A Study of Psychiatric Morbidity Among Patients with Early-onset Psoriasis

Introduction: Psoriasis is a chronic inflammatory skin condition which leads to cosmetic disfigurement. This leads to shame and stigmatization, more so in patients with onset <20 years along with significant psychosocial burden, poor body image, and low self-esteem. Purpose: To study the relationship between severity of psoriasis and psychiatric morbidity, the relationship between age of onset and severity of psychiatric morbidity, the severity of psychiatric symptoms compared with the site of psoriasis, and to assess the quality of life (QOL) using the dermatological life quality index. Materials and Methods: A total of 50 consecutive, consenting patients attending the psoriasis clinic, were included into our study group. 50 consenting age-, sex-, and education-matched normal people were taken as controls. psoriasis area severity index (PASI) was administered by the dermatologist. Then, general health questionnaire was administered to screen for psychiatric symptoms. The patients who scored positively were assessed for anxiety, depression, and suicidal ideation using Hamilton depression rating (HAM-A), HAM-D, and Beck’s suicide inventory. Stress was assessed by Holmes and Rahe life stress inventory and self-esteem by Rosenberg self-esteem scale. Results: Psoriasis patients were found to have increased anxiety (40%), increased depression (36%), and increased suicidal ideation (32%) when compared with controls. 60% had reduced self-esteem. Self-esteem was affected more (77%) than patients with onset after 20 years. The QOL was equally affected in both age groups. PASI scores were found to be statistically significantly (P < 0. 001) associated with an increase in severity of anxiety and depression. Conclusion: Psychiatric comorbidity is greater among patients with psoriasis. Anxiety, depression, and suicidal tendencies are significantly higher in early-onset psoriasis. Poor QOL and low self-esteem are significantly more among patients with psoriasis. Clinicians caring for patients will be doing a greater service by paying attention to these invisible burdens, such as anxiety and depression.