Screening for anxiety and depression in people with psoriasis: a cross-sectional study in a tertiary referral setting
Screening for anxiety and depression in people with psoriasis: a cross-sectional study in a tertiary referral setting
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DOI：
10.1111/bjd.14833
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发表时间：
2017-04-01
影响因子：
10.3
通讯作者：
Smith, C. H.
中科院分区：
文献类型：
--
作者：
Lamb, R. C.;Matcham, F.;Smith, C. H.
研究背景国家健康与护理卓越研究所推荐对银屑病患者进行心理和社会幸福感评估。目的在常规临床实践中系统筛查银屑病患者的抑郁和焦虑，并确定精神疾病的高危人群。方法连续10个月内连续在一个三级中心就诊的患者被邀请完成患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑障碍量表(GAD-7)和皮肤病生活质量指数(DLQI)，作为传授：整合心理和身体保健：研究，培训和服务的一部分。有关人口统计、治疗和临床疾病严重程度的信息从电子患者记录中整理出来。结果607例患者中，56.2%的患者服用生物制剂，9.9%(95%可信区间7.5~12.3%)的患者为重度抑郁障碍(MDD)，13.1%(79/604)的患者(95%可信区间10.4~15.8%)为广泛性焦虑症(GAD；GAD-7评分和GT；9)。35%的MDD患者有自杀意念，38.3%的MDD和45.6%的GAD患者DLQI<10。在调整协变量后，女性和那些患有严重临床疾病、牛皮癣关节炎和既往抑郁/焦虑的人患MDD或GAD的风险显著更高。亚裔种族和仅使用局部治疗显著增加了广泛性焦虑症的风险。结论仅使用DLQI数据对焦虑和抑郁进行系统的筛查可以确定可能被遗漏的临床上重要的抑郁和焦虑水平。妇女和有严重疾病、牛皮癣关节炎和/或既往精神病史的人可能特别危险。
Background National Institute for Health and Care Excellence guidance recommends assessment of psychological and social well-being in people with psoriasis.Objectives To screen systematically for depression and anxiety in patients with psoriasis in routine clinical practice and to identify at-risk groups for psychiatric morbidity.Methods Consecutive patients attending a single, tertiary centre over a 10-month period were invited to complete the Patient Health Questionnaire Depression Scale (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Dermatology Life Quality Index (DLQI) as part of IMPARTS: Integrating Mental and Physical Healthcare: Research, Training and Services. Information on demographics, treatment and clinical disease severity was collated from electronic patient records. Regression models were used to identify at-risk groups for psychiatric morbidity.Results Of 607 patients included (56.2% on biologics), 9.9% (95% confidence interval 7.5-12.3%) screened positive for major depressive disorder (MDD) and 13.1% (79/604) (95% confidence interval 10.4-15.8%) for generalized anxiety disorder (GAD; GAD-7 score > 9). Suicidal ideation was reported in 35% of those with MDD; DLQI was < 10 in 38.3% and 45.6% cases of MDD and GAD, respectively. After adjusting for covariates, the risk of MDD or GAD was significantly higher in women and those with severe clinical disease, psoriatic arthritis and previous depression/anxiety. The risk of GAD was significantly increased with Asian ethnicity and use of topical treatments only.Conclusions Systematic screening for anxiety and depression identifies clinically important levels of depression and anxiety that may be missed using DLQI data alone. Women and those with severe disease, psoriatic arthritis and/or a prior history of psychiatric morbidity may be at particular risk.