title: The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis.
abstract: BACKGROUND
  Sparse information is available concerning mental health issues in psoriasis, psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients.
  
  
  OBJECTIVE
  To estimate risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, PsA and AS, respectively, compared with the general population.
  
  
  METHODS
  This population-based cohort study analysed 36 214 psoriasis patients, 5138 PsA patients and 1878 AS patients who were frequency-matched with a general population cohort. Annual incidence rate of depression, suicidal ideation and suicide attempt was calculated separately for psoriasis, PsA and AS.
  
  
  RESULTS
  There was an increased risk of depression in the three cohorts; adjusted IRR: psoriasis, 1.14 (95% CI, 1.11, 1.17); PsA, 1.22 (95% CI, 1.16, 1.29); AS, 1.34 (95% CI, 1.23, 1.47). There was no significantly increased risk for suicidal ideations or suicide attempt among psoriasis, PsA or AS patients.
  
  
  CONCLUSIONS
  Patients were not excluded if previously diagnosed with depression, suicidal ideation or suicide attempt. Suicide attempt and completed suicide analyses were not adjusted for presence of depression. Use of systemic psoriasis treatment to measure severe psoriasis could lead to psoriasis severity misclassification.
  
  
  CONCLUSIONS
  The risk of depression, but not suicidal ideation or suicide attempt, was significantly increased in patients with psoriasis, PsA and AS.
authors.affiliation: Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wu
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Penfold
authors.affiliation: Quantitative Safety & Epidemiology, Novartis Pharma AG, Basel, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Primatesta
authors.affiliation: Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland.
authors.forename: T K
authors.initials: TK
authors.lastname: Fox
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Stewart
authors.affiliation: University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Reddy
authors.affiliation: Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Egeberg
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000150:complications / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000523:psychology*; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000523:psychology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted; D055815:Young Adult