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. 2022 Jul 3;2(3):e145.
doi: 10.1002/ski2.145. eCollection 2022 Sep.

The effect of the Covid-19 pandemic on illness perceptions of psoriasis and the role of depression: Findings from a cross-sectional study

Georgia Lada  1   2 , Hector Chinoy  3 , Peter S Talbot  2 , Richard B Warren  1 , C Elise Kleyn  1
Affiliations

The effect of the Covid-19 pandemic on illness perceptions of psoriasis and the role of depression: Findings from a cross-sectional study

Georgia Lada et al. Skin Health Dis. .

Abstract

Background: Illness perceptions in psoriasis have an impact on adherence and disability. Changes in dermatological healthcare provision during the Covid-19 pandemic and distress may have affected illness perceptions in psoriasis patients.

Objectives: To test whether illness perceptions about psoriasis changed during the first year of the Covid-19 pandemic compared to pre-pandemic in a tertiary population with psoriasis and whether pandemic effects differed depending on depressive burden, given this population's high depression prevalence.

Methods: In a cross-sectional survey of n = 188 tertiary patients with dermatologist-confirmed psoriasis recruited before and during the pandemic, eight illness perceptions domains were assessed using the Brief-Illness Perceptions Questionnaire (BIPQ). Presence of depression was assessed with the Hospital Anxiety and Depression Scale (HADS).

Results: Beliefs about treatment control and patients' understanding of psoriasis were significantly worse in patients responding during the pandemic compared to before Covid-19. These differences were greater when depression was absent (treatment control: adjusted p < 0.001; coherence: adjusted p = 0.01). However, participants during the pandemic felt less emotionally affected (adjusted p = 0.02) and concerned (adjusted p = 0.007) about psoriasis, independently of depression.

Conclusions: We found diverse pandemic effects on illness perception domains in psoriasis. Uncertainty and reduced healthcare access may drive poorer treatment and coherence beliefs during Covid-19. These beliefs can hinder patients' health-promoting behaviours and may explain the high pandemic non-adherence reported previously in psoriasis. Appropriate interventions are needed to establish positive long-term cognitions and improve psoriasis management, for example, using the PsoWell patient materials. Dermatology services should invest in engaging and educating patients regardless of concurrent psychological distress.

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Conflict of interest statement

C. Elise Kleyn has received honoraria, consultant and/or research funding from Janssen, Eli Lilly, LEO, Novartis, Abbvie, UCB, Almirall, Pfizer, and L’Oréal. Hector Chinoy has received personal compensation for activities with Novartis, UCB, Lilly, Biogen, Orphazyme as a speaker, advisory board member or consultancy, grants via The University of Manchester from Novartis, UCB and MedImmune, and has received travel support from Abbvie and Janssen. Richard B. Warren has received research grants from AbbVie, Almirall, Amgen, Celgene, Janssen, Lilly, Leo, Medac, Novartis, Pfizer, and UCB and consulting fees from AbbVie, Almirall, Amgen, Arena, Astellas, Avillion, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, DiCE, GSK, Janssen, Lilly, Leo, Medac, Novartis, Pfizer, Sanofi, Sun Pharma, UCB, and UNION. GL has received speaker honoraria from Janssen, Lilly, Leo, and Novartis. Peter S. Talbot has no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Estimated marginal means and confidence intervals (CIs) for Brief‐Illness Perceptions Questionnaire (BIPQ) scores representing six illness perceptions domains in depressed and non‐depressed patients with psoriasis before and during the Covid‐19 pandemic. Lower BIPQ scores in the three domains of the top row indicate beliefs of poorer (a) treatment control, (b) personal control and (c) understanding of disease. Lower scores in the three domains of the bottom row indicate beliefs of less (d) emotional impact (e) impact on life and (f) concern. Score differences before versus during the pandemic were significantly greater for non‐depressed than depressed patients for treatment control and coherence
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