title: Detection of psychological distress in patients with psoriasis: low consensus between dermatologist and patient.
abstract: BACKGROUND
  Researchers have indicated that 30-40% of patients with psoriasis suffer significant psychological distress. For the appropriate clinical management of the patient with psoriasis it is important that dermatologists are able to recognize this distress.
  
  
  OBJECTIVE
  To examine the level of agreement between dermatologists and patients with psoriasis as to the presence of clinically significant psychological distress.
  
  
  METHODS
  Forty-three consultations between dermatologists and patients with psoriasis were assessed. Following the consultation two assessments were undertaken: the patients completed measures of anxiety and depression, and the consulting dermatologists recorded whether they believed the patient to be psychologically distressed and, if so, their subsequent action. At the end of the study, all dermatologists who participated completed the Jefferson Scale of Physician Empathy.
  
  
  RESULTS
  Self-report questionnaires indicated that 37% and 12% of patients were identified as probable clinical cases for anxiety and depression, respectively. In general, the level of agreement between patient rating and dermatologist rating as to the presence of anxiety or depression was low (kappa statistic 0.24 and 0.26, respectively). Dermatologist empathy level did not appear to influence identification of distress. In only 39% of cases were the psychological difficulties of significantly distressed patients raised by dermatologists during the consultation.
  
  
  CONCLUSIONS
  Agreement between dermatologists and patients with psoriasis regarding the presence of clinically significant psychological distress was low. When dermatologists did identify patients as being anxious and/or depressed, in the majority of cases no further action was taken following the consultation. This study highlights a number of areas for improvement in the psychological management of patients with psoriasis.
authors.affiliation: Department of Behavioural Medicine, University of Manchester School of Medicine, Hope Hospital, Salford, Manchester M6 8HD, U.K. hrichard@fs1.ho.man.ac.uk
authors.forename: H L
authors.initials: HL
authors.lastname: Richards
authors.forename: D G
authors.initials: DG
authors.lastname: Fortune
authors.forename: A
authors.initials: A
authors.lastname: Weidmann
authors.forename: S K T
authors.initials: SK
authors.lastname: Sweeney
authors.forename: C E M
authors.initials: CE
authors.lastname: Griffiths
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002908:Chronic Disease; D032921:Consensus; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011565:Psoriasis / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy