Is a patient’s mental health status associated with discordance between patient and physician assessments of psoriasis severity?
In this cohort study of 502 patients with psoriasis, analysis of repeated cross-sectional data from a tertiary psoriasis service in London found discordance in patient and physician psoriasis severity ratings at 39% of the appointments. Twenty-six percent of the patients underestimated their psoriasis severity, and 13% of patients overestimated their psoriasis severity, compared with physician ratings.
Although patient assessments of disease severity remain important for informing appropriate treatment decisions, the data from this study suggest that recognition of anxiety and depression among individuals with psoriasis is important for interpretation of the assessments.
The emerging paradigm of treat-to-target in psoriasis requires accurate monitoring of treatment response. The commonly used physician global assessment tool does not capture the patient’s perception of their disease. Patient assessments facilitate shared decision-making and foster patient-centered care; however, recent research reports a discordance between patient- and physician-reported psoriasis severity. Understanding the factors underlying this discordance may improve treatment satisfaction and disease outcomes.
To evaluate the discordance between patient- and physician-reported measures of psoriasis severity and assess the association with patient mental health status.
Design, Setting, and Participants
A cohort study using repeated cross-sectional analysis of real-world longitudinal data was conducted at a large specialist psoriasis service serving London and Southeast England. A total of 502 patients attending the psoriasis service between May 12, 2016, and November 1, 2018, were included. Data analysis was conducted July 22 to October 22, 2019.
Main Outcomes and Measures
Psoriasis severity was assessed on each visit with identical 5-point physician and patient global assessment scales (clear/nearly clear, mild, moderate, severe, and very severe). Each patient completed validated self-report screens for depression and anxiety on each visit.
Longitudinal data from 502 individuals with psoriasis (1985 total observations) were available. A total of 339 patients (68%) were men, 396 (79%) were White, mean (SD) age was 47 (13) years, and 197 patients (39%) had concurrent psoriatic arthritis, 43 (9%) screened positive for depression, and 49 (10%) screened positive for anxiety. There was discordance between physician and patient measures of disease severity in 768 of 1985 office appointments (39%); on 511 visits (26%) patients rated their psoriasis as less severe and on 257 visits (13%) patients rated their psoriasis as more severe compared with their physician. Individuals who screened positive for depression or anxiety were more likely to overestimate their psoriasis severity compared with their physician (relative risk ratio: depression, 2.7; 95% CI, 1.6-4.5; anxiety, 2.1; 95% CI, 1.3-3.4). These findings remained statistically significant after adjustment for age, ethnicity, sex, body mass index, smoking, number of comorbidities, treatment modality, and presence of psoriatic arthritis.
Conclusions and Relevance
The findings of this cohort study suggest that discordance between patient and physician assessments of psoriasis severity is associated with patients’ mental health status. Recognition of anxiety and depression in individuals with psoriasis appears to be important when interpreting patient-reported outcome measures and informing appropriate treatment decisions.
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Carr E, Mahil SK, Brailean A, et al. Association of Patient Mental Health Status With the Level of Agreement Between Patient and Physician Ratings of Psoriasis Severity. JAMA Dermatol. 2021;157(4):413–420. doi:10.1001/jamadermatol.2020.5844
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