Psychosocial Burden of Psoriasis: A Systematic Literature Review of Depression Among Patients with Psoriasis

Abstract

Psoriasis is associated with various comorbidities with a notable psychosocial burden. This systematic literature review explores the burden of depression in patients with psoriasis, comparing it with that experienced by patients with other chronic medical conditions. Embase via Ovid, PubMed, and Cochrane Database of Systematic Reviews via Ovid were searched for peer-reviewed studies published in English between January 1, 2016 and December 6, 2021 that reported real-world evidence or observational studies involving at least 100 adults (age ≥ 18 years) with general (unspecified) or plaque psoriasis experiencing symptoms of depression (but not restricted to patients with a clinical diagnosis). Any report of depression or suicidality was eligible for inclusion. Systematic literature reviews reporting depression/suicidality in other chronic medical conditions were also included. Statistical analysis was not performed; the study was descriptive only. A total of 1744 records were identified, and after several defined screenings by two independent reviewers for publication year, relevance, and sample size, 82 publications were included. Psoriasis was significantly associated with depression. The prevalence of depression in patients with psoriasis ranged from 0.2% to 74.6%, with incidence from 4.83 to 91.9 per 1000 person-years. The prevalence of depression was generally higher among patients with more severe psoriasis than those with less severe disease (as determined by Psoriasis Area Severity Index [PASI] scoring system) and was more prevalent among women than men with psoriasis. Depression in psoriasis significantly reduced quality of life, including factors such as sexual dysfunction, sleep difficulties, subjective well-being, and addictions. Comorbid hypertension, hyperlipidemia, psoriatic arthritis, obesity, inflammatory bowel disease, diabetes, and statin use were all associated with increased depression risk in patients with psoriasis. This systematic literature review found that the burden of depression in psoriasis is no lower than in other chronic medical conditions. Greater awareness of the psychological impact of psoriasis would improve care and management, which should incorporate psychological interventions.

Keywords: Depression; Psoriasis; Psychosocial.

Fig. 1

PRISMA diagram

Fig. 2

Assessment tools used to measure depression. BDI Beck Depression Inventory, CES-D Center for Epidemiologic Studies Depression Scale, DASS-42 Depression Anxiety and Stress Scale, DSM-5 Diagnostic and Statistical Manual of Mental Disorders 5th Edition, HADS Hospital Anxiety and Depression Scale, HRDS Hamilton Depression Rating Scale, MADRS Montgomery-Asberg Depression Rating Scale, MINI Mini-International Neuropsychiatric Interview, PHQ-2/9 2-item/9-item Patient Health Questionnaire, SCL-90-R Symptom Checklist-90 Revised, WHO-5 World Health Organization—Five Well-Being Index, Zung-SDS Zung Self-Rating Depression Scale

Fig. 3

Prevalence of depression in patients with psoriasis

Fig. 4

Incidence rate of depression per 1000 person-years among patients with psoriasis. ^aNo depression at baseline. ^bContinuously enrolled group

Fig. 5

Prevalence of suicidal ideation in patients with psoriasis. ^aContinuously enrolled group. ^bPast suicidal ideation. ^cCurrent suicidal ideation. ^dPHQ-9. ^eMINI. MINI Mini-International Neuropsychiatric Interview, PHQ-9 9-item Patient Health Questionnaire

Fig. 6

Range of prevalence of depression in patients with psoriasis and in patients with other chronic medical conditions. ^aModerate to severe depression. ^bAll depression severity. COPD chronic obstructive pulmonary disease, HF heart failure, IBD inflammatory bowel disease, PAD peripheral arterial disease