Frequency and magnitude of anxiety and depression in patients with psoriasis vulgaris.

OBJECTIVE To determine the frequency of anxiety and depression in patients with psoriasis. STUDY DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Outpatient Departments of Dermatology and Psychiatry, Ziauddin University Hospital, KDLB Campus, Karachi, from October 2005 to September 2006. PATIENTS AND METHODS All patients presenting with psoriasis vulgaris above the age of 15 years, of either gender, fulfilling the selection criteria were included in the study. Clinical diagnosis was confirmed by biopsy and histopathology. Documentation of disease severity as mild, moderate and severe was done, using Psoriasis Area Severity Index (PASI). Patients were asked to fill "AKUADS" for their psychiatric assessment and scoring was done on this basis. Patients scoring equal to or above 19 were labeled as having anxiety or depression. RESULTS There were 56 males (62%) and 33 females (38%), aged 20 to 65 years in the study. Out of those, 52 (58%) were married; while 37 (42%) were unmarried. The minimum duration of illness was 6 months and maximum 15 years. Thirty-four patients (38%) were suffering from mild disease, 31 (35%) from moderate and the remaining 24 (27%) from severe psoriasis. Twenty-four (27%) were on topical therapy while the other 65 (73%) were receiving systemic as well as topical therapy. Joint involvement was seen in 25 patients (28%) and nail changes in 31 (35%). Psychiatric illness was positive in 34 patients (38%, p<0.05) i.e. 20 males (59%) and 14 females (41%). Twenty-six patients (76%) were married (p<0.05). Anxiety and depression was seen irrespective of the disease duration. The mean "AKUADS" scores in accordance with disease severity were mild psoriasis 20, moderate psoriasis 22 and severe psoriasis 25. Twenty-one patients (62%, p=0.05) with joint involvement and another 23 (68%, p<0.05) with nail involvement had a score above 19. Thirty-one patients (91%) were receiving systemic as well as local therapy, while 3 patients (9%) were on topical treatment (p<0.05). CONCLUSION There is an association of psoriasis vulgaris with anxiety and depression. The magnitude of this anxiety and depression can be influenced by variables of disease and life.