Background: Psoriasis is often associated with the risk of physical disability, social discomfort and psychological disorders. Objectives: The aim of this study was to investigate the prevalence of depressive symptomatology among Italian patients with psoriasis vulgaris, in order to better evaluate the disease severity in this patient population. Methods: Five thousand Italian patients with psoriasis were mailed the Center for Epidemiological Studies-Depression Scale (CES-D) questionnaire, a 20-item instrument developed to perform epidemiological studies of depressive symptomatology in the general population. Questionnaires with responses to 16 or more items were considered evaluable. Results: We received evaluable questionnaires from 2,391 patients, including 1,528 men (63.9%) and 863 women (36.1%). Depressive symptomatology was observed in 1,482/2,391 patients (62% overall; females, 63%; males, 61%). Men <40 years of age were significantly more likely to report depressive symptoms than were men ≧40 years of age (67 vs. 58%, respectively; p = 0.002). Depressive symptomatology was more prevalent in psoriatic patients with only primary or secondary education than in psoriatic patients with higher education (51 vs. 32%, respectively; p < 0.02). Conclusion: Our results are consistent with previous studies showing that psoriasis is associated with profound psychological morbidity, in particular with depression in a large number of patients. It is important to consider this association in the overall management of psoriasis.

1.
Punkett A, Marks R: A review of the epidemiology of psoriasis vulgaris in the community. Australas J Dermatol 1998;39:225–232.
2.
Nevitt GJ, Hutchinson PE: Psoriasis in the community: prevalence, severity and patients beliefs and attitude towards the disease. Br J Dermatol 1996;135:533–537.
3.
Rapp SR, Feldman SR, Exum ML, et al: Psoriasis causes as much disability as other major medical disease. J Am Acad Dermatol 1999;41:401–407.
4.
Ramsay B, O’Reagan M: A survey of social and psychological effects of psoriasis. Br J Dermatol 1988;118:195–201.
5.
Fortune DG, Richards HL, Main CJ, Griffiths CE: What patients with psoriasis believe about their condition. J Am Acad Dermatol 1998;39:196–201.
6.
Ginsburg IH, Link BG: Feelings of stigmatization in patients with psoriasis. J Am Acad Dermatol 1989;20:53–63.
7.
Gupta MA, Gupta AK: Quality of life of psoriasis patients. J Eur Acad Dermatol Venereol 2000;14:241–242.
8.
Choi J, Koo JYM: Quality of life issues in psoriasis. J Am Acad Dermatol 2003;49:S57–S61.
9.
Feldman SR, Fleischer AB, Reboussin DM, et al: The economic impact of psoriasis increases with psoriasis severity. J Am Acad Dermatol 1997;11:216–220.
10.
Javitz HS, Ward MM, et al: The direct cost of care for psoriasis and psoriatic arthritis in the United States. J Am Acad Dermatol 2002;46:850–860.
11.
Finzi AF, Mantovani LG, Belisari A, and AISP: The cost of hospital-related care of patients with psoriasis in Italy based on the AISP study. J Eur Acad Dermatol Venereol 2001;15:320–324.
12.
Kirby B, Richards HL, Woo P, et al: Physical and psychologic measures are necessary to assess overall psoriasis severity. J Am Acad Dermatol 2001;45:72–76.
13.
Gupta MA, Gupta AK, Schork NJ, et al: A psychocutaneous profile of psoriasis patients who are stress reactors: a study of 127 patients. Gen Hosp Psychiatry 1989;11:166–173.
14.
Rapp SR, Exum ML, Reboussin DM, Feldman SR, Fleischer A, Clark A: The physical, psychological, and social impact of psoriasis. J Health Psychol 1997;2:523–537.
15.
Seville RH: Psoriasis and stress. Br J Dermatol 1977;97:297–302.
16.
Marks R, Barton S, Shuttleworth D, Finlay AY: Assessment of disease progress in psoriasis. Arch Dermatol 1989;125:235–240.
17.
Van de Kerkhof PCM: The psoriasis area and severity index and alternative approaches for the assessment of severity: persisting areas of confusion.Br J Dermatol 1997;137:661–663.
18.
Feldman SR, Fleischer AB, Reboussin DM, Rapp SR, Exum ML, Clark AR, et al: The self-administered psoriasis area and severity index is valid and reliable. J Invest Dermatol 1996;106:183–186.
19.
Lewis G, Wesley S: Comparison of the General Health Questionnaire and the Hospital Anxiety Depression Scale. Br J Psychiatry 1990;157:860–864.
20.
Weinmann J, Petrie KJ, Moss-Morris R, Horne R: The illness perception questionnaire: a new retinoid for assessing the cognitive representation of illness. Psychol Health 1996;11:114–129.
21.
Fortune DG, Main CJ, O’Sullivan TM, Griffiths CEM: Assessing illness-related stress in psoriasis: the psychometric properties of the psoriasis life stress inventory. J Psychosom Res 1997;42:467–475.
22.
Finlay AY, Kelly SE: Psoriasis – An index of disability. Clin Exp Dermatol 1987;12:8–11.
23.
Finlay AY, Khan GK: Dermatology Life Quality Index (DLQI) – A simple practical measure for routine clinical use. Clin Exp Dermatol 1994;19:210–216.
24.
Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385–401.
25.
Kirby B, Fortune DG, Bhushan M, Chalmers RJC, Griffiths CEM: The Salford Psoriasis Index: an holistic measure of psoriasis. Br J Dermatol 2000;142:728–732.
26.
Al-Suwaidan SN, Feldman SR: Clearance is not a realistic expectation of psoriasis treatment. J Am Acad Dermatol 2000;42:796–802.
27.
Gupta MA, Gupta AK: Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998;139:846–850.
28.
Akay A, Pekcanlar A, et al: Assessment of depression in subjects with psoriasis vulgaris and a lichen planus. J Eur Acad Dermatol Venereol 2002;16:347–352.
29.
Gupta MA, Schork NJ, Gupta AK, et al: Suicidal ideation in psoriasis. Int J Dermatol 1993;32:188–190.
30.
Koo J, Lebwohl A: Psychodermatology: the mind and skin connection. Am Fam Physician 2001;64:1873–1878.
31.
Picardi A, Amerio P, Baliva G, et al: Recognition of depressive and anxiety disorders in dermatological outpatients. Acta Derm Venereol 2004;84:213–217.
32.
Wessely SC, Lewis GH: The classification of psychiatric morbidity in attenders at a dermatology clinic. Br J Psychiatry 1989;155:686–691.
33.
Sampogna F, Picardi A, et al: The impact of skin diseases on patients: comparing dermatologists’ opinions with research data collected on their patients. Br J Dermatol 2003;148:989–995.
34.
Gupta MA, Gupta AK, Watteel GN: Perceived deprivation of social touch in psoriasis is associated with greater psychologic morbidity: an index of the stigma experience in dermatologic disorders. Cutis 1998;61:339–342.
35.
Cooper-Patrick L, Crum RM, Ford DE: Identifying suicidal ideation in general medical patients. JAMA 1994;272:1757–1762.
36.
Olfson M, Weissman MM, Leon AC, et al: Suicidal ideation in primary care. J Gen Intern Med 1996;11:447–453.
37.
Gupta MA, Gupta AK: Age and gender differences in the impact of psoriasis upon the quality of life. Int J Dermatol 1995;34:700–703.
38.
Gupta MA, Gupta AK: The use of antidepressant drugs in dermatology. J Eur Acad Dermatol Venereol 2001;15:512–518.
39.
Sendur N, Sir A, Mevlitoglu I: Psoriasis ve Emosyonel Stress Faktoru. 13. Ulusal Dermatolji Kongresi I, Cukurova Universitesi, Basimevi-Adana, 1990.
40.
Dubertret L, Mrowietz U, Ranki A, van der Kerkhof PCM, Naeyaert JM, Hercogova J, Chimenti S, et al: European patients’ perspective on the impact of psoriasis: the EUROPSO patient membership survey. Br J Dermatol, in press.
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