Study finds patient overestimation of psoriasis severity is associated with mental health status

Discordance between patient and physician measures of psoriasis severity is associated with poorer mental health, according to investigators from King’s College London.

A research team, led by Ewan Carr, PhD, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, sought to discover if a patient’s mental health status is associated with discordance on patient and physician measures of psoriasis severity. 

The cohort study involved 502 patients with psoriasis, using repeated cross-sectional analysis of real-world longitudinal data. 

Within the study population, 88% of patients were men, 79% were white and the mean age was 47 years. 

As part of the study, disease severity was rated with an identical 5-point physician scale and patient global assessment scales, ranging from clear/nearly clear, mild, moderate, severe and very severe. 

A total of 43 (9%) of patients screened positive for depression and 49 (10%) screened positive for anxiety. 

The researchers identified discordance between physician and patient measures of disease severity in 768 appointments (39%).

Out of these, patients rated their psoriasis as less severe than their physicians’ measure for 511 visits (26%) and more severe for 257 visits (13%). 

Patients who screened positive for depression or anxiety were found to be more likely to overestimate their psoriasis severity compared with their physician.

Study investigators found that these findings remained statistically significant across age, ethnicity, sex, body mass index, smoking, comorbidities, treatment modality and the presence of psoriatic arthritis. 

“The findings of this cohort study suggest that discordance between patient and physician assessments of psoriasis severity is associated with patients’ mental health status,” commented the researchers. 

“Recognition of anxiety and depression in individuals with psoriasis appears to be important when interpreting patient-reported outcome measures and informing appropriate treatment decisions,” they added.