Heightened Depressive, Anxiety Burden Found in Patients With Comorbid Psoriasis and PsA

Presence of psoriatic arthritis (PsA) in patients with psoriasis may increase the risk of depression, anxiety, and other behavioral health issues, according to study findings published this week in the Journal of the Academy of Consultation-Liaison Psychiatry.

Although a heightened risk of depression and adverse behavioral health symptoms has been established among patients with psoriasis, researchers noted that the association is not clearly understood. Moreover, the impact of comorbidities such as PsA, which affects up to one-third of patients with psoriasis, may also further exacerbate these adverse risks.

“Given the detrimental effects of depression on psoriasis course, and the fact that depression often remains unrecognized in patients, it is important to identify populations likely to be affected and investigate symptoms associated with psychiatric morbidity and mortality to optimize quality of life,” said the study authors. “Combined skin and joint symptoms can contribute to significant functional impairment. Therefore, it is plausible that progression to PsA is associated with higher depressive burden.”

Seeking to explore whether PsA is associated with depression and other behavioral health symptoms, including lifetime suicidal ideation, anxiety, and anhedonia, they conducted a cross-sectional survey of tertiary patients aged 18-65 years with dermatologist-confirmed chronic plaque psoriasis (n = 219). Of the study cohort, 84 had rheumatologist-confirmed PsA.

Participants were additionally examined on whether suicidality and depressive symptom severity was associated with clinical markers of psoriasis severity and chronicity. The Hospital Anxiety and Depression Scale (HADS) and Sheehan-Suicidality Tracking Scale were used to assess depression and lifetime suicidality, respectively.

Using a HADS-Depression subscale score of 8 or greater to define depression cases, a significant association between PsA and depression was identified among patients with psoriasis after adjusting for other physical comorbidities (adjusted odds ratio [OR], 2.92; 95% confidence interval [CI], 1.53-5.68).

Significantly higher levels of anhedonia and anxiety were also reported among patients with comorbid psoriasis and PsA after controlling for psychiatric history.

Regarding suicidal risk, nearly half (48.8%) of all participants reported lifetime suicidal ideation with or without intent, in which 21.3% reported suicidal planning and 9.4% suicide attempts. No significant difference was observed between patients with and without PsA for lifetime suicidality prevalence (52.5% vs 46.6%).

Depressive symptom severity and lifetime suicidality scores were not found to be associated with objective measures of psoriasis severity or treatment group.

“There is a need for routine depression screening among patients with psoriasis, in particular when PsA is present,” concluded researchers. “Suicidality monitoring is recommended to help in reducing future psychiatric morbidity and mortality in patients with psoriasis.”

Reference

Lada G, Chinoy H, Heal C, Warren RB, Talbot PS, and Kleyn CE. Depression and suicidality in patients with psoriasis and the role of psoriatic arthritis; a cross-sectional study in a tertiary setting. J Acad Consult Liaison Psychiatry. Published online January 10, 2022. doi:10.1016/j.jaclp.2021.12.007