Why an office visit may be the best time for a mental health check-up

| Melissa Leavitt

So much to do, so little time. During an office visit for psoriatic disease, doctors and patients can feel like they’re racing against the clock to fit everything in. Physical exam, treatment update, prescription refill … and then the patient’s off to the pharmacy, and the doctor’s off to the next appointment.

It’s tough to think about squeezing anything else into a short office visit. But important aspects of psoriasis and psoriatic arthritis can be easily overlooked during routine clinical care. Depression, anxiety and emotional distress can be just as much a part of psoriatic disease as plaques on the skin and pain in the joints.

Psoriatic disease and mental health: Who, what and why

People with psoriasis have a 39 percent increased risk of being diagnosed with depression and a 31 percent increased risk of being diagnosed with anxiety than those without the disease, according to a study published in the Archives of Dermatology in August 2010. A study published in the Journal of Rheumatology in April 2014 found that rates of anxiety and depression may be even higher in psoriatic arthritis.

Many factors link psoriatic disease and mental illness. There’s the biological component. For example, the proteins in the body that trigger inflammation in psoriatic disease are also involved in depression, as noted in a January 2006 paper in Trends in Immunology.

Then there’s the stress that comes from living with the disease. Research funded by the National Psoriasis Foundation and published in September 2015 in the Journal of the American Academy of Dermatology found that psoriasis can be highly stigmatizing, and may even carry as much stigma as herpes.

Anxiety and depression often go undetected

Despite the prevalence of mental illness in psoriatic disease patients, it may go unrecognized during office visits, according to a study published in July 2016 in the British Journal of Dermatology.

The study of people attending a psoriasis clinic in the United Kingdom found that many were experiencing depression and anxiety. But these symptoms were only identified when patients took screening tests specifically designed to detect these conditions—and not during the regular course of the appointment.

Patients in the study filled out the Patient Health Questionnaire Depression Scale, the Generalized Anxiety Disorder Scale and the Dermatology Life Quality Index (DLQI).

According to results from the depression and anxiety tests, almost 15 percent of these patients had depression or anxiety. But, the researchers reported, for more than one-third of these patients, the DLQI missed the signs.

For these people, the tool more commonly used in dermatological practice — the DLQI — wasn’t enough to uncover the impact of mental health issues, one of the most common comorbidities for psoriatic disease.

Learn how to identify mental health signals — and what to do next

The psoriatic disease office visit may be the best time for doctors and patients to discuss mental and emotional issues. But without formal training or tools to detect mental health conditions, the task can seem daunting.

The National Psoriasis Foundation offers resources and services to patients and providers to help people living with psoriasis and psoriatic arthritis get the support they need. That means that health care providers don’t need to be experts in psychology to address the emotional aspects of psoriatic disease.

On Nov. 30, 2016, Dr. Richard Fried, a member of the National Psoriasis Foundation Medical Board who is both a dermatologist and a psychologist, offered a webinar to health care providers on the common mental health comorbidities of psoriatic disease. In April 2016, Fried spoke at a congressional briefing organized by NPF on the impact of psoriatic disease on mental health.

You start the conversation. We’ll keep it going.

One important resource for psoriatic disease patients and providers is NPF’s Patient Navigation Center, the world’s first personalized support center for psoriatic disease. The Navigation Center offers a range of emotional support resources to patients. Navigators can connect patients with someone else living with psoriatic disease through the One to One peer mentor program. NPF also offers fact sheets for patients, including a fact sheet on the emotional impact of psoriatic disease, available as downloads on NPF’s website.

Once providers start the conversation about mental health, NPF Patient Navigators can take it from there. 

Patients don’t have to worry about the time crunch they may feel in the doctor’s office. They can discuss all of their emotional and physical experiences with the disease and end the conversation armed with tools and resources to put them on the path toward better health.

Ashley Lindberg, one of NPF’s Patient Navigators, says that many of the patients she speaks with every day are in need of emotional support.

“I want everyone to walk away feeling like they are heard and they can come back to us whenever they want,” she says.

Navigators work directly with patients to help ease the emotional burden of the disease, suggesting ways to reduce stress or helping them identify a mental health provider. Lindberg says she was able to connect one patient to a therapist specializing in chronic disease management.

One of the most important roles of the Navigation Center is strengthening the relationship patients have with their psoriatic disease or primary care providers, whether that means helping patients prepare for appointments or encouraging them to see a specialist for their psoriasis or psoriatic arthritis.

Lindberg worked with one man in his 20s with such severe psoriatic arthritis that he required 24-hour care. He had lost trust in the health care system, Lindberg says. But with the help of the Navigation Center, he’s now ready to see a rheumatologist.

“He now feels like he has direction and goals,” Lindberg says. “A lot of it was making him feel empowered.”

More resources

Download this free fact sheet on the emotional impacts of psoriatic disease.


Driving discovery, creating community

For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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