P38: Mental health of patients with psoriasis during the COVID-19 pandemic: a cross-sectional study in a tertiary setting
G. Lada,1,2,3,4 P.S. Talbot,4,5 H. Chinoy,2,3,6 R.B. Warren1,2,3 and C.E. Kleyn1,2,3
1Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; 2National Institute for Health Research Manchester Biomedical Research Centre, Manchester, UK; 3Salford Royal NHS Foundation Trust, Salford, UK; 4Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; 5Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; and 6Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
Patients with psoriasis are at increased risk of depression. Furthermore, psoriasis is linked to social isolation, stress-related disorders and suicidality. The COVID-19 pandemic and social distancing represent potential stressors for patients, which may disproportionately affect the wellbeing of this vulnerable population. Our aim was to investigate whether the pandemic increased the affective burden of patients with psoriasis. We surveyed 194 patients with dermatologist-confirmed psoriasis attending our tertiary service. Ninety-three patients had completed questionnaires [Hospital Anxiety and Depression Scale (HADS); Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR); Sheehan Suicidality Tracking Scale; Dermatology Life Quality Index (DLQI)] before March 2020 in a pre-existing study. From May to October 2020, we recruited a different patient sample (n = 101) who completed the same questionnaires. We analysed separately data from 22 patients, who completed the survey both before and during the pandemic. Cases of depression and anxiety were defined as having a HADS subscale score of ≥ 8. Analysis was performed in R. Ninety-three patients completed the survey before the pandemic [49·5% female; mean (SD) age 42 (18) years] and 101 during the pandemic [38% female; mean (SD) age 52 (16) years; 74% shielding]. Patient proportions across treatment groups did not differ before vs. during the pandemic (73·1% vs. 78·2% on biologics; P = 0·8). Depression, anxiety and suicidality were highly prevalent at both timepoints. However, there were no significant differences in depression [31% vs. 40%; adjusted odds ratio (aOR) 1·2, 95% confidence interval (CI) 0·6–2·5], anxiety (39% vs. 47·5%; aOR 1·7, 95% CI 0·8–3·5) or suicidal ideation prevalence (13% vs. 20%; aOR 2·19, 95% CI 0·8–5·9] before vs during the pandemic. During the pandemic, depression was not associated with living alone (P = 0·45) or shielding (P = 0·13). In the paired analysis, depression scores did not differ during compared with before the pandemic (QIDS-SR 9·4 ± 5·8 vs. 8·8 ± 6·1; P = 0·56). DLQI changes did not correlate with changes in QIDS-SR (r = 0·08, P = 0·7). At follow-up, three patients (14%) reported 12-month passive suicidal ideation; no patient reported 12-month active suicidality. Depression and the prevalence of anxiety are high in patients with psoriasis. Suicidal ideation rates appear to be higher than the rates in the general population during the COVID-19 pandemic. However, we did not observe a significant increase in the psychological burden or shielding of our patients during the pandemic compared with previous levels. Our findings are consistent with recent research on psoriasis-related quality of life during the COVID-19 pandemic and may reflect population-specific resilience mechanisms. They also highlight the importance of continued monitoring of psychiatric comorbidity in this population, independently of acute stressors. Future research should address the long-term pandemic impact on patients.
