Increased risk of suicidality in patients with psoriasis: A Nationwide cohort study in Korea

Abstract

Psoriasis is a chronic immune-mediated disorder characterized by skin inflammation and multiple comorbidities, 1,2 including cardiovascular disease, and it can compromise the patient's quality of life. [1][2][3][4][5] Patients with psoriasis commonly experience stigmatization, poor self-esteem and social rejection because of their skin lesions. [6][7][8][9] Recent studies have reported an increased incidence of various psychiatric diseases, including anxiety and depressive disorder, among patients with psoriasis. [10][11][12] Suicidality conceptually includes suicidal ideation (thoughts about death or engaging in behaviour to kill oneself), suicide attempt (self-harm with at least some intent to kill oneself) and completed suicide. 13 According to the World Health Organization, approximately 700,000 people commit suicide annually. 14 Suicide is also emerging as a serious social health problem in South Korea, which has one of the highest suicide rates among the Organization for Economic Co-operation and Development countries. 15 In 2019, suicide ranked first among the causes of death in those aged 10-39 years and second in those aged 40-59 years in South Korea. 16

Epidemiology of depression and suicidal ideation in patients with psoriasis: A meta-analysis of prospective cohort studies

“…54 More recently, similar results were reported from a nationwide cohort study in Korea (adjusted hazard ratio = 1.21, 95% CI = 1.18-1.24). 31 However, our meta-analysis failed to confirm this relationship. The following two factors were considered vital to these results.…”

“…Three studies provided data regarding the prevalence of suicidal ideation in patients with PsA. 18,25,31 The pooled data also showed no significant association between suicidal ideation and PsA (RR = 1.33, 95% CI = 0.79-2.23, I² = 82.0%, P = 0.004) (Fig. 4B).…”

“…After reading the full texts, 16 cohort studies involving 1,166,840 patients with psoriasis and 3,294,205 controls without psoriasis were included in this systematic review. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Four of the studies 19,[22][23]31 involved more than 100,000 patients each, and six of the studies 16,18,[20][21][28][29] involved more than 10,000 patients each. The characteristics of all the included studies are shown in Table 1.…”

“…Seven studies involving 764,706 patients with psoriasis (19,562 with suicidal ideation) and 2,487,415 controls without psoriasis (22,329 with suicidal ideation) were included in this meta-analysis. 18,20,[22][23][29][30][31] As shown in Figure 4A, no association between psoriasis and suicidal ideation was observed (RR = 1.25, 95% CI = 0.95-1.65, I² = 96.7%, P < 0.001). Three studies provided data regarding the prevalence of suicidal ideation in patients with PsA.…”

“…Data from these studies were based on adult populations and were not combined with information on children. The 16 cohort studies were from the United Kingdom, 20,23,25,28,30 the United States, [17][18]24,26 Korea, 21,31 Denmark, 19 Belgium, 27 Sweden, 29 and Taiwan (China). 16,22…”