancer Institute; 2007. NIH Publication 07-6225. Accessed January 19, 2020. https://cancercontrol.cancer.gov/brp/docs/pcc_monograph.pdf

[doi200021r58] 58.Arora NK. Interacting with cancer patients: the significance of physicians’ communication behavior. Soc Sci Med. 2003;57(5):791-806. doi: 10.1016/S0277-9536(02)00449-5 [DOI] [PubMed] [Google Scholar]

[doi200021r59] 59.Roter D, Hall J. Doctors Talking With Patients/Patients Talking With Doctors: Improving Communication in Medical Visits. 2nd ed Praeger; 2006. [Google Scholar]

[doi200021r60] 60.Tyng CM, Amin HU, Saad MNM, Malik AS. The influences of emotion on learning and memory. Front Psychol. 2017;8:1454. doi: 10.3389/fpsyg.2017.01454 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r61] 61.Kadam UT, Croft P, McLeod J, Hutchinson M. A qualitative study of patients’ views on anxiety and depression. Br J Gen Pract. 2001;51(466):375-380. [PMC free article] [PubMed] [Google Scholar]

[doi200021r62] 62.Swenson SL, Rose M, Vittinghoff E, Stewart A, Schillinger D. The influence of depressive symptoms on clinician-patient communication among patients with type 2 diabetes. Med Care. 2008;46(3):257-265. doi: 10.1097/MLR.0b013e31816080e9 [DOI] [PubMed] [Google Scholar]

[doi200021r63] 63.Ye J, Shim R. Perceptions of health care communication: examining the role of patients’ psychological distress. J Natl Med Assoc. 2010;102(12):1237-1242. doi: 10.1016/S0027-9684(15)30779-3 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r64] 64.Schenker Y, Stewart A, Na B, Whooley MA. Depressive symptoms and perceived doctor-patient communication in the Heart and Soul Study. J Gen Intern Med. 2009;24(5):550-556. doi: 10.1007/s11606-009-0937-5 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r65] 65.Tyser AR, Gaffney CJ, Zhang C, Presson AP. The association of patient satisfaction with pain, anxiety, and self-reported physical function. J Bone Joint Surg Am. 2018;100(21):1811-1818. doi: 10.2106/JBJS.17.00372 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r66] 66.Clignet F, Houtjes W, van Straten A, Cuijpers P, van Meijel B. Unmet care needs, care provision and patient satisfaction in patients with a late life depression: a cross-sectional study. Aging Ment Health. 2019;23(4):491-497. doi: 10.1080/13607863.2018.1426716 [DOI] [PubMed] [Google Scholar]

[doi200021r67] 67.Dalgard FJ, Gieler U, Tomas-Aragones L, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135(4):984-991. doi: 10.1038/jid.2014.530 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r68] 68.Dowlatshahi EA, Wakkee M, Arends LR, Nijsten T. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J Invest Dermatol. 2014;134(6):1542-1551. doi: 10.1038/jid.2013.508 [DOI] [PubMed] [Google Scholar]

[doi200021r69] 69.Fleming P, Bai JW, Pratt M, Sibbald C, Lynde C, Gulliver WP. The prevalence of anxiety in patients with psoriasis: a systematic review of observational studies and clinical trials. J Eur Acad Dermatol Venereol. 2017;31(5):798-807. doi: 10.1111/jdv.13891 [DOI] [PubMed] [Google Scholar]

[doi200021r70] 70.Bultman DC, Svarstad BL. Effects of physician communication style on client medication beliefs and adherence with antidepressant treatment. Patient Educ Couns. 2000;40(2):173-185. doi: 10.1016/S0738-3991(99)00083-X [DOI] [PubMed] [Google Scholar]

[doi200021r71] 71.Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43. doi: 10.1043/toj-09-0040.1 [DOI] [PMC free article] [PubMed] [Google Scholar]

[doi200021r72] 72.Bhutani T, Wong JW, Bebo BF, Armstrong AW. Access to health care in patients with psoriasis and psoriatic arthritis: data from National Psoriasis Foundation survey panels. JAMA Dermatol. 2013;149(6):717-721. doi: 10.1001/jamadermatol.2013.133 [DOI] [PubMed] [Google Scholar]

[doi200021r73] 73.Pearce DJ, Stealey KH, Balkrishnan R, Fleischer AB Jr, Feldman SR. Psoriasis treatment in the United States at the end of the 20th century. Int J Dermatol. 2006;45(4):370-374. doi: 10.1111/j.1365-4632.2006.02532.x [DOI] [PubMed] [Google Scholar]

PERMALINK

Association Between the Mental Health of Patients With Psoriasis and Their Satisfaction With Physicians

Charlotte Read, MBBS, BSc

April W Armstrong, MD, MPH

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Design, Setting, and Participants

Main Outcomes and Measures

Results

Conclusions and Relevance

Introduction

Methods

Data Source and Study Population

Variables

Dependent Variable (Patient Satisfaction)

Independent Variable (Mental Health Comorbidities)

Covariates

Statistical Analysis

Results

Study Population Characteristics

Kessler 6-Item Psychological Distress Scale

Table 1. Sociodemographic and Clinical Characteristics of US Adult Patients With Psoriasis by Severity of Mental Health Symptoms From the Medical Expenditure Panel Survey.

Figure. Patient Satisfaction Among Adults With Psoriasis by Severity of Mental Health Symptoms From the Medical Expenditure Panel Survey.

Table 2. Adjusted Multivariate Logistic Regression Analyses of the Association Between Mental Health Comorbidity Symptoms and Patient Satisfaction Among Adults With Psoriasis From the Medical Expenditure Panel Surveya.

Patient Health Questionnaire 2

Discussion

Limitations

Conclusions

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

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Links to NCBI Databases

Table 2. Adjusted Multivariate Logistic Regression Analyses of the Association Between Mental Health Comorbidity Symptoms and Patient Satisfaction Among Adults With Psoriasis From the Medical Expenditure Panel Survey^a.