Women disproportionately affected by the psychological impact of skin diseases

Women in treatment for skin diseases, including psoriasis, experience higher levels of non-psychotic psychiatric disorders, including anxiety and depression, than men. Identifying these conditions earlier can not only improve their quality of life, but it can also reduce the dermatological impact, according to recently published research.

Existing research shows anxiety and depression occur frequently in patients with skin conditions. But, based on new study findings published in the European Journal of Dermatology, researchers determined if dermatologists administer questionnaires that assess a patient’s possible anxiety and depression levels, they could pinpointing who might benefit from psychological counseling.

“The aim of the present study was to define predictors that can be used by dermatologists to refer patients for psychological consultation and psychotherapy to improve patients’ clinical outcomes,” the study authors wrote.

Although the study assessed the psychological status of both men and women, the researchers reported that the psychological life of women is more severely impacted by skin diseases than that of men.

To assess patients’ psychological states, investigators used two questionnaires - the 12-question, self-administered General Health Questionnaire (GHQ-12) designed to assess psychological distress or non-psychotic disorders and the Skindex-17, a measure of health-related quality-of-life issues related to dermatologic conditions.

Using both questionnaires, they tested the effectiveness with 651 patients from Oct. 14 to Dec. 17, 2014, in three hospital wards. Of this group, 508 (78 percent) completed the GHQ-12 - 56.1 percent were women with an average age of 58.3 years. Among the participants, 179 (35.2 percent) scored 4 or more, indicating the possible presence of depression or anxiety, and 80 (15.7 percent) scored 7 or more, revealing the probable presence of depression or anxiety.

More women than men had scores above the two chosen cut-off points with a significant difference for a score of 4 or more (p=0.004). Dermatological patients who were hospitalized had higher rates of probably depression and anxiety than did outpatients (p<0.001). In fact, the highest GHQ scores (4 or more) occurred in patients with leg ulcers (p=0.013), psoriasis (p=0.058), and pemphigoid (p=0.092).

Skindex-17 scores closely mirrored those from GHQ. Average scores were higher in women than men (p=0.008). And, the psychological impact was greatest in patients with leg ulcers, hidradenitis suppurativa, psoriasis, dermatitis, and pemphigoid.

Investigators also compared the participants’ questionnaire scores with the records of which patients had undergone psychological counseling. Among the patients who had GHQ scores of 7 or more, 53.8 percent met with a psychologist, and 24.2 percent of those with scores between 4 and 6 received counseling. Again, women were more likely to receive these services than men, as were younger patients.

Overall, the researchers said, this study shows, initially, that implementing a self-administered screening questionnaire can augment a patient’s care.

“Our pilot study provides preliminary evidence that the use of a simple, self-administered screening questionnaire for non-psychotic psychiatric disorders, such as the GHQ-12, may alert the dermatologist to the needs of certain patients for further assessment and possible psychological support,” the authors wrote.

If dermatologists can recognize these disorders, they could potentially provide referrals for services that could improve a patient’s clinical condition. In fact, the researchers wrote, existing research has shown, among patients with psoriasis, that initiating mindfulness-based cognitive therapy can significantly improve both the psoriasis severity and the patient’s quality-of-life.

Ultimately, investigators determined, administering these questionnaires can be an expedient way to identify any underlying psychological conditions that could affect a patient’s dermatological treatment.

“To alleviate the suffering of a patient, the treatment of psychiatric/psychological problems is foremost,” they wrote. “Moreover, better patient morale may also improve adherence to treatment, as well as health outcomes.”