title: Disease Severity, Quality of Life, and Psychiatric Morbidity in Patients With Psoriasis With Reference to Sociodemographic, Lifestyle, and Clinical Variables: A Prospective, Cross-Sectional Study From Lahore, Pakistan.
abstract: BACKGROUND
  Psoriasis is an immune-mediated, chronic disease with a genetic background that involves skin, nails, and joints. The incidence of psoriasis varies from 2.0% to 4.0% depending on the geographical location, ethnic background, and environmental conditions. Recent research has proved that psoriasis is a systemic inflammatory disease with extensive systemic implications. Objectives of the study were to explore the severity of psoriasis, dermatology-related quality of life, and psychiatric health of the patients with reference to sociodemographic, lifestyle, and clinical characteristics.
  
  
  METHODS
  Consecutive patients with psoriasis (ICD-10 criteria) from skin outpatient clinics of 3 tertiary care hospitals in Lahore, Pakistan, between November 1, 2012, and December 31, 2012, were assessed in this prospective cross-sectional study. The final sample includes 87 patients who were evaluated for severity of psoriasis (Psoriasis Area Severity Index [PASI]), dermatology-related quality of life (Dermatology Life Quality Index [DLQI]), and psychiatric morbidity (12-item General Health Questionnaire [GHQ-12]) and were assessed on 23 sociodemographic, lifestyle, and clinical variables.
  
  
  RESULTS
  Of the 23 variables, the PASI was significantly associated with education and habit of drinking alcohol (P < .05), the DLQI was significantly associated with disturbed eating (P < .05), and the GHQ-12 score was significantly associated with hair disease (P < .05), current income (P < .05), and disturbed eating and sleeping (P < .01). The PASI, DLQI, and GHQ-12 were not usually affected by sociodemographic, lifestyle, and clinical factors, except for some variables such as education of the patient, alcohol intake, eating and sleeping disturbance, and income status. A statistically significant correlation (P < .01) was found between all 3 scores (ie, PASI, DLQI, and GHQ-12). The correlation coefficients of the PASI with the DLQI and GHQ-12 are 0.345 and 0.460, respectively, and that of the DLQI with the GHQ-12 is 0.635. A moderating effect of the DLQI score was found on the relationship between the PASI and GHQ-12 scores.
  
  
  CONCLUSIONS
  Psoriasis has an immense impact on the life of patients and common comorbidities in psoriasis including coronary heart disease, depression, cerebrovascular disease, and metabolic syndrome. Screening for these comorbidities in psoriasis patients is essential. Impaired quality of life negatively affects the psyche of patients and initiates coping mechanisms, which may lead to depression and anxiety, social dysfunction, and loss of confidence, and the psychosocial burden of the disease may become more than the physical burden. The dermatologist usually manages physical disease and fails to address the social, emotional, and psychological aspects. Quality of life improves if these psychological aspects are also properly dealt with.
authors.affiliation: AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany).
authors.forename: Abdul Rahman
authors.initials: AR
authors.lastname: Khawaja
authors.affiliation: AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany).
authors.forename: Syed Muhammad Azam
authors.initials: SM
authors.lastname: Bokhari
authors.affiliation: AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany).
authors.forename: Rasheed
authors.initials: R
authors.lastname: Tariq
authors.affiliation: AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany).
authors.forename: Shahzad
authors.initials: S
authors.lastname: Atif
authors.affiliation: AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany).
authors.forename: Hanif
authors.initials: H
authors.lastname: Muhammad
authors.affiliation: AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany).
authors.forename: Qadeer
authors.initials: Q
authors.lastname: Faisal
authors.affiliation: AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany).
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jafferany