The Risk of Depression, Anxiety, and Suicidality in Patients With Psoriasis: A Population-Based Cohort Study | Anxiety Disorders | JAMA Dermatology | JAMA Network
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1.
Kurd  SKGelfand  JM The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003-2004.  J Am Acad Dermatol 2009;60 (2) 218- 224PubMedGoogle ScholarCrossref
2.
Gelfand  JMNeimann  ALShin  DBWang  XMargolis  DJTroxel  AB Risk of myocardial infarction in patients with psoriasis.  JAMA 2006;296 (14) 1735- 1741PubMedGoogle ScholarCrossref
3.
Gelfand  JMShin  DBNeimann  ALWang  XMargolis  DJTroxel  AB The risk of lymphoma in patients with psoriasis.  J Invest Dermatol 2006;126 (10) 2194- 2201PubMedGoogle ScholarCrossref
4.
Gelfand  JMTroxel  ABLewis  JD  et al.  The risk of mortality in patients with psoriasis: results from a population-based study.  Arch Dermatol 2007;143 (12) 1493- 1499PubMedGoogle ScholarCrossref
5.
Griffiths  CEBarker  JN Pathogenesis and clinical features of psoriasis.  Lancet 2007;370 (9583) 263- 271PubMedGoogle ScholarCrossref
6.
Gelfand  JMGladman  DDMease  PJ  et al.  Epidemiology of psoriatic arthritis in the population of the United States.  J Am Acad Dermatol 2005;53 (4) 573.e1- 573.e13PubMedGoogle ScholarCrossref
7.
Devrimci-Ozguven  HKundakci  TNKumbasar  HBoyvat  A The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients.  J Eur Acad Dermatol Venereol 2000;14 (4) 267- 271PubMedGoogle ScholarCrossref
8.
Esposito  MSaraceno  RGiunta  AMaccarone  MChimenti  S An Italian study on psoriasis and depression.  Dermatology 2006;212 (2) 123- 127PubMedGoogle ScholarCrossref
9.
Chelminski  IZimmerman  M Pathological worry in depressed and anxious patients.  J Anxiety Disord 2003;17 (5) 533- 546PubMedGoogle ScholarCrossref
10.
Fortune  DGRichards  HLKirby  B  et al.  Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy.  Arch Dermatol 2003;139 (6) 752- 756PubMedGoogle ScholarCrossref
11.
Gupta  MAGupta  AKSchork  NJEllis  CN Depression modulates pruritus perception: a study of pruritus in psoriasis, atopic dermatitis, and chronic idiopathic urticaria.  Psychosom Med 1994;56 (1) 36- 40PubMedGoogle ScholarCrossref
12.
Gupta  MASchork  NJGupta  AKKirkby  SEllis  CN Suicidal ideation in psoriasis.  Int J Dermatol 1993;32 (3) 188- 190PubMedGoogle ScholarCrossref
13.
Schmitt  JMFord  DE Role of depression in quality of life for patients with psoriasis.  Dermatology 2007;215 (1) 17- 27PubMedGoogle ScholarCrossref
14.
Jick  SSKaye  JAVasilakis-Scaramozza  C  et al.  Validity of the general practice research database.  Pharmacotherapy 2003;23 (5) 686- 689PubMedGoogle ScholarCrossref
15.
Charlton  RACunnington  MCde Vries  CSWeil  JG Data resources for investigating drug exposure during pregnancy and associated outcomes.  Drug Saf 2008;31 (1) 39- 51PubMedGoogle ScholarCrossref
16.
Kaye  JABradbury  BDJick  H Changes in antipsychotic drug prescribing by general practitioners in the United Kingdom from 1991 to 2000: a population-based observational study.  Br J Clin Pharmacol 2003;56 (5) 569- 575PubMedGoogle ScholarCrossref
17.
Meier  CRWilcock  KJick  SS The risk of severe depression, psychosis or panic attacks with prophylactic antimalarials.  Drug Saf 2004;27 (3) 203- 213PubMedGoogle ScholarCrossref
18.
Mines  DHill  DYu  HNovelli  L Prevalence of risk factors for suicide in patients prescribed venlafaxine, fluoxetine, and citalopram.  Pharmacoepidemiol Drug Saf 2005;14 (6) 367- 372PubMedGoogle ScholarCrossref
19.
Schlienger  RGFischer  LMJick  HMeier  CR Current use of selective serotonin reuptake inhibitors and risk of acute myocardial infarction.  Drug Saf 2004;27 (14) 1157- 1165PubMedGoogle ScholarCrossref
20.
Haste  FCharlton  JJenkins  R Potential for suicide prevention in primary care? an analysis of factors associated with suicide.  Br J Gen Pract 1998;48 (436) 1759- 1763PubMedGoogle Scholar
21.
Jick  SSVasilakis  CMartinez  CJick  H A study of the relation of exposure to quinolones and suicidal behaviour.  Br J Clin Pharmacol 1998;45 (1) 77- 81PubMedGoogle ScholarCrossref
22.
Gelfand  JMWeinstein  RPorter  SBNeimann  ALBerlin  JAMargolis  DJ Prevalence and treatment of psoriasis in the United Kingdom: a population-based study.  Arch Dermatol 2005;141 (12) 1537- 1541PubMedGoogle ScholarCrossref
23.
Gelfand  JMFeldman  SRStern  RSThomas  JRolstad  TMargolis  DJ Determinants of quality of life in patients with psoriasis: a study from the US population.  J Am Acad Dermatol 2004;51 (5) 704- 708PubMedGoogle ScholarCrossref
24.
Kurd  SKRichardson  SKGelfand  JM Update on the epidemiology and systemic treatment of psoriasis.  Expert Rev Clin Immunol 2007;3 (2) 171- 185PubMedGoogle ScholarCrossref
25.
Lewis  JDBilker  WBWeinstein  RBStrom  BL The relationship between time since registration and measured incidence rates in the General Practice Research Database.  Pharmacoepidemiol Drug Saf 2005;14 (7) 443- 451PubMedGoogle ScholarCrossref
26.
Tyring  SGottlieb  APapp  K  et al.  Etanercept and clinical outcomes, fatigue, and depression in psoriasis.  Lancet 2006;367 (9504) 29- 35PubMedGoogle ScholarCrossref
Evidence-Based Dermatology: Study
August 16, 2010

The Risk of Depression, Anxiety, and Suicidality in Patients With Psoriasis: A Population-Based Cohort Study

Author Affiliations
 

BIGBYMICHAELMDAuthor Affiliations:Center for Clinical Epidemiology and Biostatistics (Drs Kurd, Troxel, and Gelfand), and Departments of Medicine (Dr Kurd), Psychiatry (Dr Crits-Christoph), and Dermatology (Dr Gelfand), University of Pennsylvania, Philadelphia.

Arch Dermatol. 2010;146(8):891-895. doi:10.1001/archdermatol.2010.186
Abstract

Objective  To determine the incidence of depression, anxiety, and suicidality in patients with psoriasis compared with the general population.

Design  A population-based cohort study using data collected as part of patient's electronic medical record from 1987 to 2002.

Setting  General Practice Research Database.

Patients  Analyses included 146 042 patients with mild psoriasis, 3956 patients with severe psoriasis, and 766 950 patients without psoriasis. Five controls without psoriasis were selected from the same practices and similar cohort entry dates as patients with psoriasis.

Main Outcome Measure  Clinical diagnoses of depression, anxiety, and suicidality among patients.

Results  The adjusted hazard ratios (HRs) for receiving a diagnosis of depression, anxiety, and suicidality in patients with psoriasis compared with controls were 1.39 (95% confidence interval [CI], 1.37-1.41), 1.31 (95% CI, 1.29-1.34), and 1.44 (95% CI, 1.32-1.57), respectively. The adjusted HR of depression was higher in severe (HR, 1.72; 95% CI, 1.57-1.88) compared with mild psoriasis (HR, 1.38; 95% CI, 1.35-1.40). Younger patients with psoriasis had elevated HRs of outcomes compared with older patients with psoriasis.

Conclusions  Patients with psoriasis have an increased risk of depression, anxiety, and suicidality. We estimate that in the United Kingdom, in excess of 10 400 diagnoses of depression, 7100 diagnoses of anxiety, and 350 diagnoses of suicidality are attributable to psoriasis annually. It is important for clinicians to evaluate patients with psoriasis for these conditions to improve outcomes. Future investigation should determine the mechanisms by which psoriasis is associated with psychiatric outcomes as well as approaches for prevention.

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