title: The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries.
abstract: The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants--3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67-3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68-2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33-2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.
authors.affiliation: National Center for Dual Diagnosis, Innlandet Hospital Trust, Brumundal, Norway. Electronic address: florence.dalgard@medisin.uio.no.
authors.forename: Florence J
authors.initials: FJ
authors.lastname: Dalgard
authors.affiliation: Department of Dermatology, Justus Liebig University, Giessen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Gieler
authors.affiliation: Department of Psychology, University of Zaragoza, Zaragoza, Spain.
authors.forename: Lucia
authors.initials: L
authors.lastname: Tomas-Aragones
authors.affiliation: Department of Public Health, Hedmark University College, Elverum, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Lien
authors.affiliation: Department of Dermatology, Universite Libre de Bruxelles, Brussels, Belgium.
authors.forename: Francoise
authors.initials: F
authors.lastname: Poot
authors.affiliation: Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Gregor B E
authors.initials: GBE
authors.lastname: Jemec
authors.affiliation: Department of Dermatology, University Hospital of Brest, Brest, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Misery
authors.affiliation: Department of Dermatology, University of Szeged, Szeged, Hungary.
authors.forename: Csanad
authors.initials: C
authors.lastname: Szabo
authors.affiliation: Department for Dermatology, Padua University Hospital, Padua, Italy.
authors.forename: Dennis
authors.initials: D
authors.lastname: Linder
authors.affiliation: Health Services Research Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sampogna
authors.affiliation: Institute of Psychology Health, University of Leiden, Leiden, Netherlands.
authors.forename: Andrea W M
authors.initials: AWM
authors.lastname: Evers
authors.affiliation: Department of Dermatology, University of Oslo, Oslo, Norway.
authors.forename: Jon Anders
authors.initials: JA
authors.lastname: Halvorsen
authors.affiliation: Department of Dermatology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Flora
authors.initials: F
authors.lastname: Balieva
authors.affiliation: Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Szepietowski
authors.affiliation: Department of Psychiatry and Psychosomatic Medicine, Sechenov First Moscow State Medical, Moscow, Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Romanov
authors.affiliation: Department of Dermatology, Alcaniz Hospital, Alcaniz, Spain.
authors.forename: Servando E
authors.initials: SE
authors.lastname: Marron
authors.affiliation: Department of Dermatology, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey.
authors.forename: Ilknur K
authors.initials: IK
authors.lastname: Altunay
authors.affiliation: Department of Dermatology, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Finlay
authors.affiliation: Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Salek
authors.affiliation: Institute of Medical Psychology, Justus Liebig University, Giessen, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kupfer
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications; D003880:Dermatology / Q000379:methods; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010045:Outpatients; D015995:Prevalence; D012044:Regression Analysis; D012871:Skin Diseases / Q000150:complications / Q000523:psychology*; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires