Advance Online
Advance Online

Mental Health and Psoriasis Severity Assessment

People with anxiety or depression are more likely to disagree with their provider about disease severity.

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.

When Psoriasis Impacts the Mind

Jocelyn Hall explores the connections among anxiety, depression and psoriatic disease.

Read More

Article References


  1. Gondo G, Bell S. 2020 National Psoriasis Foundation Annual Survey. In: Foundation NP, editor. 2020
  2. Nicholas MN, Gooderham M. Psoriasis, Depression, and Suicidality. Skin Therapy Lett. May 2017;22(3):1-4.
  3. Sahi FM, Masood A, Danawar NA, Mekaiel A, Malik BH. Association Between Psoriasis and Depression: A Traditional Review. Cureus. Aug 13 2020;12(8):e9708.
  4. Wu JJ, Penfold RB, Primatesta P, et al. The Risk of Depression, Suicidal Ideation and Suicide Attempt in Patients with Psoriasis, Psoriatic Arthritis or Ankylosing Spondylitis. Jour of the Eur Acad of Derm and Ven, Feb 2017. doi/abs/10.1111/jdv.14175
  5. Tribó MJ, Turroja M, Castaño-Vinyals G, et al. Patients with Moderate to Severe Psoriasis Associate with Higher Risk of Depression and Anxiety Symptoms: Results of a Multivariate Study of 300 Spanish Individuals with Psoriasis. Acta Derm Venereol. Apr 1 2019 ;99(4):417-422.


Heather Onorati


Freelance writer

Stay in the Know.

Expert tips, can’t-miss events and the latest news, straight to your inbox.

National Health Council Standards of ExcellenceCharity NavigatorCommunity Health Charities logoTwill Care logo

Copyright © 1996-2023 National Psoriasis Foundation/USA

Duplication, rebroadcast, republication, or other use of content appearing on this website is prohibited without written permission of the National Psoriasis Foundation (NPF).

NPF does not endorse or accept any responsibility for the content of external websites.

NPF does not endorse any specific treatments or medications for psoriasis and psoriatic arthritis.

We use cookies to offer you a better experience and analyze our site traffic. By continuing to use this website, you consent to the use of cookies in accordance with our Privacy Policy.