The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study.
OBJECTIVE
To determine the incidence of depression, anxiety, and suicidality in patients with psoriasis compared with the general population.


METHODS
A population-based cohort study using data collected as part of patient's electronic medical record from 1987 to 2002.


METHODS
General Practice Research Database.


METHODS
Analyses included 146 042 patients with mild psoriasis, 3956 patients with severe psoriasis, and 766 950 patients without psoriasis. Five controls without psoriasis were selected from the same practices and similar cohort entry dates as patients with psoriasis.


METHODS
Clinical diagnoses of depression, anxiety, and suicidality among patients.


RESULTS
The adjusted hazard ratios (HRs) for receiving a diagnosis of depression, anxiety, and suicidality in patients with psoriasis compared with controls were 1.39 (95% confidence interval [CI], 1.37-1.41), 1.31 (95% CI, 1.29-1.34), and 1.44 (95% CI, 1.32-1.57), respectively. The adjusted HR of depression was higher in severe (HR, 1.72; 95% CI, 1.57-1.88) compared with mild psoriasis (HR, 1.38; 95% CI, 1.35-1.40). Younger patients with psoriasis had elevated HRs of outcomes compared with older patients with psoriasis.


CONCLUSIONS
Patients with psoriasis have an increased risk of depression, anxiety, and suicidality. We estimate that in the United Kingdom, in excess of 10 400 diagnoses of depression, 7100 diagnoses of anxiety, and 350 diagnoses of suicidality are attributable to psoriasis annually. It is important for clinicians to evaluate patients with psoriasis for these conditions to improve outcomes. Future investigation should determine the mechanisms by which psoriasis is associated with psychiatric outcomes as well as approaches for prevention.
Kurd
Shanu Kohli
SK
Department of Medicine, University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104, USA. shanu.kurd@uphs.upenn.edu
Troxel
Andrea B
AB
Crits-Christoph
Paul
P
Gelfand
Joel M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D016208:Databases, Factual; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000150:complications* / Q000523:psychology; D012720:Severity of Illness Index; D013405:Suicide / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult