Mental Health and Psoriasis Severity Assessment

The presence of anxiety or depression may influence how patients with psoriasis rate their disease severity, creating a discrepancy with the assessment completed by a health care provider, according to a study published March 3,2021 in JAMA Dermatology.

“Overall, patient and physician severity assessments tended to be in agreement,” wrote lead author Ewan Carr, Ph.D, and colleagues from King’s College London and St. John’s Institute of Dermatology, London, United Kingdom. “Where disagreements occurred, patients were more likely to underestimate their psoriasis severity, compared with the physician rating.”

Health care providers will generally employ a tool for patients to rate the impact and severity of their disease. This tool, in combination with a health care provider’s assessment, is used to inform treatment direction and progress.

While disagreement between these measures has been identified in other chronic conditions and associated with various disease factors, data are limited for psoriasis. However, poor mental health has been associated with a disconnect between patient and health care provider assessments of psoriatic and rheumatoid arthritis disease severity, the authors wrote.

Results from a recent survey of patients with psoriasis conducted by the National Psoriasis Foundation suggest that nearly 24% of patients with psoriasis experience depression.[1] Previous studies also have identified associations with both depression and anxiety in patients with psoriasis.[2][3] One study suggests that compared to the general population, patients with psoriasis have a 14% higher risk of depression. [4] Another study has demonstrated an association between psoriasis severity and risk for depression.[5]

Because a higher prevalence for depression or anxiety exists among patients with psoriasis, and because optimal treatment relies upon equivalent patient-health care provider assessments, Dr. Carr and colleagues questioned whether mental health status might impact the patient perception of their condition and to what extent.

What they found is that patients who screened positive for depression or anxiety were more likely than those without depression or anxiety to overestimate or underestimate the severity of their disease when compared with the assessment of their health care provider. Specifically, patients with depression or anxiety and milder disease were more likely to overestimate the severity of their psoriasis while patients with depression or anxiety and moderate disease were more likely to underestimate their disease severity.

“Recognition of anxiety and depression in individuals with psoriasis appears to be important when interpreting patient-reported outcome measures and informing appropriate treatment decisions,” the authors wrote.