Depression in dermatological patients identified by the Mini International Neuropsychiatric Interview questionnaire

Global Prevalence of Anxiety, Depression, and Stress Among Patients with Skin Diseases: A Systematic Review and Meta-analysis

The changes in human lifestyle over the past few decades have impacted the prevalence of skin diseases within different societies. Skin diseases may result in various physical and mental disorders. The most common mental disorders observed among the patients are stress, anxiety, and depression. This study aims to investigate the global prevalence of anxiety, depression, and stress in patients with skin diseases. In this Systematic Review and Meta-Analysis study, the PubMed, Scopus, Science Direct, Embase, Web of science, and Google Scholar repositories were searched without a lower time limit. Heterogeneity among the identified studies was examined using the I2 index, and accordingly random effects model was adopted for analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v. 2). In total, 113 studies were included for the final analysis. The overall pooled prevalence of stress, depression, and anxiety in skin disease patients was found to be 39.4%, 27.2% and 28.8%, respectively. Among patients with psoriasis, acne, vitiligo or atopic dermatitis diseases, the highest number of patients suffering from stress was related to patients with acne (75.7%). The highest prevalence of depression, and anxiety was reported in patients with vitiligo (38.3%) and acne (36.5%), respectively. Considering the high prevalence of mental disorders among patients with skin diseases and recognising the impacts of mental health challenges on patients' well-being, the findings of this study provide valuable insights for identifying specific populations that require targeted interventions for the diagnosis, treatment, and prevention of mental illnesses. Accordingly, healthcare policymakers should incorporate psychological treatment and support measures as integral components of comprehensive care strategies for patients with skin diseases.

Determination of depression, anxiety and stress (DAS) levels in patients with atopic dermatitis: a case-control study

The present study was aimed at comparing depression, anxiety and stress (DAS) levels of individuals with atopic dermatitis with those of the individuals without atopic dermatitis, and to examine the DAS levels of the patients with atopic dermatitis in terms of their socio-demographic characteristics. Case control study conducted in a city in western Turkey. The present study in which the relational screening model was used was conducted with patients with atopic dermatitis who presented to the Dermatology Clinic/Polyclinic of a university hospital and healthy subjects, and volunteered to participate in the study. The study conducted between December 2017 and February 2018 included 150 people (75 healthy subjects, 75 patients with atopic dermatitis). To collect the study data, the participants were administered the Socio-demographic Characteristics Questionnaire prepared by the researcher and the Depression, Stress and Anxiety Scale (DASS-42). No significant difference was determined between the mean DASS scores obtained by the atopic dermatitis patients and those obtained by the healthy subjects in the control group (p > 0.05). Of the atopic dermatitis patients, 58.7%, 82.3% and 49.3% were within the normal ranges in terms of the mean scores they obtained from the stress, depression and anxiety subscales respectively. In the present study, the mean scores obtained from the depression and anxiety subscales by working atopic dermatitis patients were higher than those obtained by the nonworking patients (p < 0.05). The mean scores obtained from the stress subscale by the smokers with atopic dermatitis were higher than those obtained by the non-smokers with atopic dermatitis.

Assessment of Anxiety, Depression, Stress, and Associated Psychological Morbidities among Patients Receiving Ayurvedic Treatment for Different Health Issues: First Study from Sri Lanka

Background

Good mental condition is a vital part of health. Physical impairments would potentially have psychiatric manifestations during the course of a disease that could cause patients to experience a wide range of psychological conditions. This study was conducted to determine prevalence of anxiety, depression, stress, and psychological morbidities among the patients who received warded treatments at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Sri Lanka.

Methods

A total of 148 patients admitted to the hospital were selected for the study on a random systematic basis under four systemic groups (gastrointestinal, integumentary, musculoskeletal, and nervous system) depending on the chief complaint. The presence of depressive, anxiety, and stress symptoms was assessed by the Depression Anxiety Stress Scale 21 item version (DASS 21). The General Linear Model (GLM) was used for statistical analysis.

Results

Over 50% of the participants in all four patient groups belonged to age group of 35 to 65 years, encompassing the fraction of population that actively contribute to the workforce in the society. Stress, anxiety, and depression values of patients belonging to different complications varied significantly, as indicated by GLM (p < 0.05). Patients diagnosed with integumentary system-related issues denoted the highest stress levels (27.7 ± 2.54), while the mean stress values among the other systemic groups were not significantly different among each other. The highest anxiety levels were indicated by patients with nervous system-related issues (18.6 ± 1.51), while the lowest anxiety levels were indicated by patients with integumentary disorders (6.0 ± 2.73). The highest depression level was identified from patients suffering from integumentary system-related disorders (31.7 ± 3.42), followed by nervous system (23.2 ± 1.78), gastrointestinal (19.5 ± 3.77), and musculoskeletal (16.8 ± 1.57) disorders.

Conclusion

Overall, high distress levels were observed among the majority of the patients. Furthermore, integumentary issues may lead to significant psychological impacts. As most of the patients seek for Ayurveda treatments when their diseased condition becomes chronic, it is vital to focus on a biopsychosocial approach to patient assessment and patient care, in actual practice.

How Informative Are Self-Reported Adult Attention-Deficit/Hyperactivity Disorder Symptoms? An Examination of the Agreement Between the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale V1.1 and Adult Attention-Deficit/Hyperactivity Disorder Investigator Symptom Rating Scale

OBJECTIVES

Assess agreement between self-ratings via the adult attention-deficit/hyperactivity disorder (ADHD) Self-Report Scale (ASRS)-v1.1 Symptom Checklist and clinician ratings via the adult ADHD Investigator Symptom Rating Scale (AISRS) expanded version using DSM-5 adult ADHD patients (referred sample) and ADHD controls (recruited from a primary care physician practice).

METHODS

The ASRS v1.1 Symptom Checklist was administered to measure self-reported ADHD symptoms and impairment, the Adult ADHD Clinical Diagnostic Scale v1.2 was used to establish an adult ADHD diagnosis and the childhood and adult/current sections of the scale were used to provide scores to measure symptoms of childhood ADHD and recent symptoms of adult ADHD, the AISRS to measure ADHD current symptom severity.

RESULTS

Participants (n = 299; range 18-58), of which 171 were ADHD+ and 128 ADHD-. ASRS and AISRS total scores and individual subsections examining inattention, hyperactivity, emotional dysfunction (EF), and emotional dyscontrol (EC) were all significantly correlated (Spearman's ρ's = 0.78-0.89, ps < 0.01). Correlations remained significant when controlling for demographic factors and psychiatric conditions.

CONCLUSIONS

The ASRS (self) and AISRS (clinician rated) scales have high agreement. This agreement extended not only the to the core 18 DSM symptoms, but also to the additional 13 symptoms that examine EC and EF.

Test-retest reliability of the adult ADHD Self-Report Scale (ASRS) v1.1 Screener in non-ADHD controls from a primary care physician practice

OBJECTIVES

To examine the test-retest reliability of the DSM-IV Adult ADHD Self-Report Scale (ASRS) v1.1 Screener in adults without ADHD. Prior studies have not examined test-retest reliability of the Screener in non-ADHD controls.

METHODS

Subjects completed the Screener in a primary care physician (PCP) waiting room (T1); those who screened negative for ADHD (n = 104) (<4/6 significant Screener items) symptoms were further assessed on the phone (T2). T2 included phone administration of the full ASRS v1.1 Symptom Checklist (which contains the six items from the Screener). Spearman's correlations and intra-class correlation coefficients (ICCs) between T1 and T2 were calculated for the total Screener score and for each Screener item. McNemar-Bowker tests were conducted for the Screener total score and each item to check for significant changes from T1 to T2.

RESULTS

Screener T1 and T2 total scores were significantly correlated (Spearman's rho = 0.78, P < 0.0001), as were individual items. Correlations remained significant when controlling for a variety of demographic factors and psychiatric conditions. Confirming the significant Spearman correlations, ICCs for Screener total score and each item were also significant (ICC = 0.75, P < 0.0001). The McNemar-Bowker tests showed no significant differences for Screener total score and for the IA items; however, the H-I items were somewhat higher at T1 versus T2.

CONCLUSIONS

The DSM-IV ASRS v1.1 Screener has high test-retest reliability in patients without ADHD.

Major depressive disorder and suicide risk among adult outpatients at several general hospitals in a Chinese Han population

Background

Somatic complaints are often the presenting symptoms of major depressive disorder (MDD) in the outpatient context, because this may go unrecognized. It is well understood that MDD carries an increased risk of suicide. This study aimed to identify the risk factors and association with both MDD and suicidality among Han Chinese outpatients.

Methods

A multicenter study was carried out in 5189 outpatient adults (≥18 years old) in four general hospitals in Guangzhou, China. The 1392 patients who had the Patient Health Questionnaire-9 (PHQ-9) score ≥ 5, indicating depressive symptoms were offered an interview with a psychiatrist by the Mini International Neuropsychiatric Interview (MINI); 819 patients consented and completed the MINI interview. MINI module B was used to assess suicidality. Stepwise binary logistic models were used to estimate the relationship between a significant risk factor and suicide or MDD. According to with or without MDD, the secondary analysis was performed using the logistic regression model for the risk of suicidility.

Results

The current prevalence of MDD and the one month prevalence of suicidality were 3.7% and 2.3% respectively. The odds ratio of suicidality in women was more than twice that in men (OR = 2.62; 95% CI 1.45–4.76). Other risk factors which were significantly associated with suicidality were: living alone, higher education, self-reported depression, getting psychiatric diagnoses (MDD, anxiety disorders, and bipolar disorders). Significant risk factors for MDD were also noticed, such as comorbid anxiety disorders, self-reported anxiety, insomnia, suicidal ideation.

Limitation

It’s a cross-sectional study in outpatient clinics using self-report questionnaires.

Conclusion

This study provides valuable data about the risk factors and association of MDD and suicide risk in adult outpatients in Han Chinese. Those factors allow better the employment of preventative measures.

[Cutaneous manifestations in patients on chronic hemodialysis in a developing country]

Our study aims to highlight the most common skin disorders in patients on chronic hemodialysis at the University Hospital Yalgado Ouédraogo (CHU-YO) in Ouagadougou. The study, of transverse type descriptive, carried out of September 15 to December 31, 2014, is unrolled with the CHU-YO. This descriptive transversal study was conducted at the CHU-YO from September 15 to December 31, 2014. It involved patients who had been on chronic dialysis for at least 3 months. The frequency of hemodialysis sessions was one every five days. The significance level of statistical tests was defined as the probability p ≤ 0.05. Eighty-five patients (61.1% men and 38.9% women) with an average age of 42.1 years were included in the study. The mean duration of hemodialysis was 31.9 months. The success rate of biological examinations varied from 7,4 to 85,3%. Eighty patients (85,3%) had at least one cutaneous manifestation. Cutaneous xerosis (67.4%), pruritus (45.3%), and hyperpigmentation (23.2%) were the most frequent skin manifestations that may be specific of hemodialysis. Guttate hypomelanosis (11.6%), prurigo (11.6%) and folliculitis (8.4%) were the main non-specific skin manifestations. Skin involvement was frequent but did not seem related to seniority in hemodialysis. In Ouagadougou, bad hemodialysis conditions and a hot, dry environment promote such conditions, especially xerosis and pruritus. A better subvention of health care could help to reduce the prevalence of skin diseases and to improve the quality of life of our patients on chronic hemodialysis.

The Prevalence of Anxiety and Depression in Arab Dermatology Patients

BACKGROUND

Psychiatric disorders are common among patients with physical illnesses.

OBJECTIVES

To estimate the prevalence of anxiety and depression in Arab dermatology patients and to study its association with the patients' characteristics.

MATERIALS AND METHODS

A cross-sectional study was carried out on 875 patients attending the Dermatology Clinic at King Khalid University Hospital in Riyadh, Saudi Arabia. Each patient was asked to complete the Hospital Anxiety and Depression Scale and the demographic-clinical questionnaire.

RESULTS

The frequency of anxiety and depression in Arab dermatology patients was 29% for anxiety and 14% for depression. These frequencies were not related to sociodemographic and clinical variables (p>.05), except skin disease type (p<.05). Patients suffering from hair loss had the highest anxiety and depression scores (OR 1.725 [95% CI 1.247-2.386] and OR 1.686 [95% CI 1.101-2.581], respectively). On the other hand, patients suffering from psoriasis had the highest depression scores (OR 2.909 [95% CI 1.611-5.254]).

CONCLUSION

Anxiety and depression are frequent among Arab dermatology patients.

[Depression and psoriasis]

Psychiatric co-morbidity is very frequently associated with psoriasis and depression is observed in numerous patients with psoriasis. Early detection and treatment are very important. The links between psoriasis and depression are not only psychopathological. Biological factors could also explain this association. There is a vicious circle psoriasis-alteration of quality of life-depression, but psoriasis improvement is not always followed by an improvement of depression. A contrario, it is obvious that a depressive patient has a bad observance of treatment.

Pemphigus and quality of life

Measuring the impact of disease on quality of life (QOL) is important for evaluating effectiveness of care and capturing aspects of health that may not correlate with clinical severity. Few QOL studies have been conducted on pemphigus, and a disease-specific QOL questionnaire for this condition has not been developed. The 5 previous studies of the effect of pemphigus on QOL used generic health or skin-specific measures. These measures have limitations, and results from these studies have sometimes been conflicting. The development of a disease-specific measure for pemphigus would allow for better monitoring of patients' QOL and improve management.

Development and preliminary validation of the PC-SAD5, a screener-derived short depression severity measure

BACKGROUND

The prevalence of depressive disorders is high among patients with skin disease. The PC-SAD is a 37-item self-administered depression screening questionnaire that has been validated in dermatological patients.

OBJECTIVE

The aim of this study was to develop and validate a brief depression severity instrument derived from the PC-SAD that can be used to assess severity and monitor ongoing clinical course.

METHODS

Two patient samples participated in the study: 72 adult dermatological inpatients and 73 adults attending six primary care practices. Psychiatric assessment included the Structured Clinical Interview for DSM-IV and an 18-item version of the PC-SAD; moreover, dermatological patients completed the Patient Health Questionnaire depression scale (PHQ-9), while primary care patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS). A subset of five PC-SAD items showing the best psychometric properties were selected, and the reliability and validity of the resulting instrument (PC-SAD5) were examined.

RESULTS

The PC-SAD5 showed satisfactory internal consistency in both samples. There was a high correlation between PC-SAD5 and PHQ-9 and MADRS scores. Multiple regression analysis revealed a gradient of PC-SAD5 scores from patients with no mental disorder, those with milder forms of depression, to those with Major Depressive Disorder. Similar results were observed for the 18-item version of the PC-SAD.

CONCLUSION

The availability of valid and reliable continuous measures of depression severity derived from the PC-SAD extends its field of application from depression screening to use as a follow-up measure of depression severity in routine clinical practice. A validated very short instrument such as the PC-SAD5 may have substantial clinical value.

Mood and anxiety disorders in systemic sclerosis patients

OBJECTIVE

To assess the prevalence of mood and anxiety disorders in systemic sclerosis (SSc) patients and the association of these disorders with clinical features.

METHODS

Between May 2002 and May 2004, 100 SSc patients fulfilling the American Rheumatism Association and/or Leroy & Medsger criteria were recruited: 51 were from a SSc patient association meeting, and 49 were hospitalized in an internal medicine department and recruited consecutively. Mood and anxiety disorders were assessed by use of a structured clinical interview [the Mini International Neuropsychiatric Interview (MINI)] performed by a psychiatrist and a self-reporting questionnaire [the Hospital Anxiety and Depression Scale (HADS)]. On the same day, psychiatric treatment and clinical features were recorded by a physician.

RESULTS

As assessed by the MINI, 19% [95% confidence interval 12-28%] of all SSc patients were currently experiencing a major depressive episode (MDE), 56% [46-65%] had a lifetime history of MDE and 14% [8-22%] had current dysthymia. Current MDE was more prevalent among hospitalized patients than among other patients (28% versus 10%, p=0.02). Specific anxiety disorders were diagnosed in 37 [28-47] patients. Less than 50% of the patients with mood disorders received psychiatric treatment. Patients with or without current depression did not differ in clinical symptoms of SSc, except for digestive symptoms.

CONCLUSION

The current and lifetime prevalence of major depression and anxiety disorders is high in SSc patients, especially during hospitalization. However, only half of such patients receive adequate psychiatric treatment. Therefore, a better assessment of psychiatric disorders in SSc patients is needed.

Ustekinumab significantly improves symptoms of anxiety, depression, and skin-related quality of life in patients with moderate-to-severe psoriasis: Results from a randomized, double-blind, placebo-controlled phase III trial

BACKGROUND

Anxiety, depression, and impaired health-related quality of life (HRQoL) are common in patients with psoriasis.

OBJECTIVE

We sought to analyze the effect of ustekinumab on these conditions in patients with moderate-to-severe psoriasis.

METHODS

Patients with moderate-to-severe psoriasis (n = 1230) were randomized 1:1:1 to receive 45 mg of ustekinumab, 90 mg of ustekinumab, or placebo. The Hospital Anxiety and Depression Scale was used to measure anxiety and depression, and the Dermatology Life Quality Index to measure HRQoL.

RESULTS

At baseline, 40.3% and 26.7% of patients reported symptoms of anxiety and depression, respectively, and 54.6% reported Dermatology Life Quality Index scores greater than 10, indicating a very high impact of disease on HRQoL. Greater improvements at week 12 in mean Hospital Anxiety and Depression Scale-Anxiety (13.9%), Hospital Anxiety and Depression Scale-Depression (29.3%), and Dermatology Life Quality Index (76.2%) scores were reported in ustekinumab groups compared with placebo (P < .001 each).

LIMITATIONS

Results for these measures are reported only through 24 weeks.

CONCLUSION

Patients receiving ustekinumab reported significant improvements in symptoms of anxiety, depression, and HRQoL.

Psychiatric morbidity in dermatological conditions

Abstract Objective. A relationship between psychological factors and skin diseases has long been hypothesized. The objective of this study is to investigate the association of dermatology conditions with depression, anxiety and personality disorders. Method. A total of 144 dermatology outpatients and 100 controls were selected and assessed by the Structured Clinical Interview for DSM III-R personality disorders and the Hospital Anxiety and Depression Scale for presence of personality disorders and anxiety and depression. Results. A total of 77 (70%) of the patients and 26 (20%) of the control group reported moderate to severe anxiety and depression. Twenty-two patients (15.27%) and five controls (5%) suffered from personality disorders. Obsessive-compulsive personality disorder was the most diagnosed personality disorder followed by avoidant, borderline and dependent personalities. Conclusion. The association between dermatological diseases and psychiatric and personality morbidity underscores the deep emotional suffering that can be associated with skin diseases and confirms the importance of psychiatric evaluation of dermatology patients. Our findings highlight the need for a biopsychosocial approach to patients with skin disease.

Acne vulgar e bem-estar em acadêmicos de medicina

FUNDAMENTOS - Observa-se comorbidade psiquiátrica em 40% dos pacientes dermatológicos adultos, sendo a acne vulgar de interesse da psicodermatologia por ter entre suas complicações seqüelas psicossociais. OBJETIVOS - Estabelecer a relação entre acne e o status de bem-estar. MÉTODOS - Estudo de caso-controle com dados coletados a partir do Índice de Bem-Estar da Organização Mundial da Saúde, por meio de entrevistas com dois grupos de 50 acadêmicos de medicina, sendo um com acne e outro sem acne. RESULTADOS - Foi verificado que 26% dos acadêmicos do grupo de casos e 24% do grupo controle apresentaram de 0 a 4 pontos em pelo menos um dos itens questionados. CONCLUSÕES - Apesar de a maioria dos pacientes apresentar atitudes e sentimentos desencadeados pela acne, não se demonstrou associação estatisticamente significativa entre essa dermatose e baixo nível de bem-estar.

Screening for depression and anxiety disorders in primary care patients

Mood and anxiety disorders are highly prevalent in primary health care. In this study we assessed performance of the Hospital Anxiety and Depression Scale (HADS) for screening of depression and anxiety disorders in a population of primary care patients. A total of 503 primary care patients consecutively admitted to the primary care medical center in Kaunas, Lithuania, completed the study. We found that the HADS subscale of depression (HADS-D) at a cutoff score of 6 or more showed the best performance screening for a major depressive episode diagnosed by means of the Mini International Neuropsychiatric Interview (MINI), with a sensitivity of 80%, specificity of 69%, positive predictive value of 80%, negative predictive value of 92%, and area under the receiver operating characteristic (ROC) curve of 0.75. Performance of the HADS-D against MINI diagnosis of dysthymia was weak. The HADS subscale of anxiety (HADS-A) at a cutoff score of 9 or more showed the best performance screening for MINI diagnosis of overall anxiety disorders, with a sensitivity of 77%, specificity of 75%, positive predictive value of 53%, negative predictive value of 90%, and area under the ROC curve of 0.76. These results suggest that in primary care patients HADS is an adequate screening instrument for the MINI diagnoses of major depressive episode, but not for dysthymia at a cutoff score of 6, and for anxiety disorders at a cutoff score of 9.

Obsessive-compulsive disorder in dermatology outpatients

Introduction. Epidemiological findings have suggested that a large number of obsessional patients refer initially to dermatologists for their problems and their obsessions go undiagnosed. The goal of the present study is to investigate the frequency of OCD in a group of dermatology outpatients. Method. A total of 144 outpatients of a dermatology clinic in a general hospital who agreed to participate in the study were selected. The patients were screened for DSM-IV OCD using item H of the Mini-International Neuropsychiatric Interview. Those who were OCD-positives on the interview were then screened and rated for severity on the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Results. A total of 20 patients (14%) qualified for a diagnosis of OCD. Somatic obsessions and washing compulsions were the most reported symptoms. The majority of OCD-positive patients suffered from acne. Conclusion. The frequency of OCD in the dermatology population may be 4-5 times higher than in the general population. Identification and referral for psychiatric consultation may aid in better management of both disorders.