The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries

Florence J Dalgard, Uwe Gieler, Lucia Tomas-Aragones, Lars Lien, Francoise Poot, Gregor B E Jemec, Laurent Misery, Csanad Szabo, Dennis Linder, Francesca Sampogna, Andrea W M Evers, Jon Anders Halvorsen, Flora Balieva, Jacek Szepietowski, Dmitry Romanov, Servando E Marron, Ilknur K Altunay, Andrew Y Finlay, Sam S Salek, Jörg Kupfer, Florence J Dalgard, Uwe Gieler, Lucia Tomas-Aragones, Lars Lien, Francoise Poot, Gregor B E Jemec, Laurent Misery, Csanad Szabo, Dennis Linder, Francesca Sampogna, Andrea W M Evers, Jon Anders Halvorsen, Flora Balieva, Jacek Szepietowski, Dmitry Romanov, Servando E Marron, Ilknur K Altunay, Andrew Y Finlay, Sam S Salek, Jörg Kupfer

Abstract

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants--3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67-3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68-2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33-2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.

References

    1. Aguilar-Duran S, Ahmed A, Taylor R, et al. How to set up a psychodermatology clinic. Clin Exp Dermatol. 2014;39:577–582.
    1. Bjelland I, Dahl AA, Haug TT, et al. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52:69–77.
    1. Boehm D, Schmid-Ott G, Finkeldey F, et al. Anxiety, depression and impaired health-related quality of life in patients with occupational hand eczema. Contact Dermatitis. 2012;67:184–192.
    1. Breeman S, Cotton S, Fielding S, Jones GT.2014Normative data for the hospital anxiety and depression scale Qual Life Res; e-pub ahead of print; PMID: 2506207
    1. Cvetkovski RS, Zachariae R, Jensen H, et al. Quality of life and depression in a population of occupational hand eczema patients. Contact Dermatitis. 2006;54:106–111.
    1. Dalgard F, Gieler U, Holm JO, et al. Self-esteem and body satisfaction among late adolescents with acne: results from a population survey. J Am Acad Dermatol. 2008;59:746–751.
    1. Dalgard F, Svensson A, Holm JO, et al. Self-reported skin morbidity in Oslo. Associations with sociodemographic factors among adults in a cross-sectional study. Br J Dermatol. 2004;151:452–457.
    1. Dieris-Hirche J, Gieler U, Kupfer JP, et al. Suicidal ideation, anxiety and depression in adult patients with atopic dermatitis. Hautarzt. 2009;60:641–646.
    1. Dowlatshahi EA, Wakkee M, Arends LR, et al. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J Investig Dermatol Symp Proc. 2013;134:1542–1551.
    1. Freeman EE. A seat at the big table: expanding the role of dermatology at the world health organization and beyond. J Investig Dermatol Symp Proc. 2014;134:2663–2665.
    1. Gupta MA, Schork NJ, Gupta AK, et al. Suicidal ideation in psoriasis. Int J Dermatol. 1993;32:188–190.
    1. Halvorsen JA, Lien L, Dalgard F, et al. Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study. J Investig Dermatol Symp Proc. 2014;134:1847–1854.
    1. Halvorsen JA, Stern RS, Dalgard F, et al. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study. J Investig Dermatol Symp Proc. 2011;131:363–370.
    1. Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Investig Dermatol Symp Proc. 2014;134:1527–1534.
    1. Hinz A, Brahler E. Normative values for the hospital anxiety and depression scale (HADS) in the general German population. J Psychosom Res. 2011;71:74–78.
    1. Hughes JE, Barraclough BM, Hamblin LG, et al. Psychiatric symptoms in dermatology patients. Br J Psychiatry. 1983;143:51–54.
    1. Kimball AB, Leonardi C, Stahle M, et al. Demography, baseline disease characteristics, and treatment history of patients with psoriasis enrolled in a multicenter, prospective, disease-based registry (PSOLAR) Br J Dermatol. 2014;171:137–147.
    1. Kurd SK, Troxel AB, Crits-Christoph P, et al. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010;146:891–895.
    1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442.
    1. McDonough E, Ayearst R, Eder L, et al. Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol. 2014;41:887–896.
    1. Moffatt CJ, Franks PJ, Doherty DC, et al. Psychological factors in leg ulceration: a case-control study. Br J Dermatol. 2009;161:750–756.
    1. Mykletun A, Stordal E, Dahl AA. Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry. 2001;179:540–544.
    1. Niemeier V, Nippesen M, Kupfer J, et al. Psychological factors associated with hand dermatoses: which subgroup needs additional psychological care. Br J Dermatol. 2002;146:1031–1037.
    1. Onderdijk AJ, van der Zee HH, Esmann S, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2013;27:473–478.
    1. Picardi A, Abeni D, Melchi CF, et al. Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol. 2000;143:983–991.
    1. Picardi A, Adler DA, Abeni D, et al. Screening for depressive disorders in patients with skin diseases: a comparison of three screeners. Acta Dermato-Venereologica. 2005;85:414–419.
    1. Prince M, Patel V, Saxena S, et al. No health without mental health. Lancet. 2007;370:859–877.
    1. Rea JN, Newhouse ML, Halil T. Skin disease in Lambeth. A community study of prevalence and use of medical care. Br J Prev Soc Med. 1976;30:107–114.
    1. Sanna L, Stuart AL, Pasco JA, et al. Atopic disorders and depression: findings from a large, population-based study. J Affect Disord. 2014;155:261–265.
    1. Sanna L, Stuart AL, Pasco JA, et al. Suicidal ideation and physical illness: does the link lie with depression. J Affect Disord. 2014;152-154:422–426.
    1. Scott KM, Bruffaerts R, Tsang A, et al. Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys. J Affect Disord. 2007;103:113–120.
    1. Scott KM, Hwang I, Chiu WT, et al. Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys. Psychosom Med. 2010;72:712–719.
    1. Timonen M, Jokelainen J, Hakko H, et al. Atopy and depression: results from the Northern Finland 1966 Birth Cohort Study. Mol Psychiatry. 2003;8:738–744.
    1. Wittchen HU, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21:655–679.
    1. Zachariae R, Zachariae C, Ibsen HH, et al. Psychological symptoms and quality of life of dermatology outpatients and hospitalized dermatology patients. Acta Dermato-Venereologica. 2004;84:205–212.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever