Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, 2900, Hellerup, Denmark.
Kaiser Permanente Los Angeles Medical Center, Department of Dermatology, Los Angeles, CA, U.S.A.
Br J Dermatol. 2019 Jan;180(1):116-121. doi: 10.1111/bjd.17208. Epub 2018 Nov 19.
Psoriasis impairs quality of life, but it is unknown whether psoriasis is also an independent risk factor for depression.
To evaluate the incidence and risk of new and recurrent depression in patients with psoriasis.
We used individual-level linkage of Danish administrative registers. Patients with psoriasis aged ≥ 18 years between 1 January 1997 and 31 December 2016 were matched 1 : 1 with individuals without psoriasis. Incidence rates were calculated and adjusted hazard ratios (HRs) estimated by Cox regression.
There were 247 755 patients with psoriasis: 220 721 were treated with topicals (mild psoriasis), 24 771 with systemic nonbiologics (moderate psoriasis) and 2263 with biological therapy (severe psoriasis). The same number of matched referents without psoriasis were also analysed. During a maximum 20 years of follow-up, 45 641 patients with psoriasis and 36 299 referents developed depression. In adjusted models, the HRs (95% confidence interval) of depression were 1·19 (1·17-1·20), 1·19 (1·15-1·23) and 1·50 (1·23-1·84) for mild, moderate and severe psoriasis, respectively. The highest risk was observed among patients with severe psoriasis aged 40-50 years. Concurrent inflammatory bowel disease, but not psoriatic arthritis, was associated with increased risk of depression. The incidence of depression was markedly higher among patients with previous depression.
Psoriasis was independently associated with risk of depression. These results may help clinicians identify particularly high-risk individuals.
银屑病会降低生活质量，但目前尚不清楚银屑病是否也是抑郁的独立危险因素。
评估银屑病患者新发和复发性抑郁的发病率和风险。
我们使用丹麦行政登记册的个体水平链接。1997 年 1 月 1 日至 2016 年 12 月 31 日期间年龄≥18 岁的银屑病患者与无银屑病的个体进行 1:1 匹配。计算发病率并通过 Cox 回归估计调整后的风险比（HR）。
共纳入 247755 例银屑病患者：220721 例接受局部治疗（轻度银屑病），24771 例接受全身非生物制剂治疗（中度银屑病），2263 例接受生物制剂治疗（重度银屑病）。同时对相同数量无银屑病的匹配对照者进行了分析。在最长 20 年的随访期间，45641 例银屑病患者和 36299 例对照者发生了抑郁。在调整后的模型中，抑郁的 HR（95%CI）分别为 1.19（1.17-1.20）、1.19（1.15-1.23）和 1.50（1.23-1.84），对应轻度、中度和重度银屑病。风险最高的是 40-50 岁的重度银屑病患者。同时患有炎症性肠病，而不是银屑病关节炎，与抑郁风险增加相关。既往有抑郁史的患者发生抑郁的风险明显更高。
银屑病与抑郁风险独立相关。这些结果可能有助于临床医生识别出风险较高的个体。
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