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Prevalence of Mental Health Comorbidities in Psoriasis Probed in New Study

The exact reasons for the links are not yet clear, although some evidence suggests inflammation plays a role.

About 1 in 5 people with psoriasis also have depression, and the rate is similar for anxiety, according to a new study. The report, published in Psychiatry Research, is believed to be the first to systematically evaluate the worldwide prevalence of mental health comorbidities among people with the skin condition.

The study authors said it is believed that 125 million people worldwide have psoriasis, and many of those people experience comorbidities such as cardiovascular disease, diabetes, and metabolic syndrome. There is also evidence that people with psoriasis are more likely to have mental health comorbidities, but the investigators said there is currently a lack of a comprehensive understanding within the scientific community of exactly the prevalence of such comorbidities.

“Although systematic reviews have been conducted on psoriasis and its comorbidities such as depression, anxiety, and bipolar disorder, no study has systematically focused on the epidemiology of mental health disorders, including depression, anxiety, and suicide,” they wrote.

They decided to search 5 academic and medical databases to find studies that investigated the prevalence of mental health comorbidities in people with psoriasis. They identified 56 studies that were published between 1986 and the study’s cutoff date of May 2022.

After pooling the data, they found the prevalence of diabetes in people with psoriasis was 20%; of anxiety, 21%; and of suicide, 0.77%. People in North America were more likely to have depression, and those in South America were more likely to experience anxiety, the authors added. Suicide data were only included in studies of people in Europe and North America, they noted.

In terms of incidence, per 1000 person-years, the authors found 42.1 cases of depression, 24.7 cases of anxiety, and 2.6 incidents of suicide. The investigators said these data support the idea that mental health should be a key consideration when treating people with psoriasis.

“Owing to changes in the appearance of the skin, patients with psoriasis are more likely to experience a high psychosocial burden, including comorbid depression, anxiety, and suicidal ideation,” the authors said. “Moreover, the medical community and public have acknowledged that mental health greatly impacts the quality of life in patients with psoriasis.”

The investigators said the link between psoriasis and depression may be related to proinflammatory cytokines, including tumor necrosis factor-alpha (TNF-α) and interleukins 17 and 23.

“Some studies have shown that TNF-α antagonists, which can be used to treat psoriasis, are equally effective in patients with depression,” they noted.

The authors added that there may also be an association between systemic inflammation and the risk of suicide.

“The molecular mechanisms underlying the comorbidity of psoriasis and anxiety can be attributed to disorders of the sympathetic nervous system and abnormal expression of neuropeptides, including calcitonin gene-related peptide, substance P, and nerve growth factor,” they wrote.

Still, although the authors said their report helps to show the links between psoriasis and mental disorders and the range in the prevalence of comorbid mental disorders from region to region, it was not designed to figure out the underlying biological reasons for the associations. Those answers, they said, will require further study.

Reference

Liu L, Lin N, Yu Y, et al. Epidemiology of mental health comorbidity in patients with psoriasis: an analysis of trends from 1986 to 2019. Psychiatry Res. Published online January 23, 2023. doi:10.1016/j.psychres.2023.115078

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