Department of Behavioral Sciences, Ariel University, Ariel, Israel.
Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Eur Acad Dermatol Venereol. 2019 Aug;33(8):1555-1561. doi: 10.1111/jdv.15651. Epub 2019 Jun 6.
Numerous studies have indicated that comorbid anxiety and depression are associated with a more severe course of illness. Yet generally, the study of the effect of psoriasis on patients' mental health has considered anxiety and depression to be separate states.
To measure the association between psoriasis and anxiety, depression and anxiety-depression co-occurrence among patients according to their socioeconomic statuses (SES).
A nationwide population-based study of psoriasis patients and age and gender frequency-matched controls (n = 255 862) was designed. Diagnostic data were obtained from Clalit Health Services, the largest managed care organization in Israel. This database was established using continuous real-time input from healthcare providers, pharmacies, medical care facilities and administrative computerized operating systems.
After controlling for demographic and clinical variables, psoriasis was associated with anxiety (OR 1.11, 95% CI 1.01-1.23, P < 0.05), depression (OR 1.17, 95% CI 1.08-1.26, P < 0.001), and anxiety and depression co-occurrence (OR 1.32, 95% CI 1.21-1.45, P < 0.001) among patients with low SES, yet was associated only with anxiety (OR 1.15 95% CI 1.04-1.27, P < 0.001) but not depression or comorbid anxiety-depression among patients with high SES. Survival analyses indicated that between the ages of 40 and 60, the cumulative probability of psoriasis patients with low SES to suffer from anxiety, depression and their co-occurrence inclined more sharply with age as compared to psoriasis patients with high SES.
As psoriasis patients with low SES are prone to suffer from more severe courses of anxiety and depression, the choice of treatment of psoriasis should address the SES as well as the underlying psychiatric disease.
许多研究表明，共病焦虑和抑郁与更严重的疾病过程有关。然而，一般来说，研究银屑病对患者心理健康的影响时，将焦虑和抑郁视为两种独立的状态。
根据社会经济地位（SES）衡量银屑病与焦虑、抑郁以及焦虑-抑郁共病在患者中的相关性。
设计了一项针对银屑病患者和年龄、性别频数匹配对照者（n=255862）的全国性基于人群的研究。诊断数据来自以色列最大的管理式医疗组织克利利特健康服务（Clalit Health Services）。该数据库是使用来自医疗保健提供者、药房、医疗保健设施和行政计算机操作系统的连续实时输入建立的。
在控制人口统计学和临床变量后，银屑病与低 SES 患者的焦虑（OR 1.11，95%CI 1.01-1.23，P<0.05）、抑郁（OR 1.17，95%CI 1.08-1.26，P<0.001）和焦虑-抑郁共病（OR 1.32，95%CI 1.21-1.45，P<0.001）相关，但与高 SES 患者的焦虑（OR 1.15，95%CI 1.04-1.27，P<0.001）但与抑郁或共病焦虑-抑郁无关。生存分析表明，在 40 至 60 岁之间，低 SES 银屑病患者患焦虑、抑郁及其共病的累积概率随着年龄的增长比高 SES 银屑病患者更为陡峭。
由于低 SES 的银屑病患者更容易出现更严重的焦虑和抑郁，因此选择银屑病的治疗方法应考虑 SES 以及潜在的精神疾病。
