Association of Psoriasis With Mental Health Disorders in South Korea | Dermatology | JAMA Dermatology | JAMA Network
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Table 1.  Three-Year Risk of Mental Disorder in Patients With Psoriasis
Three-Year Risk of Mental Disorder in Patients With Psoriasis
Table 2.  Risk and Time to Onset of Mental Health Disorders in 12 762 Men and Women With Psoriasis
Risk and Time to Onset of Mental Health Disorders in 12 762 Men and Women With Psoriasis
1.
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.2013.508PubMedGoogle ScholarCrossref
2.
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.2014.530PubMedGoogle ScholarCrossref
3.
Gupta  MA, Simpson  FC, Gupta  AK.  Psoriasis and sleep disorders: a systematic review.  Sleep Med Rev. 2016;29:63-75. doi:10.1016/j.smrv.2015.09.003PubMedGoogle ScholarCrossref
4.
Vieira  MM, Ferreira  TB, Pacheco  PA,  et al.  Enhanced Th17 phenotype in individuals with generalized anxiety disorder.  J Neuroimmunol. 2010;229(1-2):212-218. doi:10.1016/j.jneuroim.2010.07.018PubMedGoogle ScholarCrossref
5.
Liu  Y, Ho  RC, Mak  A.  The role of interleukin (IL)-17 in anxiety and depression of patients with rheumatoid arthritis.  Int J Rheum Dis. 2012;15(2):183-187. doi:10.1111/j.1756-185X.2011.01673.xPubMedGoogle ScholarCrossref
6.
Krueger  JG, Brunner  PM.  Interleukin-17 alters the biology of many cell types involved in the genesis of psoriasis, systemic inflammation and associated comorbidities.  Exp Dermatol. 2018;27(2):115-123. doi:10.1111/exd.13467PubMedGoogle ScholarCrossref
Research Letter
May 8, 2019

Association of Psoriasis With Mental Health Disorders in South Korea

Author Affiliations
  • 1College of Medicine, Department of Dermatology, Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
  • 2Department of Business Management, Kwangwoon University, Seoul, South Korea
JAMA Dermatol. 2019;155(6):747-749. doi:10.1001/jamadermatol.2019.0315

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.1-3 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).

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.

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.1-3 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.4-6 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.

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Article Information

Accepted for Publication: February 14, 2019.

Corresponding Author: Ji Hyun Lee, MD, PhD, College of Medicine, Department of Dermatology, Seoul St Mary’s Hospital, The Catholic University of Korea, 222, Sechogu, Banpodaero, Seoul 06591, South Korea (ejee@catholic.ac.kr).

Published Online: May 8, 2019. doi:10.1001/jamadermatol.2019.0315

Author Contributions: Drs Chul Hwan Bang and Jae Woong Yoon contributed equally to this work as co–first authors. Drs Ji Hyun Lee and Suk Jun Lee contributed equally to this work as co–corresponding authors. Dr Suk Jun Lee had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Bang, Han, J. Lee.

Acquisition, analysis, or interpretation of data: Bang, Yoon, Chun, Han, Park, S. Lee.

Drafting of the manuscript: Bang, Han, J. Lee.

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

Statistical analysis: Bang, Yoon, Chun, Han, Park, S. Lee.

Administrative, technical, or material support: Han, Park, S. Lee, J. Lee.

Study supervision: Han, Park, S. Lee, J. Lee.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by a National Research Foundation of Korea grant funded by the Korean government (MSIP [Nos. NRF-2015R1C1A2A01054767 and 2018R1D1A1B07044100] and MSIT [No. 2018R1A2B6007954]). And the present research was also funded the Research Grant of Kwangwoon University in 2018.

Role of the Funder/Sponsor: The funders 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.

References
1.
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.2013.508PubMedGoogle ScholarCrossref
2.
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.2014.530PubMedGoogle ScholarCrossref
3.
Gupta  MA, Simpson  FC, Gupta  AK.  Psoriasis and sleep disorders: a systematic review.  Sleep Med Rev. 2016;29:63-75. doi:10.1016/j.smrv.2015.09.003PubMedGoogle ScholarCrossref
4.
Vieira  MM, Ferreira  TB, Pacheco  PA,  et al.  Enhanced Th17 phenotype in individuals with generalized anxiety disorder.  J Neuroimmunol. 2010;229(1-2):212-218. doi:10.1016/j.jneuroim.2010.07.018PubMedGoogle ScholarCrossref
5.
Liu  Y, Ho  RC, Mak  A.  The role of interleukin (IL)-17 in anxiety and depression of patients with rheumatoid arthritis.  Int J Rheum Dis. 2012;15(2):183-187. doi:10.1111/j.1756-185X.2011.01673.xPubMedGoogle ScholarCrossref
6.
Krueger  JG, Brunner  PM.  Interleukin-17 alters the biology of many cell types involved in the genesis of psoriasis, systemic inflammation and associated comorbidities.  Exp Dermatol. 2018;27(2):115-123. doi:10.1111/exd.13467PubMedGoogle ScholarCrossref
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