[Depression and anxiety disorders among psoriasis patients: protective and exacerbating factors].
BACKGROUND
Psoriasis is associated with higher risk for depression and anxiety disorders. Yet the complex system linking disease symptoms with physical and mental outcomes is poorly understood.


OBJECTIVE
The central aim of this study was to identify physical, psychological, and social factors that exacerbate or protect against the perception of symptoms of depression and anxiety among individuals starting in-patient treatment for psoriasis. Another aim was to investigate if improved clinical status of the psoriasis is associated with improved psychological and physical wellbeing one year after treatment.


METHODS
In this follow-up study a sample of 381 psoriasis in-patients in Germany were questioned before starting treatment and one year after treatment (166 participants) using instruments to measure socioeconomic variables, perceived somatic severity, life quality (DLQI, SF-8), feelings of stigmatization (QES), and depression and anxiety (HADS-D). Coping (Trier Coping Scale) and pathological worry (PSWQ-PW) were also measured at the initial time point. Multiple regression analyses of variance for repeated measurements and of correlation were conducted.


RESULTS
Self-reported symptoms of anxiety and depression were higher than in normal populations. Perceived severity of physical symptoms was not correlated with depression or anxiety at the initial time point. The strongest predictors of depression and anxiety in our sample were measures of life quality. Life quality was predicted in a large part by stigmatization. Increased momentary symptom severity and increased perceived discomfort over time was not associated with increased perception of symptoms of depression.


CONCLUSIONS
Our findings extend previous research on the importance of stigmatization for quality of life to the specific outcome of depression and anxiety. It confirms the desirability of early screening of psoriasis patients for depression and anxiety and initiating treatment by a qualified therapist.
Institut für Innovative Rehabilitation, Krankenhaus-Management und Stressmedizin (IREHA) der Lielje Gruppe in Löhne bei Bad Oeynhausen, Bad Oeynhausen, Deutschland.
K
K
Bangemann
W
W
Schulz
J
J
Wohlleben
A
A
Weyergraf
I
I
Snitjer
T
T
Werfel
G
G
Schmid-Ott
D
D
Böhm
D001008:Anxiety Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D015984:Causality; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015995:Prevalence; D011565:Psoriasis / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D057545:Social Stigma; D012959:Socioeconomic Factors; D016896:Treatment Outcome