银屑病共病精神障碍（如抑郁、焦虑等）严重程度的相关因素

OBJECTIVE To identify the prevalence and factors associated with depression and anxiety in patients with psoriasis BACKGROUND: Psoriasis is a chronic, non-contagious, autoimmune inflammatory skin disease associated with psychological comorbidities. DESIGN A cross-sectional study conducted between March 2017 and December 2018 in a dermatology infirmary and outpatient clinic of a public hospital in the inner State of São Paulo (Brazil). METHODS We used questionnaires with sociodemographic data and clinical history, the HAD (Hospital Anxiety and Depression Scale), DLQI-BRA (Dermatology Life Quality Index) and PASI (Psoriasis Area Severity Index). The correlations between variables were explored using multivariate techniques. STROBE checklist was applied as the reporting guideline for this study (Supporting Information File S1). RESULTS A total of 281 participants were included, the majority female 146 (52%), with a mean age of 52.1 years (SD 13.8), elementary school 154 (55%), married/cohabiting 209 (74%) and with low income 201 (72%). The median (p25-p75) time with the disease was 14 years (7-23). Regarding the quality of life, 31% of respondents reported being little affected by the disease. The prevalence of depression was 19% and 36% anxiety. The multivariate analysis showed that the variables that influenced the anxiety and depression scores were: DLQI-BRA, income, female sex, illness length, and age. For the multiple correspondence analysis, the highest levels of anxiety and depression referred to women, middle age, lower-income, and low PASI. CONCLUSION The prevalence of anxiety and depression symptoms was low. Female sex, income, age, illness length and quality of life were associated with anxiety and depression scores in patients with psoriasis. RELEVANCE TO CLINICAL PRACTICE Due to the scarcity of studies in the field of nursing with psoriasis patients, we believe these findings contribute to the reorganization of the care provided, allowing nurses to timely identify mood disorders such as anxiety and depression and adopt the necessary measures to a service and/or specialized referral.

BACKGROUND Evidence suggests an association between atopic eczema (AE) or psoriasis and mental illness; however, the factors associated with mental illness are unclear. OBJECTIVES To synthesize and evaluate all available evidence on factors associated with depression, anxiety and severe mental illness (SMI) among adults with AE or psoriasis. METHODS We searched electronic databases, grey literature databases and clinical trial registries from inception to February 2022 for studies of adults with AE or psoriasis. Eligible studies included randomized controlled trials (RCTs), cohort, cross-sectional or case-control studies where effect estimates of factors associated with depression, anxiety or SMI were reported. We did not apply language or geographical restrictions. We assessed risk of bias using the Quality in Prognosis Studies tool. We synthesized results narratively, and if at least two studies were sufficiently homogeneous, we pooled effect estimates in a random effects meta-analysis. RESULTS We included 21 studies (11 observational, 10 RCTs). No observational studies in AE fulfilled our eligibility criteria. Observational studies in people with psoriasis mostly investigated factors associated with depression or anxiety - one cross-sectional study investigated factors associated with schizophrenia. Pooled effect estimates suggest that female sex and psoriatic arthritis were associated with depression [female sex: odds ratio (OR) 1.62, 95% confidence interval (CI) 1.09-2.40, 95% prediction intervals (PIs) 0.62-4.23, I2 = 24.90%, τ2 = 0.05; psoriatic arthritis: OR 2.26, 95% CI 1.56-3.25, 95% PI 0.21-24.23, I2 = 0.00%, τ2 = 0.00] and anxiety (female sex: OR 2.59, 95% CI 1.32-5.07, 95% PI 0.00-3956.27, I2 = 61.90%, τ2 = 0.22; psoriatic arthritis: OR 1.98, 95% CI 1.33-2.94, I2 = 0.00%, τ2 = 0.00). Moderate/severe psoriasis was associated with anxiety (OR 1.14, 95% CI 1.05-1.25, I2 0.00%, τ2 = 0.00), but not depression. Evidence from RCTs suggested that adults with AE or psoriasis given placebo had higher depression and anxiety scores compared with comparators given targeted treatment (e.g. biologic agents). CONCLUSIONS Our review highlights limited existing research on factors associated with depression, anxiety and SMI in adults with AE or psoriasis. Observational evidence on factors associated with depression or anxiety in people with psoriasis was conflicting or from single studies, but some identified factors were consistent with those in the general population. Evidence on factors associated with SMIs in people with AE or psoriasis was particularly limited. Evidence from RCTs suggested that AE and psoriasis treated with placebo was associated with higher depression and anxiety scores compared with skin disease treated with targeted therapy; however, follow-up was limited. Therefore, long-term effects on mental health are unclear.

Objectives Psoriasis is a chronic, immune-mediated illness that primarily affects the skin, nails and joints. This illness may predispose people to mental disorders such as depression and anxiety. This study aims to determine the prevalence of depression and anxiety in patients with psoriasis and their correlation with quality of life and associated factors. Methods This cross-sectional study involved 174 patients with psoriasis at the dermatology clinic of Hospital Sultanah Bahiyah, Alor Setar. All patients were instructed to complete four sets of questionnaires relating to: sociodemographic profile, clinical characteristics of illness, the validated Malay version of Hospital Anxiety and Depression Scale (HADS) and the Malay validated version of Dermatology Life Quality Index (DLQI). Data were analysed using a descriptive analysis and correlational and multiple logistic regression analyses. Results We have found that 8.5% patients had depressive and 16.9% had anxiety symptoms. Multiple logistic regression analysis showed that higher DLQI scores, presence of lower limbs' lesions and dyslipidaemia were associated with depression in the sampled population. Conclusion This study has shown that the cohort with psoriasis exhibited notable symptoms of depression and anxiety. This emphasises the need for the assessment of anxiety and depression among patients with psoriasis as these symptoms predict poor quality of life. Such correlation of psoriasis with anxiety and depression essentially leads to psychological sequelae. Affected psoriasis patients need appropriate intervention. Our study paves the way for further research by involving other underlying constructs such as perceived body image and stigma.

Background: Psoriasis is an immune-mediated chronic skin disease that is associated with a significant psychological burden. A newer line of therapy is represented by biologic agents. Our study aimed to evaluate the effect of biologic therapies in the treatment of psoriasis concerning both disease severity and psychological comorbidity. Material and Methods: We performed a prospective case-control comparison to evaluate the prevalence of depression and anxiety in psoriasis patients and unaffected individuals. All patients were recruited between October 2017 and February 2021. Baseline depression (PHQ-9), anxiety (GAD-7), PASI, and DLQI scores were noted. Then, we evaluated the efficacy of biologic treatment in reducing these scores at 6 months of therapy. Patients were treated with either ixekizumab, secukinumab, guselkumab, certolizumab, ustekinumab, risankizumab, or adalimumab. Results: 106 bio-naïve patients with psoriasis and 106 controls without the disease were included in this study. Depression and anxiety were significantly more common among psoriasis patients than in unaffected individuals (p < 0.0001). Female patients presented both depression and anxiety more frequently than men in both case and control groups. Disease severity was significantly associated with worsened depression and anxiety symptoms. Biologic therapy resulted in a significant decrease in all four scores at the 6-month mark for each patient (p < 0.0001). Only an improved PASI correlated significantly with lower depression and anxiety scores (p < 0.005), whereas a decreased DLQI did not (p > 0.955). None of the seven biologic agents used was discovered to be superior. Conclusion: biologic therapies are effective in decreasing both disease severity and alleviating depression and anxiety symptoms in psoriasis.

Importance The emerging paradigm of treat-to-target in psoriasis requires accurate monitoring of treatment response. The commonly used physician global assessment tool does not capture the patient's perception of their disease. Patient assessments facilitate shared decision-making and foster patient-centered care; however, recent research reports a discordance between patient- and physician-reported psoriasis severity. Understanding the factors underlying this discordance may improve treatment satisfaction and disease outcomes. Objectives To evaluate the discordance between patient- and physician-reported measures of psoriasis severity and assess the association with patient mental health status. Design, Setting, and Participants A cohort study using repeated cross-sectional analysis of real-world longitudinal data was conducted at a large specialist psoriasis service serving London and Southeast England. A total of 502 patients attending the psoriasis service between May 12, 2016, and November 1, 2018, were included. Data analysis was conducted July 22 to October 22, 2019. Main Outcomes and Measures Psoriasis severity was assessed on each visit with identical 5-point physician and patient global assessment scales (clear/nearly clear, mild, moderate, severe, and very severe). Each patient completed validated self-report screens for depression and anxiety on each visit. Results Longitudinal data from 502 individuals with psoriasis (1985 total observations) were available. A total of 339 patients (68%) were men, 396 (79%) were White, mean (SD) age was 47 (13) years, and 197 patients (39%) had concurrent psoriatic arthritis, 43 (9%) screened positive for depression, and 49 (10%) screened positive for anxiety. There was discordance between physician and patient measures of disease severity in 768 of 1985 office appointments (39%); on 511 visits (26%) patients rated their psoriasis as less severe and on 257 visits (13%) patients rated their psoriasis as more severe compared with their physician. Individuals who screened positive for depression or anxiety were more likely to overestimate their psoriasis severity compared with their physician (relative risk ratio: depression, 2.7; 95% CI, 1.6-4.5; anxiety, 2.1; 95% CI, 1.3-3.4). These findings remained statistically significant after adjustment for age, ethnicity, sex, body mass index, smoking, number of comorbidities, treatment modality, and presence of psoriatic arthritis. Conclusions and Relevance The findings of this cohort study suggest that discordance between patient and physician assessments of psoriasis severity is associated with patients' mental health status. Recognition of anxiety and depression in individuals with psoriasis appears to be important when interpreting patient-reported outcome measures and informing appropriate treatment decisions.

Introduction: Psoriasis is a chronic inflammatory disease that negatively impacts patients’ quality of life (QoL) and mental health. Itch and pain are prevalent symptoms of psoriasis and contribute to the psychosocial burden of this disease. This study aimed to evaluate the impact of skin pain on the prevalence and severity of symptoms of anxiety and depression and on the QoL in psoriasis patients. Methods: The studied population comprised 106 adults with psoriasis (34% female; mean age 42.1 ± 13.0 years). Disease severity was measured with the Psoriasis Area and Severity Index (PASI). The intensity of skin pain was assessed with the NRS and the Short Form McGill Pain Questionnaire (SF-MPQ). The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) questionnaires were used to estimate the severity of depression and anxiety, respectively, as was the Hospital Anxiety and Depression Scale (HADS). Quality of life (QoL) was studied using the Dermatology Life Quality Index (DLQI). Results: Regarding anxiety assessment, females reported significantly higher scores with the HADS-A (8.42 ± 4.85 points vs. 5.14 ± 3.9 points; p < 0.001) and the GAD-7 compared to men (7.50 ± 5.58 points vs. 5.24 ± 4.79 points; p = 0.036). Similarly, the severity of depression was significantly higher in women, as measured with the PHQ-9 (7.50 ± 5.58 points vs. 5.24 ± 4.79 points, p = 0.021). Psoriasis patients with skin pain scored significantly higher in HADS Total score (p = 0.043), HADS-A (p = 0.022), PHQ-9 (p = 0.035), and DLQI (p < 0.001) than the rest of the studied group. The intensity of skin pain measured with the SF-MPQ correlated significantly with HADS Total score (p = 0.021), HADS-A (p < 0.001), HADS-D (p = 0.038), and PHQ-9 (p < 0.001). Additionally, there was a significant correlation between the intensity of cutaneous pain assessed using the VAS and the PHQ-9 (p = 0.022). Conclusions: Skin pain significantly influences the well-being of patients with psoriasis as well as the symptoms of anxiety and depression. In particular, women with psoriasis are at increased risk of developing anxiety and depression. Our findings underline the necessity for a multidisciplinary approach to the management of this dermatosis.

Background The ultimate goal of medical care is to eradicate disease and restore normality to a person’s life. Quality of life (QOL) is a concern as dermatologists and researchers strive to find better drug treatments. However, there have been few reports on the factors associated with QOL among Chinese people with psoriasis. Methods A total of 185 people with psoriasis were surveyed to assess their sociodemographic status, disease-related information, psychosocial status, and QOL. The questionnaires included a sociodemographic questionnaire, the Athens Insomnia Scale, the Hospital Anxiety and Depression Scale, the Perceived Social Support Scale, the Psychosocial Adaptation Questionnaire of Chronic Skin Disease and the Dermatology Life Quality Index. Multiple stepwise regression and path analysis were used to study the factors associated with QOL among Chinese people with psoriasis and to analyse the relationship between them. Results The results showed that the presence of anxiety/depression, lesion area, sleep disorders, psychosocial adaptation, and sex could jointly predict 62.1% of the variance in QOL among Chinese people with psoriasis. According to previous theories and the literature, a path model was established for five variables. Four internal variables could be effectively explained. The values of the explanatory variables were 62.1% (F(1056) = 61.020, p  = 0.000) for QOL, 71.8% (F(2433) = 117.370, p  = 0.000) for anxiety/depression, 44.0% (F(660) = 36.935, p  = 0.000) for sleep disorders, and 66.9% (F(6886) = 93.556, p  = 0.000) for psychosocial adaptation. The path analysis confirmed that 9 paths were consistent with the predicted path, and 3 paths were not confirmed. Conclusion To improve QOL among Chinese people with psoriasis, attention should be given to the presence of anxiety/depression, lesion area, sleep disorders, psychosocial adaptation and sex differences. Therefore, health care programs for psoriasis should include physical, psychological and social aspects.

Objective: Psoriasis is a chronic inflammatory skin disease, and psychiatric comorbidities are common in these patients. Skin lesions can cause shame, anxiety, social avoidance, irritability, and depressive symptoms in psoriasis patients. This study aimed to investigate anxiety, depression, social anxiety, anxiety sensitivity, and perceived stress in patients with psoriasis and their relationship with disease severity and duration. Methods: Forty patients and 40 healthy controls were included in our study. All study patients were administered the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), the Liebowitz Social Anxiety Scale (LSAS), the Perceived Stress Scale (PSS-14), and the Anxiety Sensitivity Index (ASI-3). Disease severity in psoriasis patients was assessed using the Psoriasis Area Severity Index (PASI). Results: Anxiety, depression, social anxiety, perceived stress, and anxiety sensitivity were significantly higher in psoriasis patients than in healthy controls. There was no correlation between PASI scores and BAI, BDI, LSAS, PASS-14 and ASI-3 scores. Also, no correlation was found between disease duration and BAI, BDI, LSAS, PSS-14 and ASI-3 scores. Conclusion: Our results show that anxiety, depression, social anxiety, anxiety sensitivity, and perceived stress are high in psoriasis patients regardless of disease duration and severity. This is the first study to examine anxiety sensitivity in psoriasis patients to the best of our knowledge. Clinicians should consider the possible psychiatric comorbidity at all stages of the disease in patients with psoriasis. Collaboration between the disciplines of dermatology and psychiatry is necessary to ensure full recovery and maintain patient well-being.

BACKGROUND Depression is overrepresented in psoriasis. However, it is not clear whether the presence of psoriatic arthritis (PsA) independently increases patients' depressive burden. Furthermore, current evidence regarding suicidality risk of psoriasis populations is conflicting and the role of PsA on suicidality outcomes in psoriasis is unknown. OBJECTIVES (i) To test whether PsA is associated with depression and lifetime suicidal ideation among patients with psoriasis; (ii) to capture different suicidal phenomena in these patients; and (iii) to investigate whether suicidality and depressive symptom severity are associated with clinical markers of psoriasis severity and chronicity. METHODS A cross-sectional survey of tertiary patients (n=219, aged 18-65 years) with dermatologist-confirmed chronic plaque psoriasis, of whom 84 had rheumatologist-confirmed PsA, was undertaken. The Hospital Anxiety and Depression Scale and Sheehan-Suicidality Tracking Scale were used to assess depression and lifetime suicidality respectively. RESULTS PsA presence was associated with depression in patients with psoriasis, independently of other physical comorbidities (adjusted Odds Ratio 2.92, 95% Confidence Interval 1.53-5.68). Furthermore, patients with PsA experienced significantly higher levels of anhedonia and anxiety, after controlling for psychiatric history. 48.8% of all participants reported lifetime suicidal ideation with or without intent; 21.3% reported suicidal planning and 9.4% suicide attempts. Lifetime suicidality prevalence did not differ between patients with and without PsA. Depressive symptom severity and lifetime suicidality scores were not associated with objective measures of psoriasis severity or treatment group. CONCLUSION These data suggest that joint involvement in psoriasis is associated with higher depressive burden. There is a need for routine depression screening among patients with psoriasis, in particular when PsA is present. Anhedonia appears to be a particularly relevant symptom in the depression phenotype of this population. We did not find a statistically significant association between PsA and suicidality. Nevertheless, suicidality rates in tertiary patients with psoriasis appear to be higher than in the general population. Suicidality monitoring is recommended to help in reducing future psychiatric morbidity and mortality in patients with psoriasis.

The literature reported higher depression rates in psoriasis patients compared to the general population. Our study aimed to verify whether variability in depression prevalence was due to using different diagnostic tools. We also aimed to determine whether dysfunctional coping strategies might increase the depression burden. We assessed psoriasis severity by the Psoriasis Area Severity Index (PASI) and PSOdisk. We analyzed mental alterations of 120 outpatients by Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A), Symptom Checklist-90-Revised (SCL-90-R), plus coping strategies and quality of life by Coping Orientation to Problems Experienced (COPE) Inventory and 36-Item Short Form Health Survey (SF-36). We divided our cohort into five subgroups from minimal to severe psoriasis using the PSOdisk total score. Depression prevalence varied according to the assessment criteria for specificity, frequency, and severity. Different mood disorders other than major depression emerged when we used DSM-IV-TR criteria. Correlation analysis of the criteria we used to diagnose depression or depressed mood indicated that a dysfunctional coping strategy was highly and positively correlated only in patients of the severe subgroup. Differently, a negative correlation emerged between the SF-36 Mental Summary Component (MSC) and behavioral disengagement, thus suggesting that psychopathological distress might induce patients with a marked/severe psoriasis to adopt dysfunctional coping strategies. Dermatologists are fundamental in detecting comorbid depression, referring psoriasis patients to mental health specialists to achieve adequate treatments, and preventing suicide risk.

Psoriasis, a chronic inflammatory skin disorder, is often accompanied by psychological comorbidities. While the psychological effects of plaque psoriasis are well-documented, other psoriasis subtypes, such as guttate, erythrodermic, pustular, and palmoplantar psoriasis (PPP), remain less studied. This review aimed to examine psychological comorbidities in less-studied psoriasis variants. However, the available literature was limited to PPP and psoriatic arthritis (PsA). A comprehensive search of Medline, Embase, PsycINFO, and PubMed was conducted up to February 2025. Data were extracted on psychological comorbidities, disease severity, and patient demographics in patients with PPP and/or PsA. Seventeen studies (76,567 patients) were included. Depression prevalence in PsA ranged from 7.1% to 41%. In PPP, depression prevalence ranged from 5.7% in Japan to 17.1% in the United States. Anxiety prevalence ranged from 5.1% to 61.4%. Both depression and anxiety were more severe in patients with higher disease activity, with depressed patients being over 4 times more likely to report higher disease severity (AOR: 4.43, P = .001). Additional psychological comorbidities included sleep disturbances (38%) and mood disorders in PPP patients (19.6%). Functional impairment ranged from mild to moderate, with moderate but variable discomfort reported in pain assessments. Current evidence on psychological comorbidities in non-plaque psoriasis is limited to PsA and PPP. PsA and PPP can potentially be associated with an elevated risk for psychological comorbidities, particularly depression, anxiety. These findings highlight the need for comprehensive mental health screening and management in these patient populations. Further research is needed to characterize the psychological burden in other non-plaque psoriasis subtypes.

… The association between psychiatric comorbidity and … psychiatric burden to be significant in patients with psoriasis. It represents an unmet need with treatment of psychiatric comorbidity …

Ab s t r Ac t Background: Psoriasis has been known to be associated with various psychiatric comorbidities like depression, anxiety, adjustment disorder, persistent stress, and impaired sexual and marital life. Aim: The aim of this study was to find out the prevalence of psychiatric comorbidities in patients with psoriasis. Methods: One hundred and forty-nine consecutive patients with psoriasis fulfilling the inclusion criteria got examined by a senior consultant dermatologist. Sociodemographic and clinical pro forma were filled in. Following informed consent, the patients were assessed for severity of the condition by Psoriasis Area and Severity Index score and were screened for the presence of psychiatric comorbidities by a validated Bengali version of the screening tool Self-Reporting Questionnaire 20 (SRQ 20). Subjects were administrated in succession with Bengali version of Self-Reporting BDI (Beck Depression Inventory) (already validated), Hamilton Anxiety Scale, and SKINDEX 61 (interviewer-rated) for evaluating the depression, anxiety, and psychiatric morbidities under the guidance of a consultant psychiatrist. Results: In index study, a majority of the subjects (98%) had a mild degree of anxiety symptoms. In BDI, the majority of the subjects had minimal depression, whereas near about two-fifths of the subjects had mild to severe depression. As per SRQ assessment of psychopathology, the majority of subjects (57.71%) had psychiatric disorder. Around two-thirds male and half of the female subjects, respectively, were SRQ positive. On SKINDEX-61, the majority of the subjects responded affirmatively in a decreasing order of frequency in the following domains: embarrassment, discomfort, fear, anger, physical limitation, depression, and cognitive impairment. Severity of psoriasis had a significant positive correlation with depression severity grades and the presence or absence of psychopathology. The index study also revealed that the number of body sites involved in psoriasis had a significant positive correlation with depression severity. Conclusion: Psoriasis was associated with significant psychiatric comorbidities, and those need to be addressed.

… Improvement in PASI score was correlated with decreases of HAM-A and HAM-D scores. … effects to ustekinumab on both psoriasis and psychiatric comorbidities achieving a reduction in …

The link between psoriasis and psychiatric disorders is crucial due to their bidirectional relationship and shared biological mechanisms. Due to the chronicity, psoriasis often leads to psychological distress and exacerbation of conditions such as depression and anxiety, while stress and emotional factors can trigger psoriasis flares. The visible nature of psoriasis lesions can cause social stigma, embarrassment, and negative body image, which may exacerbate psychiatric symptoms. This interplay can have an impact on treatment outcomes, necessitating a comprehensive approach to care that addresses both physical and psychological components, thereby enhancing overall well-being and quality of life (QoL) for people affected. We aimed to collect and study the sociodemographic profile of patients with psoriasis in a tertiary care hospital and to estimate common psychiatric comorbidities in them. The study also aims to assess the severity of psoriasis and QoL of individuals living with psoriasis using standardized assessment tools. Subsequently, the correlation between the severity of psoriasis symptoms and the presence of psychiatric comorbidities and their combined effect on QoL was assessed. A cross-sectional study was conducted on patients diagnosed with psoriasis vulgaris who presented to the dermatology department of a tertiary care hospital in Goa between July 2023 and December 2023 using a sociodemographic questionnaire, the MINI plus scale, the WHOQOL scale, and the Psoriasis Area and Severity Index scale. Nearly half of the patients in the study experienced psychiatric comorbidities. The study revealed significant correlations between psychiatric comorbidities and QoL in all domains, including physical, psychological, social, and environmental. In addition, associations were observed between psychiatric comorbidities and current illness status. Psoriasis impacts all aspects of a person’s QoL and increases the likelihood of acquiring a psychiatric disease, further lowering the affected person’s QoL.

Background Dermatosis has symptoms of flushing, itching, pain, and burning, which causes psychological distress in patients. Methods We collected the data of 214 patients from the Wuhan Institute of Dermatology and Venereology from January 2020 to January 2022, including age, gender, diagnosis, Hamilton Anxiety Rating Scale (HAMA), and anxiety. First, descriptive analysis and difference analysis of the included data were carried out. Second, a correlation matrix was used to exclude the confounding factors with strong collinearity. Finally, logistic regression was used to analyze and predict the risk factors of anxiety. Results In the anxiety group and nonanxiety group, eczema and generalized eczema accounted for the largest proportion, and there was no difference in the composition of the diagnosis between the 2 groups. Several related analyses proved the accuracy of the logistic model. The results showed that age had a protective effect on the anxiety of patients with skin diseases [odds ratio (OR) =0.8606 with 95% confidence interval (CI): 0.7812, 0.8987]. Neurodermatitis (OR =1.0853 with 95% CI: 1.0115, 1.2512), eczema (OR =1.1358 with 95% CI: 1.0215, 1.2129), generalized eczema (OR =1.3346 with 95% CI: 1.1212, 1.5521), and psoriasis (OR =1.3685 with 95% CI: 1.1728, 1.6215) were associated with the anxiety of patients. Prediction analysis showed that with increase of patients’ age, the likelihood of anxiety decreased. Conclusions This study demonstrated a strong correlation between skin diseases and anxiety and that the likelihood of anxiety decreases as age increases. Therefore, psychological intervention for patients with skin diseases, especially young patients, is essential.

Background Psoriasis significantly impacts patients’ mental health and social relationships, often leading to feelings of stigmatization and shame due to the visibility of skin lesions. This study aimed to identify factors influencing the quality of life in patients with psoriasis. Methods A cross-sectional study was conducted from November 2018 to December 2020, involving 100 patients treated for psoriasis. The research utilized the WHO Quality of Life Questionnaire (WHOQoL-Bref), the Psoriasis Area and Severity Index (PASI), the Acceptance of Illness Scale (AIS), the Hospital Anxiety and Depression Scale (HADS), and the Mini Nutritional Assessment (MNA). The analysis included demographic, clinical, and psychological variables to evaluate their impact on quality of life. Results The multivariate linear regression model revealed that significant independent predictors of quality of life included age (p=0.001), duration of disease (p=0.004), and nutritional status (p=0.002). In the physical domain, factors such as phototherapy (r=2.46) and anxiety levels assessed by the HADS anxiety subscale (r=−0.23) were particularly relevant. In the psychological domain, the presence of psoriatic arthritis (r=1.978), hand and foot psoriasis (r=2.34), and scores on the HADS anxiety (r=−0.212) and depression subscales (r=−0.226) were significant. Male gender (r=1.632) and depressive symptoms (r=−0.352) impacted the social domain. In the environmental domain, predictors included erythrodermic psoriasis (r=1.98), hand and foot psoriasis (r=2.312), phototherapy (r=1.877), PASI score (r=−0.04), and depression as measured by HADS (r=−0.228). Conclusion The primary predictors of quality of life in patients with psoriasis are the type of psoriasis, the presence of anxiety and depressive disorders, and treatment with phototherapy. However, the study’s single-center design and relatively small sample size may limit the generalizability of the findings. Further multi-center studies are needed to confirm these results and broaden their applicability.

Health-related quality of life (HRQoL) is reduced in atopic dermatitis and psoriasis. Several factors impact HRQoL including sociodemographic and skin disease-related characteristics, health behaviours, cardiometabolic comorbidities, and psychological conditions. However, their differential and unique effects on HRQoL are not well studied. In this cross-sectional online survey, adult patients with atopic dermatitis (n = 155) or psoriasis (n = 246) provided data on features of their respective skin diseases, health behaviours, and cardiometabolic comorbidities. Validated self-report measures assessed HRQoL, psychopathology (Patient Health Questionnaire-4), and stress (Perceived Stress Scale). Linear regression analyses were used to determine key predictors of HRQoL. In atopic dermatitis, linear regression analyses revealed that self-rated disease severity (Patient-Oriented Eczema Measure), anxiety, and stress were significant predictors of the Dermatology Life Quality Index (DLQI), explaining 59% of the variance. In psoriasis, disease severity (Psoriasis Symptoms and Signs Diary) and depression significantly predicted DLQI, with an explained variance of 57%. Health behaviours and cardiometabolic comorbidities did not impact DLQI scores. While skin disease severity is the most important determinant of HRQoL, stress and anxiety are important in atopic dermatitis, whereas depression is relevant in psoriasis. These findings hold implications for both clinical practice and research.

The impact of dermatological diseases goes beyond symptoms and often includes psychosocial burden. Self-stigmatization plays a key role in this relationship and was compared in patients with psoriasis and atopic dermatitis to evaluate the validity of cross-disease stigmatization models. In total, 101 patients per indication were included in this cross-sectional study. Besides sociodemographic and clinical data, patient-reported outcome measures relating to self-stigmatization, depression, anxiety, and quality of life were compared across groups. Sociodemographic and clinical factors were tested for their moderating effects between self-stigmatization and quality of life. Group mean comparisons yielded no significant differences in self-stigmatization between patient groups. In both diseases, self-stigmatization significantly predicted depression and anxiety symptoms as well as quality of life. Current symptoms, not having close social relationships, and lower age predicted self-stigma in patients with psoriasis, whereas the involvement of sensitive body areas, the sum of previous treatments, and female sex were predictors in patients with atopic dermatitis. In both groups, symptoms had significantly moderating effects. The results underline the relevance of self-stigmatization in patients with chronic skin diseases. Awareness should be raised, screening implemented, and psychosocial support offered early on. Assessments, conceptual models of self-stigma, and interventions are probably applicable for both diseases. SIGNIFICANCE Patients with chronic skin diseases often experience psychosocial impairment alongside somatic effects. This can have a considerable influence on their entire lives. Stigmatization, especially when generated by oneself, is a key element in the relationship between social, demographic, and clinical factors and quality of life, feelings of depression, and anxiety. Therefore, the mechanisms of self-stigmatization should be studied so that screenings can be developed, and appropriate interventions devised, thus reducing the psychological and social burdens on affected individuals and thereby empowering them throughout their lives.

Background and Objectives: Atopic dermatitis and psoriasis are life-long inflammatory diseases affecting more than just the skin. Although their link with mental comorbidities has been established, the role of using self-assessment questionnaires is still debated. The aim of our study was to evaluate differences in the quality of life (DLQI) as well as depression (PHQ-9) and anxiety (GAD-7) questionnaire data and determine their link with individual patient and skin disease factors. Materials and Methods: Demographic, clinical and questionnaire data were collected from Riga 1st hospitals archive. For statistical evaluation, the Mann–Whitney U test and Spearman’s rank correlation coefficient were used. Results: The median DLQI for atopic dermatitis and psoriasis was 10.5 and 10, respectively. The prevalence among women with atopic dermatitis who had a PHQ-9 ≥ 10 was 42.9%, compared to 50.0% in men, and GAD-7 ≥ 10 prevalence was 14.3% and 20.0%, respectively. Psoriatic women had a PHQ-9 ≥ 10 prevalence of 25.0% compared with 28.9% in men. The prevalence of GAD-7 ≥ 10 was 20.0% in females and 15.8% in males. GAD-7 score was elevated in patients with psoriatic genital involvement. Multiple positive correlations were noted between PHQ-9, GAD-7 and DLQI scores. Conclusions: Patient quality of life and prevalence of anxiety and depression symptoms are impacted by psoriasis and atopic dermatitis, with similar patterns observed across genders and comorbidities. Genital involvement could be associated with more severe anxiety symptoms. The correlations between PHQ-9, GAD-7 and DLQI scores indicate that further evaluation might be necessary if quality of life is impaired.

Purpose Psoriasis is a chronic immune-mediated disease with global prevalence of 2-3% that is associated with significantly reduced quality of life (QoL) and worsened mental health. Despite this, there is a lack of research in African psoriasis populations, with no modern epidemiological studies conducted in Kenya to examine these factors. This study aims to identify demographic and clinical features associated with dermatology-related QoL and mental health among psoriasis patients enrolled in the newly established Kenyan Psoriasis Registry (KPR), based at Moi Teaching and Referral Hospital in Eldoret, Kenya. Patients and Methods In a cross-sectional analysis of 97 adult psoriasis patients enrolled in the KPR, we evaluated associations of demographic and disease characteristics with independent outcomes of dermatology-associated QoL (Dermatology Life Quality Index, DLQI), anxiety (Generalized Anxiety Disorder 7-item, GAD-7), and depression (Patient Health Questionnaire 9-item, PHQ-9). Univariate and multivariate linear regression models were used to identify associations, with P < 0.05 considered statistically significant. Results In univariate analyses, age, female gender, marital status, certain subethnicities, high-impact body sites, itch and pain, sleep disturbance, and disease severity were factors associated with worse QoL, anxiety, and depression scores. In multivariate analyses, younger age, Itch Numeric Rating Scale, and Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance T-score remained significantly associated with worse DLQI. Both PROMIS Sleep Disturbance and separated marital status were associated with worse GAD-7 and PHQ-9. Conclusion Kenyan psoriasis patients experience significant QoL and mental health burden, with younger age, itch, sleep disturbance, and separated marital status associated with worse outcomes.

Psoriasis is a chronic inflammatory skin disease showing a high burden due to its aesthetic, social, psychological, and quality of life (QoL) implications which also affect patient‐physician relationship and, consequently, the adherence to treatments. Limited data on the natural history of psoriasis and factors predicting its prognosis are available. The aim of this study was to investigate patients' global characteristics, including treatments, associated with QoL impairment in psoriasis. Questionnaires evaluating sociodemographic features and Dermatology Life Quality Index (DLQI) were administered to patients. Multiple regression analysis was performed to evaluate factors associated with a large effect on patient's life (DLQI > 10), moderate effect on patient's life (DLQI ≥ 6 ≤ 10), small effect on patient's life (DLQI ≥ 2 < 6), and no effect on patient's life (DLQI < 2). Overall, 1052 consecutive patients affected by mild‐to‐severe psoriasis were recruited. Our logistic regression analysis showed that the influencing factors for a large effect on QoL were living in Southern Italy, depression, psoriatic arthritis, and psoriasis localization on facial, intertriginous, palmoplantar, trunk and scalp regions. For a moderate effect on patient's life, phototherapy and non‐biological systemic therapies resulted to be the predictive factors. Mild psoriasis, living in social housing and the isolated involvement of scalp psoriasis had a small effect on QoL. Lastly, mild psoriasis and current biological therapies including anti‐IL‐12/23, anti‐IL‐17, and anti‐TNF‐α were positively associated with no life quality impairment. Perceived quality of life impairment in psoriasis not only depends on the skin disease but rather on patients' global characteristics. Therefore, the individual background of these patients should be respected in the selection of treatment options.

Psoriasis is a multisystemic inflammatory disease with a significant burden in terms of disability and reduced quality of life. The interrelations between disease severity, psychological well-being, and disability and/or health-related quality of life (HRQOL) of psoriatic patients are not fully understood. The aim of the study was to assess the relative role of disease severity, depressive symptoms, and insecure attachment in predicting disability and HRQOL in 105 patients with psoriasis. Objective measures of disease severity included the Body Surface Area (BSA), the Psoriasis Area and Severity Index (PASI), and the Pain Visual Analog Scale (pain-VAS). The Sheehan Disability Scale (SDS). The Dermatology Life Quality Index (DLQI). Multivariate hierarchical regression analysis showed that a preoccupied style of attachment and the presence of depressive symptoms were predictors of disability and HRQOL over and above the contribution of demographic and clinical variables. The inclusion of attachment and depression into multivariate regression models improved substantially the prediction of disability and HRQOL. Conversely, the predictive utility of objective indicators of disease severity was scarce and only the pain-VAS emerged as a significant predictor of disability whereas there were no significant correlations between HRQOL and any of the objective indicators of disease severity. Measures capturing patients’ perspectives of the functional impact of disease should be routinely included in the clinical assessment of psoriasis.

Psoriasis is a chronic and recurrent immune-related skin disease that often causes disfigurement and disability. Due to the visibility of lesions in patients and inadequate understanding of dermatology knowledge in the general public, patients with psoriasis often suffer from stigma in their daily lives, which has adverse effects on their mental health, quality of life, and therapeutic responses. This review summarized the frequently used questionnaires and scales to evaluate stigmatization in patients with psoriasis, and recent advances on this topic. Feelings of Stigmatization Questionnaire, Questionnaire on Experience with Skin Complaints, and 6-item Stigmatization Scale have been commonly used. The relationship between sociodemographic characteristics, disease-related variables, psychiatric disorders, quality of life, and stigmatization in patients with psoriasis has been thoroughly investigated with these questionnaires. Managing the stigmatization in patients with psoriasis needs cooperation among policymakers, dermatologists, psychologists, psychiatrists, researchers, and patients. Further studies can concentrate more on these existing topics, as well as other topics, including predictors of perceived stigmatization, stigmatization from non-patient groups, influence of biologics on stigmatization, and methods of coping with stigmatization.

Psoriasis is a chronic immune-mediated skin disease with known physical and mental health comorbidities, such as cardiovascular disease, depression, and anxiety. Psoriasis also has a significant impact on quality of life and sleep due to factors like itch and pain. This study aims to assess the relationship between sleep quality, mental health, and psoriasis, and specifically investigate the impact of poor sleep quality on mental health outcomes within participants with psoriasis. In this cross-sectional study, we enrolled 556 participants into two cohorts: 487 participants were enrolled into the psoriasis cohort, and 69 were enrolled into the healthy control cohort. The demographics, disease severity, family history, sleep quality (PROMIS 8a, PROMIS 8b, and Insomnia Severity Index), and mental health (Patient Health Questionnaire-8 and Generalized Anxiety Disorder-7) of participants were assessed. Descriptive analysis and logistic regression models were employed to examine sleep and mental health, adjusting for potential confounders like demographics and comorbidities. A comparison of patients with psoriasis and healthy controls revealed worsened sleep and mental health outcomes in patients with psoriasis. Among participants with psoriasis, greater sleep impairment (Patient-Reported Outcomes Measurement Information System (PROMIS) 8a), sleep disturbance (PROMIS 8b), and insomnia were significantly associated with anxiety (ORa 1.22; 95% confidence interval (CI) 1.16, 1.30; ORa 1.26; 95% CI 1.16, 1.80; ORa 5.13; 95% CI 2.91, 9.33; respectively) and depression (ORa 1.42; 95% CI 1.32, 1.56; ORa 1.16; 95% CI 1.08, 1.26; ORa 7.04; 95% CI 4.01, 12.77; respectively). These findings underscore the importance of recognizing how psoriasis can impact mental health and sleep. Building a collaborative relationship between patients with psoriasis and their providers is essential to improve overall sleep and life quality.

Introduction Psoriasis (Pso) and psoriatic arthritis (PsA) can reduce the quality of life (QoL) and are known to be associated with depression. Within this study, we aimed to assess the burden of disease, functional capacity, quality of life, and depressive symptoms and identify factors predicting functional impairment and depression in patients with psoriatic disease. Methods A cross-sectional survey was conducted in a cohort of 300 patients with psoriatic disease including 150 patients from a university hospital dermatology outpatient clinic and 150 patients from a university hospital rheumatology outpatient clinic. Questionnaire-based assessment of signs of arthritis (Psoriasis Epidemiology Screening Tool; PEST), functional status (Functional Questionnaire Hannover; FFbH), quality of life (World Health Organization Quality of Life Brief Version; WHOQOL-BREF), and depressive symptoms (Patient health questionnaire 9; PHQ-9) and retrospective medical chart analysis were performed. Results Despite treatment, burden of disease was high. Joint pain was reported in multiple regions in patients with Pso ( n  = 111) and patients with PsA ( n  = 189), but with differences in frequency and distribution patterns of symptoms. Functional impairment in everyday life was independently associated with diagnosis of PsA (odds ratio [OR] 9.56, p  = 0.005), depressive symptoms (OR 5.44, p  < 0.001) and age (OR 1.04, p  = 0.033). At least mild depressive symptoms were demonstrated in 54% and 69% of patients with Pso and PsA, respectively. In a logistic regression model, depressive symptoms were independently associated with functional impairment (OR 4.50, p  = 0.003), axial complaints (OR 2.80, p  = 0.030), diagnosis of psoriatic arthritis (OR 2.69, p  = 0.046), and number of joint regions with complaints (OR 1.10, p  = 0.032). Conclusion Functional impairment, QoL, and depressive symptoms are mutually interdependent. Early diagnosis of PsA and initiation of anti-inflammatory therapy are essential to avoid long-term damage, disability, and mental health complications. However, despite therapy many patients with PsA, and especially female patients, report a substantial residual disease burden due to their psoriatic disease which will need to be addressed by a more patient-centered approach.

This study aimed to investigate the perceived threat, mental health outcomes, behavior changes, and associated predictors among psoriasis patients during the COVID-19 pandemic. The COVID-19 has been known to increase the health risks of patients with psoriasis owing to patients’ immune dysregulation, comorbidities, and immunosuppressive drug use. A total of 423 psoriasis patients not infected with COVID-19 was recruited from the Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Chang Gung Memorial Hospital, and China Medical University Hospital from May 2020 to July 2020. A self-administered questionnaire was used to evaluate the perceived threat, mental health, and psychological impact on psoriasis patients using the Perceived COVID-19-Related Risk Scale score for Psoriasis (PCRSP), depression, anxiety, insomnia, and stress-associated symptoms (DAISS) scales, and Impact of Event Scale-Revised (IES-R), respectively. Over 94% of 423 patients with psoriasis perceived threat to be ≥ 1 due to COVID-19; 18% of the patients experienced psychological symptoms more frequently ≥ 1, and 22% perceived psychological impact during the pandemic to be ≥ 1. Multivariable linear regression showed that the higher psoriasis severity and comorbidities were significantly associated with higher PCRSP, DAISS, and IES-R scores. The requirement for a prolonged prescription and canceling or deferring clinic visits for psoriasis treatment among patients are the two most common healthcare-seeking behavior changes during the COVID-19 pandemic. Psoriasis patients who perceived a higher COVID-19 threat were more likely to require a prolonged prescription and have their clinic visits canceled or deferred. Surveillance of the psychological consequences in psoriasis patients due to COVID-19 must be implemented to avoid psychological consequences and inappropriate treatment delays or withdrawal.

Abstract Psoriasis, a chronic inflammatory disease affecting approximately 3% of the global population, presents complex challenges that extend beyond its physical manifestations. This comprehensive review examines the multidimensional impact of psoriasis on patients’ lives, encompassing physical, psychological, and social aspects. We analyze current therapeutic approaches, from traditional systemic treatments to cutting-edge biological therapies and emerging oral medications, evaluating their efficacy, limitations, and accessibility. The review explores how disease severity correlates with quality of life measures and psychological burden, noting the high prevalence of depression (20%), anxiety (21%), and suicidal ideation (0.77%) among affected individuals. However, emerging evidence suggests that clinical severity, as measured by PASI or BSA, does not always correlate with the psychoemotional burden experienced by patients, highlighting the need for a more comprehensive assessment of disease impact. We discuss the evolution of treatment strategies, highlighting recent developments in targeted therapies, including JAK inhibitors, particularly selective TYK2 inhibitors, and PDE4 inhibitors, which offer promising alternatives to traditional treatments. Additionally, we examine the role of various assessment tools and quality of life measures in evaluating treatment outcomes. The analysis emphasizes the need for a holistic approach to patient care that integrates medical interventions with psychological support, addressing both the visible and invisible burdens of the disease. This review underscores the importance of personalized treatment strategies that consider not only clinical efficacy but also patient preferences, accessibility, and long-term safety profiles.

Abstract Psoriasis is a common chronic, systemic inflammatory disease, affecting approximately 2% of the population worldwide. Psoriasis is associated with profound psychosocial comorbidity with a burden that extends well beyond the physical signs and symptoms. Psychosocial comorbidities strongly associated with psoriasis include anxiety and depression, suicidal ideation, and substance misuse. There is a substantial unmet need for access to psychological support for people with skin disease in the UK. Recent reports found that while up to 98% of patients felt that their skin disease had affected their emotional or psychological well-being, only 18% sought help. This care gap is largely due to a lack of awareness about the limited available services alongside poor recognition, diagnosis, and triaging. Addressing psychosocial support needs starts with early identification, which can be complex and challenging. Once patients who need further support are identified, outcomes can be improved through prompt and effective treatment of inflammation, cognitive behavioural therapy, meditation and mindfulness-based therapy (including motivational interviewing), and to some extent psychotropic medication. Finally, resources for mental health support are notoriously limited, with dire consequences for patients. It is imperative that a proportion of the new funding promised for mental health services is bookmarked for dermatology patients and adequate provision of multidisciplinary psychodermatology teams to best serve the needs of this population. Ultimately, psoriasis is a complex condition with multifactorial psychological and biological drivers. Psoriasis is associated with high levels of distress, which is often under-recognized. Fully addressing this condition requires a holistic approach to the physical and psychosocial aspects to maximise adherence, efficacy, and optimise patient quality of life.

Psoriasis has a strong impact on patients’ lives and is closely linked to psychiatric disorders such as depression, anxiety and substance‐related disorders, especially dependence on alcohol and nicotine. The aim of our study was to systematically assess the psychiatric comorbidity and possible associations between psychological factors, disease severity and dermatology‐related quality of life in psoriatic patients from a high‐need university hospital dermatology department. Consecutive psoriatic patients (new and permanent patients) at the Department of Dermatology, University Hospital Essen, Germany, were asked to fill out a paper‐based questionnaire. In the first part of the questionnaire, baseline demographics, pre‐existing mental disorders and data on substance abuse were collected. In the second part of the questionnaire, mental and physical health was explored using different validated self‐rating tests. The current Psoriasis Area and Severity Index (PASI) was documented by a dermatologist. Patients with signs of mental disorders were offered an appointment with a board‐certified psychiatrist. Between August 2016 and February 2019, 228 consecutive psoriatic patients (138 men [60.5%], 90 women [39.5%]; mean age, 48.3 years [standard deviation, 13.6; range, 18–80]) participated in the study. Approximately 50% of the patients had evidence of suffering from mental health problems, mostly depression and anxiety, as well as alcohol dependence. Patients with a PASI of 3 or more showed a statistically significant reduced Dermatology Life Quality Index (DLQI) and a significantly impaired psychological as well as physical quality of life. DLQI correlated with all psychological test results. The data indicate a significant psychological burden in a tertiary psoriatic population. Our findings underscore the importance of screening psoriatic patients for psychiatric disorders, with a focus on depression, anxiety as well as alcohol and nicotine dependence, in a multidimensional approach involving psychiatrists and psychologists.

Background: Generalized pustular psoriasis (GPP) is a rare, systemic disease characterized by persistent or recurrent flares of painful neutrophilic pustules. There is limited real-world evidence characterizing patients with GPP. Objectives: To establish the distinguishing characteristics of GPP relative to plaque psoriasis, and help inform future treatment decisions and improve patient outcomes. Methods: North American adults with GPP or plaque psoriasis (without pustules) identified from CorEvitas’ Psoriasis Registry were included in this dataset. Registry enrollment data, including patient sociodemographics, disease characteristics, medication use, and patient-reported outcome measures were compared for patients with GPP vs those with plaque psoriasis. This study was descriptive, and no hypothesis tests were performed. Results: In this sample, patients with GPP (N = 60) reported greater median (interquartile range) pain (20 [3-62] vs 5 [0-35]), fatigue (44 [15-73] vs 20 [4-50]), and itch (59 [10-85] vs 22 [5-70]) than those with plaque psoriasis (N = 4894). Descriptively, patients with GPP also reported more anxiety and depression (EQ-5D-3L: 38% vs 26%) and had more treatment experience (≥2 previous systemics: 15% vs 7%). Conclusions: A greater degree of symptom severity and impact on quality of life was reported by patients with GPP compared with plaque psoriasis in this sample. Importantly, patients with GPP had more treatment experience, suggesting that current treatment options do not adequately resolve the disease—highlighting the need to develop more effective GPP treatments.

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.

This descriptive study aimed to identify factors that can influence the quality of life of psoriasis patients. A total of 118 psoriasis outpatients completed a questionnaire consisting of the Dermatology Life Quality Index (DLQI), Psoriasis Life Stress Inventory (PLSI), Mishel Uncertainty in Illness Scale-Community form (MUIS-C), Center for Epidemiologic Studies-Depression scale (CES-D), and Self-Reported Severity Score (SRSS). The Psoriasis Area Severity Index (PASI) was calculated. The collected data were analyzed by descriptive statistics, t-test, one-way ANOVA, Scheffé test, Pearson’s correlation analysis, and stepwise multiple regression using SPSS/WIN 26.0. The average score of the DLQI was 14.19 ± 6.83 (range 0–30); the DLQI showed statistically significant differences according to age (F = 4.02, p = 0.021) and smoking type (F = 7.49, p = 0.001). The dermatology-related quality of life was significantly affected by psoriasis-related stress (β = 0.37, p < 0.001), depression (β = 0.35, p < 0.001), and subjective severity (β = 0.19, p = 0.005); these variables explained 60.7% of the variance in the dermatology-related quality of life (F = 61.34, p < 0.001). The results demonstrated that psoriasis-related stress, depression, and perceived severity of psoriasis should be considered when developing nursing interventions to improve patients’ quality of life.

Psoriasis is a chronic relapsing dermatological disorder that significantly affects the patients’ psychosocial well-being and quality of life (QOL). This study aimed to determine the proportion of severely impaired QOL, the factors associated with severely impaired QOL, and its correlation with depression among semi-urban populations on the Northeast Coast of the Peninsular Malaysia. A cross-sectional study was conducted among 257 patients with psoriasis at the Dermatology Clinic of Hospital Sultanah Bahiyah via a self-administered questionnaire that included sociodemographic profiles, the validated Malay version of the Dermatology Life Quality Index (DLQI), and the Malay version of the Beck depression scale. The data were analysed using logistic and linear regression models. About 20.5% of the patients had severely impaired QOL quality of life, while 79.5% of the patients had non-impaired QOL. Multiple logistic regression analysis showed that the psoriatic severity [Adjusted OR = 1.91, 95% CI: 1.76, 9.93; p < 0.001] and exposed area [Adjusted OR 2.93, 95% CI: 0.38, 2.29; p = 0.050] had a significant association with severely impaired QOL. Among the patients, 18.7% had a positive result in the screening for depression, which revealed a significant association between QOL and depression scores [r = 0.47, 95% CI: 0.35, 0.56, p < 0.001]. Psoriasis can impair QOL and have a relation with mental health. Regular screening for depression among patients with psoriasis is a beneficial strategy for the early detection of depression, especially in semi-urban areas.

Psoriasis is a chronic inflammatory skin disease that significantly affects patients’ quality of life (QoL), as measured by the Dermatology Life Quality Index (DLQI). This study employs penalized regression and machine learning (ML) techniques to develop predictive models for DLQI in psoriasis patients. Using a dataset of 149 Thai patients, 16 models including multiple linear regression (MLR), five penalized regression models, five Random Forest (RF) models, and five Support Vector Regression (SVR) models were trained. Feature selection was performed using ridge, LASSO, adaptive LASSO, elastic net, and adaptive elastic net to optimize predictive accuracy and interpretability. Results indicate that RF-L1L2, a Random Forest model trained on elastic net-selected features, achieved the best performance with the lowest Root Mean Square Error (RMSE) of 5.6344, and lowest Mean Absolute Pencentage Error (MAPE) of 35.5404, outperforming traditional regression models. Bland–Altman analysis further confirmed the superiority of RF models in reducing systematic bias and improving predictive agreement. However, our findings should be interpreted with caution due to the limitations of small-sample size modeling. Key features included four psychological stress factors, age, Psoriasis Area and Severity Index (PASI), comorbidities and gender, reinforcing the interplay between physical and mental health. SHapley Additive exPlanations (SHAP) was employed in model explainability. Integrating ML models into clinical decision-making, can enhance patient stratification and personalized treatment strategies, with potential applications in AI-driven healthcare solutions. • Apply penalized and ensemble methods to predict quality-of-life outcomes in chronic dermatological care. • Use machine learning models to identify physical and psychological predictors of disease impact. • Select critical clinical features using advanced regularization and SHAP for enhanced interpretability. • Validate model performance with multiple metrics and consistency checks to ensure robustness. • Enable personalized care strategies by predicting high-impact patient profiles in clinical practice.

Introduction: Psoriasis is a systemic inflammatory condition that effects the psychosocial functioning of the individuals battling the disease. Such visible conditions are associated with catastrophizing, discrimination and stigma. Aim: The current Meta analysis aims to understand the correlates of internalized, perceived and other forms of stigma in adult patients with psoriasis. Method: The protocol in this study was registered with PROSPERO on 30 Oct. 2025 number CRD420251143904. PRISMA 2020 statement was used as guidelines for this review. PubMed, Web of Science, Scopus and JSTOR databases were searched for observational studies exploring stigma in adult patients diagnosed with psoriasis and any of its subtypes. The risk of bias was assessed using Study Quality Assessment Scale recommended by the Agency for Healthcare Research and Quality (AHRQ). All correlation coefficients (r) and effect sizes (spearman rho, AOR, β) were first standardized using the Fisher's r-to-Z transformation within the R package meta (metacorfunction). The pooled effect size was then estimated using a Random-Effects model, and the 95% confidence intervals were calculated using the Hartung-Knapp adjustment method. The pooled effect size was subsequently back-transformed to the correlation coefficient (R) for interpretation. Results: After removal of the duplicates and final screening of the full texts, twenty two studies were included in the final synthesis of the studies. Several correlates of stigma were identified such as demographic variables, psychological variables and disease related variables. Conclusion: It is essential for dermatologists and other medical professionals to address issues such as impaired life quality, increased disease severity and depressive symptoms in patients with psoriatic and related skin diseases.

Background: Psoriasis is a systemic inflammatory disease capable of creating stigmatization in the form of social exclusion and decrement of psychological conditions. Aim: The aim of the study was to determine the level of stigmatization in patients with plaque psoriasis. Methods: The study included 166 patients with plaque psoriasis (55.6% women and 44.3% men) with Psoriasis Area and Severity Index scores ≤10. The age of the study patients ranged between 18 and 72 years (arithmetic mean = 37.4; median = 38; standard deviation [SD] = 11.0). The mean age at the diagnosis of psoriasis was 21.5 years (median = 20; SD = 9.1) and disease duration varied from 2 to 59 years (arithmetic mean = 15.8; median = 15; SD = 11.3). The study patients completed the Polish version of the 6-item Stigmatization Scale and the 33-item Feelings of Stigmatization Questionnaire and a survey developed by the authors of this study, containing questions about the participants’ sociodemographic characteristics (sex, age, place of residence, marital status, education, employment status) and information about their disease (location of psoriatic lesions, time elapsed since the diagnosis of psoriasis). Results: The mean score for the 6-item Stigmatization Scale for the whole study group was 7.6 out of 18 points (median = 7; SD = 3.8; minimum = 0; maximum = 17). The average score for the 33-item Stigma Feelings Questionnaire in our series was 84.5 out of 165 points (median = 88; SD = 20.9; minimum = 30; maximum = 136). A statistically significant sex-related difference was observed in the 6-item Stigmatization Scale scores, with higher stigmatization levels found in men than in women (p = 0.0082). Moreover, significantly higher levels of stigmatization were observed in countryside dwellers (p = 0.0311) and unmarried persons (p = 0.0321). Patients with a longer history of the disease (≥15 years) scored significantly higher on the 6-item Stigmatization Scale (p = 0.0217) than those in whom psoriasis lasted less long, and presented with higher, at the threshold of statistical significance, scores for the 33-item Feelings of Stigmatization Questionnaire. Conclusions: Stigmatization awareness should be promoted among physicians and psoriatic patients to improve psoriasis management.

The aim of the study was to analyze the level of stigmatization among patients with plaque psoriasis according to their demographic and clinical characteristics. The study included 122 patients who completed the 6-item and 33-item Feelings of Stigmatization Questionnaire and a sociodemographic survey. The analysis of the 6-item Stigmatization Scale showed a mean stigmatization score of 6.4 points. (Me = 6; s = 3.7); the mean score for the 33-item scale was 81.3 points (Me = 79.5; s = 19.9). Female patients felt stigmatized more often than males. Respondents living in the countryside had a stronger sense of stigmatization in the Sensitivity to Others’ Attitudes (p = 0.0238) and Secretiveness (p = 0.0234) domains. The presence of psoriatic lesions across the entire body was the only explanatory variable significantly determining the level of stigmatization in the Positive Attitudes domain, either through the main effect or through the interaction with the patient sex. A highly significant difference was found for the feeling of being flawed domain (p = 0.044), with a mean score of 13.4 points. The issue of stigmatization in psoriasis deserves more attention, as the analysis of this problem may provide a better insight into the effect of the disease on the patient’s condition, not merely in the context of its clinical manifestation.

Background Patients with psoriasis also often experience stigma due to skin lesions, and this stigma further leads to severe psychological problems such as anxiety and depression. However, it is unclear how, and under what conditions, stigma relates to mental health. This study aimed to investigate the current status and interrelationships between stigma, social appearance anxiety, alexithymia, and mental health in patients with psoriasis. It also sought to identify the factors that influenced their mental health and to examine the mediating roles of social appearance anxiety and alexithymia in the relationship between stigma and psychological health. Method From June to December 2023, patients with psoriasis were recruited from the outpatient department or ward of the dermatology department of a tertiary hospital in Guangzhou. Patients were assessed using the General Information Questionnaire, the Psoriasis Stigma Scale, the Social Appearance Anxiety Scale, the Toronto Alexithymia Scale, and the Satisfaction with Life Scale. Structural equation modeling (SEM) was conducted using Amos 24.0 to explore the relationships among the variables, and mediation effects were tested using SPSS 26.0. Results A total of 317 psoriasis patients were recruited to participate in the survey. The total score of stigma of patients was (82.03 ± 1.52), which was at a moderate level. The total score of social appearance anxiety scale was (49.38 ± 1.00), which was at a high level. The total score of negative mental health of patients was (2.77 ± 0.14), which was at a low level. The total score of positive mental health of patients was (20.14 ± 0.36), which was at a medium level. The findings revealed that social appearance anxiety and alexithymia play significant chain mediating roles between stigma and negative mental health in patients with psoriasis, with an effect size of -0.031. Similarly, these factors also mediate the relationship between stigma and positive mental health, with an effect size of 0.056. Conclusion Stigma in patients with psoriasis can directly impact their mental health and can also influence it indirectly through social appearance anxiety and alexithymia. Both social appearance anxiety and alexithymia serve as mediators in the relationship between stigma and mental health in these patients.

Background Chronic inflammatory skin diseases substantially impair health-related quality of life (HRQoL). However, clinical severity alone does not fully account for variability in patient-reported outcomes. Objectives To test a theory-driven pathway model linking disease severity to HRQoL via illness-related stigma and to examine the roles of hope and perceived social support. Methods In this single-center cross-sectional study (n = 404), disease severity was assessed using affected body surface area (BSA), itch and skin pain. Illness-related stigma (8-item Stigma Scale for Chronic Illnesses, SSCI-8), hope (Herth Hope Index, HHI), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS) and HRQoL (Dermatology Life Quality Index, DLQI) were assessed using validated Chinese-language versions. Structural equation modeling with maximum likelihood estimation and bias-corrected bootstrapping (5,000 resamples) was performed. Results The model demonstrated good fit (χ2/df = 2.04; CFI = 0.977; TLI = 0.969; RMSEA = 0.051; SRMR = 0.058). Greater BSA (β = 0.30), itch (β = 0.20) and pain (β = 0.20) were associated with higher stigma (all P < 0.001). Stigma was associated with lower hope (β = −0.53) and worse dermatology-specific HRQoL (higher DLQI scores; β = 0.44) (both P < 0.001). Hope (β = −0.30, P < 0.001) and perceived social support (β = −0.13, P = 0.007) were independently associated with better dermatology-specific HRQoL. The model accounted for 16.1% of the variance in stigma, 28.0% in hope, and 44.0% in dermatology-specific HRQoL. Conclusion Disease burden may influence HRQoL partly through illness-related stigma and reduced hope. These findings support integrating psychosocial assessment into routine dermatologic care.

Perceived stigmatization places a large psychosocial burden on patients with some skin conditions. Little is known about the experience of stigmatization across a wide range of skin diseases. This observational cross-sectional study aimed to quantify perceived stigmatization and identify its predictors among patients with a broad spectrum of skin diseases across 17 European countries. Self-report questionnaires assessing perceived stigmatization and its potential predictors were completed by 5,487 dermatology outpatients and 2,808 skin-healthy controls. Dermatological diagnosis, severity, and comorbidity were clinician-assessed. Patients experienced higher levels of perceived stigmatization than controls (p < 0.001, d = 0.26); patients with psoriasis, atopic dermatitis, alopecia, and bullous disorders were particularly affected. Multivariate regression analyses showed that perceived stigmatization was related to sociodemographic (lower age, male sex, being single), general health-related (higher body mass index, lower overall health), disease-related (higher clinician-assessed disease severity, presence of itch, longer disease duration), and psychological (greater distress, presence of suicidal ideation, greater body dysmorphic concerns, lower appearance satisfaction) variables. To conclude, perceived stigmatization is common in patients with skin diseases. Factors have been identified that will help clinicians and policymakers to target vulnerable patient groups, offer adequate patient management, and to ultimately develop evidence-based interventions.

The goal of this study was to investigate the role of the subjective assessment of one's body image in the relationship between objective indices of appearance and perceived stigma in young women affected by obesity and psoriasis. These are chronic diseases that decrease one's physical attractiveness and are associated with stigmas related to body defects. A total of 188 women in early adulthood took part in the study (M = 25.58; SD = 2.90), including obese women (n = 54), women suffering from psoriasis (n = 57), and a control group (n = 77). The participants completed the Multidimensional Body-Self Relations Questionnaire, Perceived Stigmatisation Questionnaire, and a socio-demographic questionnaire. Anthropometric data were gathered using a body composition analyzer. Objective parameters of body shape were calculated (WHR and ICO). Subjective assessment of one's body and attitudes towards one's body were found to influence perceived stigma, independently of the condition causing the stigma and of the objective appearance of the participant. This study did not support the existence of a relationship between parameters regarding body shape and sense of stigma, even when subjective body assessment acted as a moderator. At the same time, body mass was a strong predictor of levels of perceived stigma. Women affected with obesity perceived a higher level of stigma than the other groups. The severity of psoriasis did not impact the perceived stigma. Moreover, women with psoriasis assessed their health—as a part of the assessment of their bodies—the highest, which may explain the lower perceived stigma in this group.

Abstract Background: Psoriasis is a common, inflammatory immune-mediated dermatosis, occurring in patients of all ages, sexes, and races, associating significant comorbidities. One such comorbidity is represented by psychological disorders, which negatively influence the clinical course of the disease. The purpose of our study is to offer a first glimpse into the stigmatization of Romanian psoriasis patients, as well as their potential anxious or depressive manifestations. Materials and methods: The present study is based on an adapted questionnaire previously used to estimate stigmatizing attitudes in the general population, mirrored to reflect the patients’ experience in social situations such as shaking hands, maintaining friendship, kissing, or intercourse. GAD7 and PHQ8 scales were used to screen for anxiety or depression traits in the same patients. Results: Our study group consisted of 12 psoriasis patients, with a mean age of 46.75 years. While few patients reported feeling discriminated against in social contexts, 16.66% presented with mild depressive symptoms recorded by PHQ8 and 24.99% presented mild anxiety manifestations according to their GAD7 scores. Conclusion: In spite of the small sample group, our study outlines a tendency for depressive and anxious manifestations in patients with psoriasis.

60–90% of patients with psoriasis suffer from pruritus and 65% report itching as one of the most burdensome symptoms, raising significant quality of life (QoL) impairments. However, pruritus is not only an intrapersonal symptom but also a psychosocial interactive phenomenon and little is known about the effects of itching on interpersonal experiences.

The assessment of psoriatic arthritis is complex and multidimensional. It is increasingly common to include the patient perspective using patient-reported outcomes. Although some research has explored sleep quality in patients with psoriatic arthritis, most studies have had small sample sizes, failed to assess sleep quality considering the inflammatory process together with the psychological well-being of patients, and have not described any use of sleep medication. Further, research to date has not provided data on the relationship of sleep quality with axial forms. In this context, the objective of this study was to assess sleep quality in patients with psoriatic arthritis and its relationship with clinical characteristics, disease activity, functioning, disease impact, fatigue and psychological status. A cross-sectional study was conducted including 247 consecutive patients with PsA recruited during 2021. Sleep quality was measured using the Pittsburgh Sleep Quality Index. We assessed correlations of Pittsburgh Sleep Quality Index score with peripheral disease activity (Disease Activity Index for PSoriatic Arthritis), axial disease activity (Ankylosing Spondylitis Disease Activity Score-C-reactive protein and Bath Ankylosing Spondylitis Disease Activity Index), functioning (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire), impact (Psoriatic Arthritis Impact of Disease questionnaire), anxiety, depression (Hospital Anxiety and Depression Scale) and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) scores. A multiple linear regression model was constructed with PSQI as the dependent variable and as independent variables those that could influence sleep quality. Nearly two-thirds (63.15%) of patients had poor sleep quality. Poorer sleep quality was associated with being female, higher joint counts, greater peripheral and axial disease activity, fatigue, anxiety and depression, functioning and disease impact (p < 0.001). Multiple linear regression analysis found that pain (β: 0.3; p < 0.007) and fatigue β: − 0.1; p < 0.001 contributed 40% to the sleep quality model. Poor sleep quality was common among patients with psoriatic arthritis. Emotional factors (fatigue, anxiety) seemed more important than inflammatory factors in sleep quality.

OBJECTIVES To study whether poor sleep and comorbidities are associated with high symptom levels of patient reported outcomes (PROs) pain, patient global assessment and fatigue in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), in a nation-wide cross-sectional setting. METHODS Clinical data were extracted from The Finnish Rheumatology Quality Register between 1.2021 and 9.2022. Self-reported sleep was categorized as "good‿ (little/no difficulties) or "poor‿ (great difficulties/can't) sleep. Data concerning comorbidities were collected from national registers. Descriptive statistics were used. Regression analyses were applied to analyze independent associations of sleep status, comorbidities and disease activity with pain in RA and PsA, adjusting for age and sex. RESULTS Among 13512 patients with RA, 6052 (mean (SD) age 62(13), 71% female) had sleep status reported; in PsA 1861/3636 (age 55(13), 48% female). In RA, 5072(84%) reported good and 980(16%) poor sleep; the corresponding numbers in PsA were 1460(78 %) and 401(22%). Median values for objective disease activity were low and similar in patients with poor sleep and good sleep in both diseases. Among patients with no swollen joints, the median values for PROs were approximately 3 times higher for patients with poor sleep vs good sleep in both diagnoses (p<0.001 ). In regression analyses, ''poor'' sleep was independently associated with higher symptoms in pain (B(95%CI) 20 (18,22) in RA and 23 (19, 26) in PsA), followed by comorbid fibromyalgia, as well as depression in RA and sleep apnea in PsA. CONCLUSION ''Poor'' sleep quality and comorbidities are independently associated with pain. Patient's sleep status is important to know especially in patients with severe symptoms without objective disease activity.

Psoriasis alters patients’ quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most quality-of-life scores. Thus, the specific evaluation of sleep disorders using dedicated scores is necessary, especially because such disorders alter patients;’ physical and psychological health. The relationship between psoriasis and sleep disorders has been shown in numerous studies, but has not yet been fully elucidated. The aim of this study was to update knowledge of sleep disorders in patients with psoriasis, through a review of the scientific literature since 1980. This work covers several topics of interest, such as sleep assessment methods, the prevalence of sleep disorders in patients with psoriasis, factors predictive of sleep disorders in patients with psoriasis, the impact of sleep disorders on comorbidities and quality of life, pathogenic mechanisms, obstructive sleep apnoea and restless leg syndromes, and the impact of biotherapy treatments on sleep disorders in patients with psoriasis.

Psoriasis is associated with several comorbidities and different psychological disorders including anxiety and depression. Psoriasis may also affect sleep quality and consequently the quality of life. The use of immunosuppressants used in the treatment of psoriasis were also reported to increase insomnia, so the purpose of the study is to assess the quality of sleep and degree of insomnia in patients with psoriasis not on any systemic or immunosuppressive therapy compared to controls and to examine the relation between sleep quality, insomnia with depressive, and anxiety symptoms. One hundred psoriasis cases, not receiving immunosuppressive therapy, and 80 apparently healthy subjects were recruited as controls. We assessed quality of sleep, insomnia and screened for anxiety and depressive symptoms among psoriasis patients and healthy controls; any patient on immunosuppressant therapy was excluded. Quality of sleep using Pittsburgh Sleep Quality Index, insomnia using Insomnia Severity Index, depression using Beck Depression Inventory, and anxiety using Taylor Anxiety Manifest Scale were statistically significant higher among psoriasis patients than healthy controls all with p value p < 0.001. Depressive symptoms were significantly positively correlated with Pittsburgh Sleep Quality Index (PSQI) global score (p = 0.045) and subjective sleep quality subscale (p = 0.005). Also, BDI scores was significantly positively correlated with insomnia scores as measured by ISI (p = 0.026). Anxiety symptoms were significantly positively correlated with global score of PSQI (p = 0.004) and its subscale (subjective sleep quality, sleep latency, sleep disturbance, use of medications and daytime dysfunction) and insomnia (p = 0.001). Abnormal sleep quality and insomnia were detected in patients with psoriasis not using any immunosuppressive or systemic therapy, and this could be due to the psoriasis disease itself or due to the associated anxiety and depression associated with psoriasis. Screening for psychiatric symptoms specially that of depression, anxiety, and sleep among patients with psoriasis is of utmost importance for better quality of life. Thus, collaboration between dermatologists and psychiatrists may show better life quality for these cases and better treatment outcomes.

… of questionnaires exploring anxiety (Beck Anxiety Inventory; … sleep quality in psoriatic patients, focusing on the level of itch and pain intensity as key indicators of self-reported disease …

BACKGRUOND Studies in axial spondyloarthritis (AxSp) have shown that intensity of pain, anxiety, depression, and inflammatory activity are associated with poor sleep quality. AIM To describe mood and sleep disorders and positive psychological factors in patients with AxSp and psoriatic arthritis (PsA) and to evaluate the psychological factors that are potentially involved in sleep disorders. DESIGN Multicenter cross-sectional observational study based on a series of patients with AxSp and PsA. PARTICIPANTS Participants were selected consecutively from patients aged ≥18 years with AxSp or PsA followed at the rheumatology department of 4 Spanish hospitals. INCLUSION CRITERIA age ≥18 years, AxSp (ASAS criteria) or PsA (CASPAR criteria), ability to understand the study and prepared to complete the questionnaires. MAIN OUTCOMES Oviedo Sleep Quality questionnaire result. SECONDARY OUTCOMES psychological status evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire, health-related quality of life evaluated using SF-36, perception of pain evaluated using the short questionnaire for assessmentof pain (BDU), and fatigue evaluated using the Fatigue Scale (FACIT) questionnaire. We performed a descriptive multivariate linear regression analysis to study factors that were independently associated with sleep disorders. The STROBE guidelines were adopted. RESULTS we included 301 patients (152 [50.5%] with AxSp and 149 [49.5%] with PsA). The multivariate linear regression analysis for the whole sample showed that insomnia was inversely associated with emotional recovery and biological disease-modifying antirheumatic drugs and directly associated with depression in both groups. The analysis by disease (AxSp and PsA) showed that insomnia was independently associated with depression and emotional recovery. CONCLUSIONS Insomnia may be associated with other mood disorders, quality of life, and inflammatory activity in the patients studied here. RELEVANCE TO CLINICAL PRACTICE A nurse intervention can be carried out to prevent sleep disorders Knowing the consecuences and triggers of the problem.

Objective The aim of this systematic review and metaanalysis is to summarize evidence regarding the relationship between psoriatic arthritis (PsA) and sleep problems. Methods We identified 36 eligible studies—26 cross-sectional, 7 cohort, and 3 interventional studies—in PubMed and Embase. Results The prevalence of self-reported sleep problems in patients with PsA ranged from 30% to 85%. A metaanalysis of 6 studies that used the Pittsburgh Sleep Quality Index revealed a prevalence of poor sleep quality for patients with PsA of 72.9% (95% CI 63-81.8; I2 = 78%), which was statistically higher than in healthy controls (26.9%, 95% CI 11.7-45.4; I2 = 81%) but not significantly different than in patients with psoriasis (59.8%, 95% CI 46.9-72.1; I2 = 51%). Sleep disturbance was ranked in the top 4 health-related quality of life domains affected by PsA. One study suggested a bidirectional relationship between PsA and obstructive sleep apnea. Predictors of sleep problems included anxiety, pain, erythrocyte sedimentation rate, depression, fatigue, physical function, and tender or swollen joint count. Tumor necrosis factor inhibitors, guselkumab, and filgotinib (a Janus kinase inhibitor) were associated with improved sleep outcomes. Conclusion Poor sleep quality is prevalent in patients with PsA. Objective sleep measures (ie, actigraphy and polysomnography) have not been used in PsA studies, and evidence on the validity of patient-reported sleep measures in PsA is lacking. Future studies should validate self-reported sleep measures in PsA, explore how sleep quality relates to PsA disease activity and symptoms using both objective and subjective sleep measures, assess the efficacy of strategies to manage sleep problems, and assess the effects of such management on symptoms and disease signs in patients with PsA.

… of psoriasis severity and marital adjustments on depressive symptom scores. The association of depression with psoriasis severity has also been documented in other studies …

Psoriatic disease is a chronic, systemic immune‐mediated inflammatory disorder comprising three major domains, skin, vascular and bone/joint inflammation. It is known for a long time that psoriatic disease is associated with a number of conditions such as hypertension, dyslipidemia, diabetes (metabolic syndrome) and depression. Up to one out of five people with psoriasis show concomitant depression. In the past, this was attributed to psychological stress of suffering from a chronic condition that is often visible and itchy, leading to stigmatization and adding to a significant burden of disease. Recent data provide evidence that depression associated with psoriatic disease is linked to the specific inflammatory pattern with IL‐23, IL‐17 family cytokines, TNF, IL‐6 and IL‐8 causing neuroinflammation and subsequently depression or depressive behaviour and/or anxiety. Psoriatic disease shows a distinct pattern of immune cells (e.g. dendritic cells, Th17 cells, neutrophils), mediators (e.g. IL‐17A/F, IL‐23, TNF) and tissue‐related factors in all major domains that is different from other inflammatory dermatoses. There is a striking similarity between the inflammatory pattern in psoriatic disease and neuroinflammation that leads to depression. A number of risk factors have been identified in psoriatic disease, the most important of which are obesity and tobacco smoking. Obesity is known as a major risk factor for depression and anxiety due to its inflammatory signature. Apart from psychotherapy and anti‐depressive medication, targeted treatments for psoriasis, including TNF, IL‐17 and IL‐23 inhibitors, can improve depression/depressive symptoms. The review summarizes the current knowledge about depression as a comorbidity in psoriatic disease.

ABSTRACT Introduction: Estimates of the prevalence of comorbid depression vary, ranging from 9 and 62%. Deterioration of mental health may emerge as a result of psoriasis; however, it is theorized that depression alone may independently predispose patients to new-onset psoriasis. Areas covered: The aim of this brief review is to explore the impact of depression on psoriasis treatment. Expert opinion: The two studies that directly assess the role of depression in psoriasis treatment outcomes are important, as unaddressed depression can undermine the success of a given treatment. This may reflect the notion that depressed individuals are less likely to be adherent. Thus, it may be valuable for clinicians to not only screen for depression, but to ensure that it is adequately treated. Our knowledge of treatment preferences in psoriasis patients with comorbid depression is limited. Expanding our understanding of preferences may allow providers to better align their recommendations to ultimately increase adherence. Additionally, given that many psoriasis treatments have an impact on depression, it may be beneficial for clinicians to evaluate patients for psychiatric risk factors to optimize the treatment regimen.

OBJECTIVES This study aimed to compare the health-related quality of life scores among rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis and to evaluate socio-demographic and clinical determinantes of quality of life across diseases. METHODS The sample comprised 490 patients with rheumatoid arthritis, 198 with psoriatic arthritis, and 119 with spondyloarthritis who completed a series of health examinations and self-reported questionnaires. Quality of life was evaluated using the Short-Form 36 Health Survey, disease activity by DAS28-CRP, DAPSA, and ASDAS-CRP (for rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis, respectively), depression and anxiety using the Hospital Anxiety and Depression Scale. ANOVA was used to compare the quality of life dimensions and their physical and mental summary measures among rheumatic diseases, and multivariate analysis was used to explore their potential determinants. RESULTS Rheumatoid arthritis had significantly worse scores than spondyloarthritis in the following dimensions: physical functioning, role limitation due to physical health, physical component score, and mental health. Psoriatic arthritis was not significantly different from the other two diseases. Multivariate analysis revealed that physical quality of life was mainly associated with disease activity across rheumatic diseases, rheumatological treatment and depression in rheumatoid arthritis and psoriatic arthritis. Mental quality of life is primarily associated with depression and anxiety across rheumatic diseases. CONCLUSION There were differences in quality of life among patients with inflammatory rheumatic diseases, but overall, approximately uniform factors explained the variance in quality of life across diseases. Clinicians should develop general approaches and strategies for inflammatory rheumatic diseases to improve patients' quality of life.