Association of Skin Psoriasis and Somatic Comorbidity With the Development of Psychiatric Illness in a Nationwide Swedish Study

Geale, Kirk; Henriksson, Martin; Jokinen, Jussi; Schmitt‐Egenolf, Marcus

doi:10.1001/jamadermatol.2020.1398

Cited by 16 publications

(9 citation statements)

References 35 publications

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“…In this study, the psoriasis group had a higher risk of suicidality, including suicidal ideation and suicide attempts, than that in the control group, but no significant difference was observed between the two groups regarding incidences of completed suicides. Our results suggest an association between psoriasis and suicidality, similar to that observed in previous cohort studies 12,24 …”

Section: Discussionsupporting

confidence: 92%

“…Our results suggest an association between psoriasis and suicidality, similar to that observed in previous cohort studies. 12,24 There exist conflicting study results regarding psoriasis and suicidality. Wu et al 25 reported that the risk of depression increased in patients with psoriasis and PsA, but that of suicidal ideation and suicide attempt did not increase.…”

Section: Discussionmentioning

confidence: 99%

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Increased risk of suicidality in patients with psoriasis: A Nationwide cohort study in Korea

Kim

Ahn

Cho

et al. 2022

Acad Dermatol Venereol

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Psoriasis is a chronic immune-mediated disorder characterized by skin inflammation and multiple comorbidities, 1,2 including cardiovascular disease, and it can compromise the patient's quality of life. [1][2][3][4][5] Patients with psoriasis commonly experience stigmatization, poor self-esteem and social rejection because of their skin lesions. [6][7][8][9] Recent studies have reported an increased incidence of various psychiatric diseases, including anxiety and depressive disorder, among patients with psoriasis. [10][11][12] Suicidality conceptually includes suicidal ideation (thoughts about death or engaging in behaviour to kill oneself), suicide attempt (self-harm with at least some intent to kill oneself) and completed suicide. 13 According to the World Health Organization, approximately 700,000 people commit suicide annually. 14 Suicide is also emerging as a serious social health problem in South Korea, which has one of the highest suicide rates among the Organization for Economic Co-operation and Development countries. 15 In 2019, suicide ranked first among the causes of death in those aged 10-39 years and second in those aged 40-59 years in South Korea. 16

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Increased risk of suicidality in patients with psoriasis: A Nationwide cohort study in Korea

Kim

Ahn

Cho

et al. 2022

Acad Dermatol Venereol

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“…Suicidal patients may prioritize physical over mental health care because they consulted non–mental health care professionals twice as often as mental health professionals in the 30 days before death by suicide. Therefore, nonpsychiatric health care settings, especially primary care and emergency departments, are crucial for suicide risk screening …”

Section: Discussionmentioning

confidence: 99%

Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis

Xiao,

Bi,

Yip

et al. 2024

JAMA Psychiatry

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ImportanceSuicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies.ObjectiveTo identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts.Design, Setting, and ParticipantsThis cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023.ExposuresSuicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods.Main Outcomes and MeasuresDisclosure of recent intent, suicide note presence, and known psychotropic usage.ResultsAmong 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]).Conclusions and RelevanceThis study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.

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“…Psoriasis is a chronic‐inflammatory, immune‐mediated disease with typical erythematous, indurated, scaly, puritic, often painful skin plaques, affecting about 125 million people, worldwide (Korman, 2020). As underlying pathophysiology, an increased secretion of certain pro‐inflammatory cytokines have been proven, leading to a state of increased systemic inflammation and risk for numerous somatic comorbidities, for example, psoriatic arthritis, cardiovascular and metabolic diseases (Bu et al., 2022; Grozdev et al., 2014; Purzycka‐Bohdan et al., 2022), which in turn display independent and additional risk factors for mental comorbidities in psoriasis (Geale et al., 2020). In about every second to fifth patient, clinically relevant symptoms of anxiety and depression occur as major mental comorbidities (Dalgard et al., 2015; Pollo et al., 2021; Sondermann et al., 2021).…”

Section: Introductionmentioning

confidence: 99%

Psychosocial stress affects the change of mental distress under dermatological treatment—A prospective cohort study in patients with psoriasis

et al. 2023

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Psoriasis is a chronic‐inflammatory, immune‐mediated disease leading to a state of increased systemic inflammation. Mental comorbidities often occur in the patients and may additionally affect the therapy outcome. Currently, it is unknown whether the disease severity, psychosocial stress or health‐related quality of life determines the manifestation of anxiety/depression, or vice versa, in psoriasis. The interplay between these variables during the dermatological treatment of psoriasis remains to be elucidated in order to initiate appropriate psychological interventions and to identify patients at risk for comorbid anxiety/depression. In a prospective cohort study, the impact of disease severity, health‐related quality of life and psychosocial stress on anxiety/depression were examined during the dermatological treatment in patients with moderate to severe psoriasis (patients with psoriasis = PSO). Patients were examined before (T1) and about 3 months after (T2) the beginning of a new treatment episode, in most cases by means of systemic therapy. Data were analysed, exploratory, using Bivariate Latent Change Score Models and mediator analyses. Assessments included patient‐reported outcomes (Hospital Anxiety and Depression Scale/HADS, Perceived Stress Scale/PSS, Childhood Trauma Questionnaire/CTQ, Dermatology Life Quality Index‐DLQI, Body Surface Area‐BSA), at both T1 and T2. 83 PSO patients (37.3% women, median age 53.7, IQR 37.8–62.5, median BSA 18.0, IQR 9.0–40.0) with complete data of HADS and DLQI were included. In the total group, a higher anxiety/depression at T1 was associated with a lower improvement in psoriasis severity in the course of the dermatological treatment (γBSA = 0.50, p < 0.001). In subgroups of PSO with low/high CTQ scores, anxiety/depression at T1 had no impact on the change in psoriasis severity. Only by tendency, in CTQ subgroups, a higher psoriasis severity at T1 was linked with a higher improvement in anxiety/depression at T2 (low/high CTQ, γHADS = −0.16/−0.15, p = 0.08). An improvement in the health‐related quality of life was positively associated with an improvement in anxiety/depression (Pearson's r = 0.49, p = 0.02). Here, the reduction of acute psychosocial stress seems to be a decisive factor, mediating this association (β = 0.20, t [2,60] = 1.87; p = 0.07, 95% CI −0.01, 0.41). The results allude, that the initial severity of anxiety/depression may presumably have an impact on the treatment outcome in the total group. In contrast, analysing subgroups of patients with high/low childhood trauma, the impact of the initial disease severity on the course of anxiety/depression after a switch to a new dermatological treatment could not be conclusively ruled out. The latter results from the latent change score modelling should be treated cautiously because of the small sample size. A common aetiopathological mechanism for psoriasis and anxiety/depression might be assumed with impact of dermatological treatment on both. The change in perceived stress seems to play an important role in the manifestation of anxiety/depression, substantiating the need for adequate stress management in patients with increased psychosocial stress during their dermatological treatment.

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Association of Skin Psoriasis and Somatic Comorbidity With the Development of Psychiatric Illness in a Nationwide Swedish Study

Cited by 16 publications

References 35 publications

Increased risk of suicidality in patients with psoriasis: A Nationwide cohort study in Korea

Increased risk of suicidality in patients with psoriasis: A Nationwide cohort study in Korea

Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis

Psychosocial stress affects the change of mental distress under dermatological treatment—A prospective cohort study in patients with psoriasis

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