The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study.
Objective: The purpose of this study is to determine the incidence of depression, anxiety and suicidality in patients with psoriasis compared to the general population.
Design: A population-based cohort study using data collected as part of patient's electronic medical record from 1987 to 2002.
Setting: General Practice Research Database
Patients: Up to 5 controls without psoriasis were selected from the same practices and cohort entry dates as psoriasis patients.
Main Outcome Measures: Clinical diagnosis of depression, anxiety and suicidality were compared among 146,042 mild psoriasis, 3,956 severe psoriasis, and 766,950 control patients.
Results: The adjusted hazard ratios for receiving a diagnosis of depression, anxiety and suicidality in patients with psoriasis compared to controls, were 1.39 (95% CI 1.37, 1.41), 1.31 (95% CI 1.29, 1.34) and 1.44 (95% CI 1.32, 1.57), respectively. The adjusted relative risk of depression was higher in severe (HR 1.72, 95% CI 1.57, 1.88), compared to mild psoriasis (HR 1.38, 95% CI 1.35, 1.40). Younger psoriasis patients had elevated relative risks of outcomes compared to older psoriasis patients.
Conclusions: Psoriasis patients have an increased risk of depression, anxiety, and suicidality. We estimate that in the UK, in excess of 10,400 diagnoses of depression, 7,100 diagnoses of anxiety, and 350 diagnoses of suicidality are attributable to psoriasis annually. It is important for clinicians to evaluate patients with psoriasis for these conditions in order to improve outcomes. Future investigation should determine the mechanisms by which psoriasis is associated with psychiatric outcomes as well as approaches for prevention.