Depression and anxiety are associated with disagreement between patient and doctor assessments of psoriasis severity

Findings from a recent study by St John's Institute of Dermatology and the Institute of Psychiatry, Psychology & Neuroscience, King’s College London.

Researchers from St John’s Institute of Dermatology and the Institute of Psychiatry, Psychology & Neuroscience, King’s College London found a disagreement in 39% of patient and doctor ratings of psoriasis severity and an association between this disagreement and patient mental health.

Psoriasis is a lifelong skin condition which affects around 2 in every 100 people in the UK and is associated with a reduced quality of life. It causes red, scaly patches of skin that are itchy and painful. Depression and anxiety are more common among people with psoriasis compared to the general population.

In a study of 500 patients attending St John’s Institute of Dermatology across two years, researchers compared disease severity assessments completed by both doctors and patients at almost 2,000 appointments. Patients were also asked screening questions for depression and anxiety during these visits.

This study was funded by The National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) and The NIHR Guy’s and St Thomas’ BRC.

In a quarter (26%) of appointments patients rated their psoriasis as being less severe compared with their doctor’s assessment.

In 13% of appointments patients rated their psoriasis as being more severe compared with their doctor’s assessment. Patients with anxiety or depression were twice as likely to overestimate their psoriasis severity compared with their doctor.

Senior author Professor Catherine Smith, Consultant Dermatologist and Professor of Dermatology and Therapeutics at St John’s Institute of Dermatology, said:

"Our findings suggest that psoriasis treatment strategies that rely on self-reported disease severity scores will not meet the needs of people with anxiety and depression. This is especially relevant in the current pandemic where we have reduced access to face-to-face consultations".

Joint first author Dr Ewan Carr, Statistician Research Fellow at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, said:

“Drawing on longitudinal data from IMPARTS and St John’s Institute of Dermatology, we found that patients with symptoms of anxiety and depression were more likely to disagree with their clinician regarding symptom severity. This highlights the need for patient-reported scores to be interpreted in the context of a patient’s mental health”. 

Joint first author Dr Satveer Mahil, Consultant Dermatologist and Senior Lecturer at St John’s Institute of Dermatology, said: 

“Our study has highlighted important differences in patients’ and doctors’ perceptions of psoriasis severity, and patient anxiety and depression was associated with these differences. Given the recognised large mental health burden in psoriasis, the routine use of mental health screening tools in psoriasis may help to align patient and doctor treatment goals and inform shared decision making”. 

‘Association of Patient Mental Health Status with the Level of Agreement Between Patient and Physician Rating of Psoriasis Severity’ was published today (Wednesday 3rd March 2021) in JAMA Dermatology.

IMPARTS

The questionnaires filled in by patients were part of the Integrating Mental and Physical healthcare: Research Training and Services (IMPARTS) initiative which studies the interface between mental and physical health, in particular the link between depression and anxiety and long-term physical health conditions.