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Psoriatic arthritis (PsA) is significantly associated with depression among patients with psoriasis, with an overall high depressive and suicidality burden, according to study results published in Journal of the Academy of Consultation-Liaison Psychiatry.
In a cross-sectional survey, patients aged between 18 and 65 years with dermatologist-confirmed diagnoses of chronic plaque psoriasis and rheumatologist-confirmed diagnoses of PsA (N=219) completed the Hospital Anxiety and Depression Scale (HADS) and the Sheehan Suicidality Tracking Scale (S-STS). The treating dermatologist performed the Psoriasis Area and Severity Index (PASI) within a week of questionnaire completion.
A HADS-Depression subscale cutoff of 8 and higher was used to define primary depression. The Suicidal Ideation/Intent Factor Score of the S-STS (positive/zero) was used to identify lifetime suicidal ideation.
Researchers noted that PsA was significantly associated with depression in both crude and confounder-adjusted models (odds ratio [OR], 2.92; 95% CI, 1.53-5.68). No significant difference was found between patients with PsA and those without PsA in terms of reported lifetime suicidal ideation (52.5%vs 46.6%, respectively). Active suicidal ideation was present in 29.8% (n=39) of patients with psoriasis only and in 26.9% (n=21) of patients with PsA (OR, 0.89; 95% CI, 0.46-1.61; P =.784). Patients who had vs had not attempted suicide were shown to have higher lifetime suicidal ideation S-STS scores. A total of 48.8% of all participants reported lifetime suicidal ideation, with or without intent. Researchers did not note further significant associations of psychiatric measures with clinical characteristics.
This study was limited due to participant enrollment that was hindered by COVID-19 quarantines and the small sample size, which may have resulted in insufficient power to identify small effects for suicidality. Researchers noted that the potential psychologic effects of the pandemic cannot be excluded for confounding the data and should be taken into consideration when examining these results. In addition, causality assumptions were underlying the inflammatory processes among patients with PsA.
“It is plausible that the heightened systemic inflammatory state of PsA and associated pain may prime the development of depression through both functional impairment and neuroimmunological effects,” the researchers concluded. “We recommend routine depression screening (eg, using [Patient Health Questionnaire-2] PHQ-2) among [patients with] psoriasis, in particular when PsA is present, as well as suicidality monitoring….Future studies should aim to identify risk and protective factors for suicidality as well as inflammatory and neurobiological correlates of depression among patients with psoriasis and [PsA],” they added.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Reference
Lada G, Chinoy H, Heal C, Warren RB, Talbot PS, Kleyn CE. Depression and suicidality in patients with psoriasis and the role of psoriatic arthritis; a cross-sectional study in a tertiary setting. J Acad Consult Liaison Psychiatry. Published online January 8, 2022. doi:10.1016/j.jaclp.2021.12.007
