The Prevalence and Odds of Depressive Symptoms and Clinical Depression in Psoriasis Patients: A Systematic Review and Meta-Analysis

Abstract

The reported prevalence of depression in psoriasis varies substantially. This study aims to determine the prevalence and odds of depressive symptoms and clinical depression in psoriasis. A systematic literature search was conducted. Mean questionnaire values and proportions for depressive symptoms and clinical depression were pooled according to different assessment methods. In controlled studies, standardized mean differences (SMDs) and odds ratio (OR) compared depression in psoriasis patients with controls using the random-effect model. The majority of the 98 eligible studies were conducted in tertiary centers without a control group. The prevalence of depressive symptoms was 28% using questionnaires and the prevalence of clinical depression was 12% using International Classification of Diseases codes, 19% using Diagnostic and Statistical Manual of Mental Disorders IV, and 9% for antidepressant use. Psoriasis patients had significantly more depressive symptoms (SMD 1.16; 95% confidence interval (CI) 0.67-1.66), and population-based studies showed that they were at least one and a half times more likely to experience depression (OR 1.57; 95% CI 1.40-1.76) and used more antidepressants than did controls (OR 4.24, 95% CI 1.53-11.76). More than 10% of psoriasis patients suffer from clinical depression, and twice as many have depressive symptoms. The high prevalence of these symptoms is likely to be affected by the tertiary study populations and differential misclassification using questionnaires, where psoriasis-related symptoms may be detected as depressive symptoms.

Impact and management of depression in psoriasis patients

“…Depression in psoriasis patients can be assessed by dermatologist-subjective clinical judgment, questionnaires, International Classification of Disease codes, and DSM-IV/V criteria; the most common method in clinical practice is clinician judgment, while the most common method in research studies is questionnaire use [3]. About one in four psoriasis patients has depression by dermatologists' judgment (Table 1) [8].…”

“…Questionnaires and clinical tools find depressive symptoms in 9-55% of psoriasis patients (Table 1) [3,17]. Depression detection in psoriasis patients is currently limited by three factors: variability of detection by the currently available questionnaires, no questionnaire has been designed and validated for dermatologic populations, and limited use and familiarity of questionnaires among dermatologists [3].…”

“…The impact on the quality of life may cause depression, which in turn negatively affects adherence to treatment. Based on a meta-analysis, the prevalence of depression in patients with psoriasis is 20-30% [3,29]. Severity of psoriasis was unrelated to depression risk [17].…”

“…Psoriasis patients are 1.5 times more likely to experience depression compared to those without psoriasis (odds ratio 1.57; 95% confidence interval 1.40-1.76) [3]. The proportion of psoriasis patients who have depressive symptoms ranges from 9% to 55%, likely due to differences in screening methods and study populations ( Table 1).…”

Comorbilidades em Doentes com Psoríase: Revisitar as Antigas, Reconhecer as Emergentes

“…6 Apesar destas evidências, os doentes psoriáticos permanecem subdiagnosticados e subtratados para estes factores de risco. 7 O carácter crónico e por vezes incapacitante da doença contribui para um compromisso biopsicossocial de indivíduos afectados, comparável a outras doenças major. 8 Associa-se a hábitos de vida menos saudáveis, como o sedentarismo e o tabagismo, e a uma pletora de perturbações do humor como a depressão, ansiedade, alterações da auto-imagem e suicídio.…”