Individuals with psoriatic arthritis (a form of psoriasis characterized by chronic inflammation of joints, tendons, and ligaments) have higher rates of depression than those with non-arthritic psoriasis (a skin disease that causes red, itchy patches), according to a report in the Journal of Consultation-Liaison Psychiatry. Although there was no significant difference in suicidal thinking between psoriasis patients with and without arthritis, all psoriasis patients reported higher rates of suicidality than the general population.
“We recommend routine depression screening among psoriasis patients, in particular when psoriatic arthritis is present, as well as suicidality monitoring,” wrote Georgia Lada and Elise Kleyn, Ph.D., both of the University of Manchester, United Kingdom, and colleagues.
They conducted a survey of 219 adults aged 18 to 65 who were attending specialist psoriasis and psoriatic arthritis clinics in Greater Manchester in the United Kingdom. Adults were included in the analysis if they had a dermatologist-confirmed diagnosis of chronic plaque psoriasis and/or if they had a rheumatologist-confirmed diagnosis psoriatic arthritis. Of the 219 psoriasis patients, 84 had psoriatic arthritis.
Participants completed several self-report questionnaires—including the Hospital Anxiety and Depression Scale (HADS) and the Snaith-Hamilton Pleasure Scale (assesses ability to experience pleasure)—and answered questions about their medical and psychiatric history. Patients with psoriatic arthritis also completed the Psoriatic Arthritis Impact of Disease Questionnaire.
Even when adjusting for other medical problems, those with psoriatic arthritis were 2.92 times more likely to have depression than those with non-arthritic psoriasis, as defined by a score of 8 or higher on the HADS. “[Psoriatic arthritis] patients also had significantly lower hedonic tone and higher anxiety, after controlling for presence of psychiatric disorder,” the authors wrote.
There was no significant difference between patients with psoriatic arthritis and those with psoriasis only in terms of reported lifetime suicidal ideation (52.5% vs 46.6%), although the authors noted that both of those rates were higher than those of the general population. The prevalence of past-week suicidal ideation was higher in patients with psoriatic arthritis than those with psoriasis only (22.5% vs 13.4%).
“Suicidality monitoring and identification of risk factors in psoriasis patients is critical to tackle this major, yet preventable, public health issue,” the researchers wrote. “Future studies should aim to identify risk and protective factors for suicidality as well as inflammatory and neurobiological correlates of depression among patients with psoriasis and psoriatic arthritis.”
For related information, see the Psychiatric News article “Psychiatrists Work to Tease Apart Psychosomatic Aspects of Skin Disease.”
(Image: iStock/AsiaVision)
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