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Original Investigation
May 6, 2020

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

Author Affiliations
  • 1Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
  • 2Department of Medicine, Imperial College London, London, United Kingdom
JAMA Dermatol. Published online May 6, 2020. doi:10.1001/jamadermatol.2020.1054
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.

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