Risk of depression in women with psoriasis: a cohort study

Abstract

Summary Background Psoriasis is a common, chronic and inflammatory disease of the skin, which has been associated with depression in cross-sectional studies with limited adjustment for confounders. Objectives In this prospective cohort study, we investigated the risk of incident depression among individuals with psoriasis and psoriatic arthritis (PsA). Methods We included 50 750 US female nurses from the Nurses’ Health Study who were free of depression at baseline in 2000. Those participants who had ever self-reported clinician-diagnosed depression or regular use of antidepressants, or had a Mental Health Inventory score of ≤ 52 were excluded. In 2008, we retrospectively asked participants if they had ever received a physician’s diagnosis of psoriasis or PsA. We defined depression as self-report of clinician-diagnosed depression or regular use of antidepressant medication. Time-dependent Cox proportional hazard models were used to estimate age and multivariate-adjusted relative risks (RRs) of clinical depression. Results After adjusting for covariates including body mass index, physical activity, smoking and the presence of major chronic conditions, the multivariate-adjusted RRs of clinical depression were 1.29 [95% confidence interval (CI) 1.10–1.52] for women with psoriasis and 1.52 (95% CI 1.06–2.19) for women with psoriasis and concomitant PsA, compared with women without psoriasis. Conclusions We found an increased risk of depression in US women with psoriasis compared with those without psoriasis. This risk was higher in those who reported concomitant PsA. Future studies are needed to confirm these findings in other populations and to identify pathophysiological mechanisms linking psoriasis to depression.

Psoriasis and comorbid diseases

“…122 The risk of depression was greatest among patients receiving therapies for severe psoriasis (HR 1.72; 95% CI 1.57–1.88). Similarly, a study of women in the Nurses’ Health Study 123 found psoriasis to be associated with a nearly 30% increased risk of depression (RR 1.29; 95% CI 1.10–1.52), independent of age, BMI, lifestyle factors, and comorbid conditions.…”

The inflammatory perspective of depression in the context of chronic medical conditions

“…More than 40% meet criteria for probable mood disorders [36] and the prevalence of depression and/or anxiety disorder ranges between 30% [37] and 58% [38]. Moreover, a diagnosis of psoriatic arthritis further increases the likelihood of depression [39,40]. A couple of recent reports on the relation between psoriasis and psoriatic arthritis and risk of depression in the US showed that psoriasis was significantly associated with major depression, even after adjustment for sex, age, race and co-morbidities, but that disease severity was not found co-related with increased risk [40,41].…”

Psoriasis and depression: a commentary on “In psoriasis, levels of hope and quality of life are linked”

“…Depression seen in half of the patients may affect the quality of life quite negatively [7,9]. In a study with a very large sample, depression risk in women with psoriasis has been found to be higher than those without psoriasis [4]. In a recent study, the quality of life of 3971 patients with psoriasis has been assessed with EuroQol-5 Dimension Questionnaire (EQ-5D).…”

“…In the study of Dommasch et al, individuals diagnosed with depression or receiving antidepressant treatment have been excluded from the study [4]. In addition, in the study of Hawro et al, it would have been better to exclude those diagnosed with depression or receiving antidepressant treatment from the study.…”