Psoriasis and the Risk of Depression in the US Population National Health and Nutrition Examination Survey 2009-2012
Psoriasis and the Risk of Depression in the US Population National Health and Nutrition Examination Survey 2009-2012
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DOI：
10.1001/jamadermatol.2015.3605
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发表时间：
2016-01-01
期刊：
影响因子：
10.9
通讯作者：
Ho, Roger S.
中科院分区：
文献类型：
--
作者：
Cohen, Brandon E.;Martires, Kathryn J.;Ho, Roger S.
抑郁症是抑郁症的一个危险因素。抑郁症也可能引发或加重牛皮癣。银屑病和抑郁症之间的关系，然而，仍有待充分探讨。和参与者基于人群的研究，使用2009年至2012年国家健康和营养检查调查的参与者。主要结果和指标基于患者健康问卷的重度抑郁症诊断-9.结果在12382名美国公民中，我们确定了351例（2.8%）银屑病和968例（7.8%）重度抑郁症。58例（16.5%）银屑病患者符合重度抑郁症的诊断标准。有银屑病病史的患者的平均（SD）患者健康问卷-9评分显著高于无银屑病病史的患者（4.54 [5.7] vs 3.22 [4.3]，P <0.001）。即使在调整了性别、年龄、种族、体重指数、体力活动、吸烟史、饮酒、心肌梗死（MI）史、中风史和糖尿病史后，抑郁症与重性抑郁症仍显著相关（OR，2.09 [95%CI，1.41-3.11]，P <0.001）。对同时有银屑病和心血管事件（特别是MI或卒中）病史的患者进行的交互作用项分析未显示重度抑郁症风险协同增加（银屑病和MI：OR，1.09 [95%CI，0.28-3.60]，P = 0.91;银屑病和卒中：OR，0.67 [95%CI，0.12-3.66]，P = 0.63）。在调整后的多变量模型中，重度抑郁症的风险在局限性银屑病患者与广泛性银屑病患者之间没有显著差异（OR，0.66 [95%CI，0.18-2.44]，P = 0.53）。结论和相关性自我报告的银屑病病史与重度抑郁症独立相关，这是通过有效的筛选工具评估的，即使在控制合并症时也是如此。心血管事件史并不能改变银屑病患者抑郁症的风险。银屑病的严重程度与重度抑郁症的风险无关。因此，所有银屑病患者，无论严重程度如何，都可能有患重度抑郁症的风险。
IMPORTANCE Psoriasis is a risk factor for depression. Depression may also trigger or exacerbate psoriasis. The relationship between psoriasis and depression, however, remains to be fully explored.OBJECTIVE To investigate the association between psoriasis and major depression in the US population.DESIGN, SETTING, AND PARTICIPANTS Population-based study using participants in the National Health and Nutrition Examination Survey from 2009 through 2012.MAIN OUTCOMES AND MEASURES Diagnosis of major depression based on the Patient Health Questionnaire-9.RESULTS We identified 351 (2.8%) cases of psoriasis and 968 (7.8%) cases of major depression among 12 382 US citizens included in our study. Fifty-eight (16.5%) patients with psoriasis met criteria for a diagnosis of major depression. The mean (SD) Patient Health Questionnaire-9 score was significantly higher among patients with a history of psoriasis than those without psoriasis (4.54 [5.7] vs 3.22 [4.3], P < .001). Psoriasis was significantly associated with major depression, even after adjustment for sex, age, race, body mass index, physical activity, smoking history, alcohol use, history of myocardial infarction (MI), history of stroke, and history of diabetes mellitus (OR, 2.09 [95% CI, 1.41-3.11], P < .001). Interaction term analyses involving patients with a history of both psoriasis and a cardiovascular event, specifically MI or stroke, did not reveal a synergistically increased risk of major depression (psoriasis and MI: OR, 1.09 [95% CI, 0.28-3.60], P = .91; psoriasis and stroke: OR, 0.67 [95% CI, 0.12-3.66], P = .63). In adjusted multivariable models, the risk of major depression was not significantly different between patients with limited vs extensive psoriasis (OR, 0.66 [95% CI, 0.18-2.44], P = .53).CONCLUSIONS AND RELEVANCE Self-reported history of psoriasis was independently associated with major depression as assessed by a validated screening tool, even when controlling for comorbidities. History of cardiovascular event did not modify the risk of major depression for patients with psoriasis. The severity of psoriasis was unrelated to the risk of major depression. Therefore, all patients with psoriasis, regardless of severity, may be at risk for major depression.