Psoriasis is a common condition with recognised psychological comorbidity in specialist practice. The objective of this study was to investigate the psychological comorbidities in psoriasis in patients from general (family) practices and specialist dermatology practices, using a qualitative methodology. This was a qualitative study, utilising semi-structured interviews and thematic analysis. Twenty-nine patients with psoriasis were recruited from general practices and specialist dermatology practices in an Australian non-capital city. Respondents represented a broad range of ages and psoriasis severities. The principle study finding was that psychological morbidity in psoriasis is considerable. Though mood and anxiety symptoms were present in participants, and were occasionally severe, more prominent sequelae of psoriasis were embarrassment, shame, impaired self-image, low self-esteem, self-consciousness and stigmatisation. Psoriasis was associated with behavioural avoidance and effects on respondents' sexuality. The perception of psoriasis as an incurable disease beyond respondents' control, with consequent pessimism regarding prognosis and treatment efficacy, was a contributor to psychological morbidity. Some respondents reported psoriasis having permanently and adversely affected their personality - avoidant personality traits were ascribed to the experience of living with psoriasis. Our conclusion is that the psychological effects of psoriasis can be considerable and long-lasting and are evident across a broad range of psoriasis severities. Clinicians should be aware that psychological sequelae are complex and encompass a range of psychological morbidities beyond conventional psychiatric diagnoses.

Where research objectives are concerned with the impact of a specific tumour type, treatment or symptom, choice should be guided by the availability, content, scale structure and psychometric properties of relevant European Organisation for the Research and Treatment of Cancer versus Functional Assessment of Chronic Illness Therapy modules. Because the FACT-G combines symptoms and concerns within each scale, individual items should always be reviewed within the context of specific research objectives. Where these issues are indecisive, researchers are encouraged to use an algorithm at the end of the current article.

The HADS' efficiency and substantial track record recommend its use where anxiety, mixed affective disorders or general distress are outcomes of interest. However, continuing controversy concerning the HADS depression scale cautions against dependence where depressive disorders are of primary interest. Where cost is a concern, the POMS-37 is recommended to measure anxiety or mixed affective disorders but does not offer a suitable index of general distress and, like the HADS, emphasises anhedonia in measuring depression. Where depression is the sole focus, the CES-D is recommended.