title: Depression and anxiety in psoriatic disease: prevalence and associated factors.
abstract: OBJECTIVE
  (1) To determine the prevalence of depression and anxiety in patients with psoriatic arthritis (PsA) and to identify associated demographic and disease-related factors. (2) To determine whether there is a difference in the prevalence of depression and anxiety between patients with PsA and those with psoriasis without PsA (PsC).
  
  
  METHODS
  Consecutive patients attending PsA and dermatology clinics were assessed for depression and anxiety using the Hospital Anxiety and Depression Scale. Patients underwent a clinical assessment according to a standard protocol and completed questionnaires assessing their health and quality of life. T tests, ANOVA, and univariate and multivariate models were used to compare depression and anxiety prevalence between patient cohorts and to determine factors associated with depression and anxiety.
  
  
  RESULTS
  We assessed 306 patients with PsA and 135 with PsC. There were significantly more men in the PsA group (61.4% vs 48% with PsC) and they were more likely to be unemployed. The prevalence of both anxiety and depression was higher in patients with PsA (36.6% and 22.2%, respectively) compared to those with PsC (24.4% and 9.6%; p = 0.012, 0.002). Depression and/or anxiety were associated with unemployment, female sex, and higher actively inflamed joint count as well as disability, pain, and fatigue. In the multivariate reduced model, employment was protective for depression (OR 0.36) and a 1-unit increase on the fatigue severity scale was associated with an increased risk of depression (OR 1.5).
  
  
  CONCLUSIONS
  The rate of depression and anxiety is significantly higher in patients with PsA than in those with PsC. Depression and anxiety are associated with disease-related factors.
authors.affiliation: From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: McDonough
authors.forename: Renise
authors.initials: R
authors.lastname: Ayearst
authors.forename: Lihi
authors.initials: L
authors.lastname: Eder
authors.forename: Vinod
authors.initials: V
authors.lastname: Chandran
authors.forename: Cheryl F
authors.initials: CF
authors.lastname: Rosen
authors.forename: Arane
authors.initials: A
authors.lastname: Thavaneswaran
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015535:Arthritis, Psoriatic / Q000453:epidemiology* / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011565:Psoriasis / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: ANXIETY; DEPRESSION; DISEASE ACTIVITY; HOSPITAL ANXIETY AND DEPRESSION SCALE; PSORIATIC ARTHRITIS