Depression Screening Rates Low in Patients With Psoriasis, Atopic Dermatitis

Coping with severe depression.
Coping with severe depression.
Despite well-established associations of psoriasis and atopic dermatitis with depression and suicidality, and recommendations for increased screening in these higher-risk patients, clinical practice gaps remain, with low rates of depression screening.

Study data published in the British Journal of Dermatology suggest that depression screening rates are low in patients with psoriasis and atopic dermatitis (AD), despite known associations between these skin conditions and adverse psychiatric outcomes.

Investigators abstracted data from the 2006-2015 National Ambulatory Medical Care Survey. In the survey, participating physicians provide data on approximately 30 patient visits during a randomly assigned 1-week reporting period. Patient visits for psoriasis and AD were identified using the associated International Classification of Diseases, 9th edition codes. Practitioners were asked to report whether they performed a depression screening at patient visits. Depression screening rates were calculated for each diagnostic group, stratified by use of ≥1 step-up treatments as a proxy for disease severity. Multivariable logistic regression models were constructed to identify the association of depression screening with disease severity, clinician specialty, and patient gender.

Data were extracted from 9345 patients with AD and 2085 patients with psoriasis. Depression screening rates were low for both patient groups: 1.2% and 1.6% for psoriasis and AD, respectively. In patients with AD, depression screening rates were similar between dermatologists and non-dermatologists (0.7% vs 2.0%; P =.25). However, among patients with psoriasis, dermatologists were less likely to perform a screening compared with other practitioners (0.1% vs 3.0%; P <.001).

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Men with AD were less likely to receive a depression screening than women with AD (0.8% vs 2.4%; P <.003). In psoriasis, depression screening rates were similar between men and women (1.1% vs 1.3%; P =.83).

Depression screening rates were similar between patients on a step-up treatment vs not on a step-up treatment for both AD (P =.29) and psoriasis (P =.19).

As study limitations, investigators noted the lack of information on disease severity or subtype. Additionally, longitudinal data were not available. Still, these results suggest that patients with AD and psoriasis are underscreened for depression, even in cases of high disease severity.

“Given significant risk of morbidity…future efforts are needed to improve screening for mental health comorbidity in psoriasis and AD,” investigators wrote.

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Singh P, Silverberg JI. Underscreening of depression in US outpatients with atopic dermatitis and psoriasis [published online October 24, 2019]. Br J Dermatol. doi:10.1111/bjd.18629