Depression Screening Tool Tied to Treatment Success in Psoriasis

The utility of the Two Questions Test as a screening tool in patients with psoriasis is examined.

Patients with psoriasis who answered the Two Question Test (TQT), a brief screening tool for depression, recorded significantly more negative responses during the course of treatment, according to data from a retrospective analysis published in The Journal of Dermatology. The TQT also correlated significantly with the Dermatology Life Quality Index (DLQI).

Investigators performed a retrospective analysis of patient records at the University Hospital Essen, Germany, dermatology clinic. They included adult patients with moderate to severe psoriasis who initiated a selective IL-23 or IL-17A inhibitor from August 2019 to February 2021, and for whom there was TQT data at baseline and up to 28 weeks after treatment initiation. A negative TQT screen was defined as no questions answered with “yes” and, to increase variance, a positive TQT screen was defined as at least 1 question answered with “yes.” When comparing results with other measures for psychiatric diseases, investigators used the guideline-recommended cut-off of 2 positively answered questions for a positive screen.

Investigators correlated TQT data with the Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) using logistic regression, and with lesions visibility using a Chi Square test. They also conducted a repeated measures/mixed model analysis to examine how sensitive TQT results are to change during the course of treatment.

Of 139 patients included at baseline, 40% were women, the mean age was 45 years, and the mean disease duration was 15 years. In addition, 95% screened positive for depression with the TQT and 7.2% listed depression as an existing comorbidity.

There was no statistically significant correlation between baseline TQT and baseline PASI scores or lesion visibility. However, there was a significant correlation between baseline TQT and baseline DLQI (P <.001), as well as the BDI (P =.017) and STADI trait depression subscale (P =.014). Higher DLQI scores were associated with an increased chance of a suspicious outcome in the TQT, ie, only 1 positive answer.

Looking at change in TQT scored over time, the investigators found that there was a significant reduction in scores from baseline to treatment week 28 (P <.001), even when controlling for covariates including sex, lesion visibility, presence of metabolic syndromes, baseline PASI score, disease duration, and age of disease onset.

Investigators found a steeper decline in TQT scores after baseline assessment in women vs men, and in patients with a shorter disease duration vs a longer disease duration. In a post hoc analysis on the type of medication used for treatment, investigators found a greater probability of a positive TQT screen in patients treated with IL-17A inhibitors. They did not find a medication effect on improved TQT scores over time.

The study was limited by its purely observational design, and the fact that psychiatric histories were recorded inconsistently in patients’ medical files.

Based on their findings, investigators recommended using the TQT “as a repeated assessment tool monitoring treatment success with regard to the patients’ mental well-being,” also citing its ease of use for busy clinical practices. Yet they cautioned against over-interpreting positive screens, since the TQT’s specificity rate is 65%.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Hölsken S, Krefting F, Schneider L, Benson S, Schedlowski M, Sondermann W. A brief screening tool for depression in psoriasis patients: The Two Questions Test in clinical practice. J Dermatol. Published online November 21, 2021. doi:10.1111/1346-8138.16241