Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK; Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.
J Acad Consult Liaison Psychiatry. 2022 Jul-Aug;63(4):372-383. doi: 10.1016/j.jaclp.2021.12.007. Epub 2022 Jan 10.
BACKGROUND: Depression is overrepresented in psoriasis. However, it is not clear whether the presence of psoriatic arthritis (PsA) independently increases patients' depressive burden. Furthermore, current evidence regarding suicidality risk of psoriasis populations is conflicting, and the role of PsA in suicidality outcomes of psoriasis is unknown. OBJECTIVES: (i) To test whether PsA is associated with depression and lifetime suicidal ideation among patients with psoriasis; (ii) to capture different suicidal phenomena in these patients; and (iii) to investigate whether suicidality and depressive symptom severity are associated with clinical markers of psoriasis severity and chronicity. METHODS: A cross-sectional survey of tertiary patients (n = 219, aged 18-65 years) with dermatologist-confirmed chronic plaque psoriasis, of whom 84 had rheumatologist-confirmed PsA, was undertaken. The Hospital Anxiety and Depression Scale and Sheehan-Suicidality Tracking Scale were used to assess depression and lifetime suicidality, respectively. RESULTS: PsA presence was associated with depression in patients with psoriasis, independent of other physical comorbidities (adjusted odds ratio 2.92, 95% confidence interval 1.53-5.68). Furthermore, patients with PsA experienced significantly higher levels of anhedonia and anxiety, after controlling for psychiatric history. Of all participants, 48.8% reported lifetime suicidal ideation with or without intent, 21.3% reported suicidal planning, and 9.4% reported suicide attempts. Lifetime suicidality prevalence did not differ between patients with and without PsA. Depressive symptom severity and lifetime suicidality scores were not associated with objective measures of psoriasis severity or treatment group. CONCLUSIONS: These data suggest that joint involvement in psoriasis is associated with higher depressive burden. There is a need for routine depression screening among patients with psoriasis, particularly when PsA is present. Anhedonia appears to be a particularly relevant symptom in the depression phenotype of this population. We did not find a statistically significant association between PsA and suicidality. Nevertheless, suicidality rates in tertiary patients with psoriasis appear to be higher than those in the general population. Suicidality monitoring is recommended to help in reducing future psychiatric morbidity and mortality in patients with psoriasis.
背景：银屑病患者中抑郁较为常见。然而，目前尚不清楚银屑病关节炎（PsA）的存在是否会独立增加患者的抑郁负担。此外，目前关于银屑病患者自杀风险的证据相互矛盾，PsA 对银屑病患者自杀结局的作用尚不清楚。
目的：（i）检测 PsA 是否与银屑病患者的抑郁和终生自杀意念相关；（ii）在这些患者中捕捉不同的自杀现象；（iii）探讨自杀意念和抑郁症状严重程度是否与银屑病严重程度和慢性的临床标志物相关。
方法：对三级医院（n=219，年龄 18-65 岁）的经皮肤科医生确诊的慢性斑块状银屑病患者进行横断面调查，其中 84 例患者经风湿病学家确诊为 PsA。采用医院焦虑抑郁量表和 Sheehan 自杀跟踪量表分别评估抑郁和终生自杀意念。
结果：银屑病患者中 PsA 的存在与抑郁相关，独立于其他躯体共病（调整后的优势比 2.92，95%置信区间 1.53-5.68）。此外，在控制精神病史后，患有 PsA 的患者表现出明显更高水平的快感缺失和焦虑。在所有参与者中，48.8%报告有过或没有自杀意念的终生自杀意念，21.3%报告有自杀计划，9.4%报告有自杀未遂。有和没有 PsA 的患者之间的终生自杀意念发生率没有差异。抑郁症状严重程度和终生自杀意念评分与银屑病严重程度的客观测量或治疗组无关。
结论：这些数据表明，银屑病的关节受累与更高的抑郁负担相关。对于银屑病患者，特别是当存在 PsA 时，需要常规进行抑郁筛查。快感缺失似乎是该人群抑郁表型的一个特别相关的症状。我们没有发现 PsA 与自杀意念之间存在统计学显著关联。然而，银屑病三级患者的自杀率似乎高于普通人群。建议进行自杀监测，以帮助降低银屑病患者未来的精神发病率和死亡率。
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