Assessment of anxiety, depression, social anxiety, anxiety sensitivity, and perceived stress in psoriasis patients: a controlled cross-sectional study

Yıl 2021, , 875 - 882, 20.11.2021

Bengü Tuman , Betül Şereflican , Taha Can Tuman

https://doi.org/10.16899/jcm.962932

Cited By: 1

Öz

Objective: Psoriasis is a chronic inflammatory skin disease, and psychiatric comorbidities are common in these patients. Skin lesions can cause shame, anxiety, social avoidance, irritability, and depressive symptoms in psoriasis patients. This study aimed to investigate anxiety, depression, social anxiety, anxiety sensitivity, and perceived stress in patients with psoriasis and their relationship with disease severity and duration.
Methods: Forty patients and 40 healthy controls were included in our study. All study patients were administered the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), the Liebowitz Social Anxiety Scale (LSAS), the Perceived Stress Scale (PSS-14), and the Anxiety Sensitivity Index (ASI-3). Disease severity in psoriasis patients was assessed using the Psoriasis Area Severity Index (PASI).
Results: Anxiety, depression, social anxiety, perceived stress, and anxiety sensitivity were significantly higher in psoriasis patients than in healthy controls. There was no correlation between PASI scores and BAI, BDI, LSAS, PASS-14 and ASI-3 scores. Also, no correlation was found between disease duration and BAI, BDI, LSAS, PSS-14 and ASI-3 scores.
Conclusion: Our results show that anxiety, depression, social anxiety, anxiety sensitivity, and perceived stress are high in psoriasis patients regardless of disease duration and severity. This is the first study to examine anxiety sensitivity in psoriasis patients to the best of our knowledge. Clinicians should consider the possible psychiatric comorbidity at all stages of the disease in patients with psoriasis. Collaboration between the disciplines of dermatology and psychiatry is necessary to ensure full recovery and maintain patient well-being.

Anahtar Kelimeler

perceived stress, anxiety, anxiety sensitivity, depression, psoriasis, social anxiety

Psoriasis Hastalarında Anksiyete, Depresyon, Sosyal Anksiyete, Anksiyete Duyarlılığı ve Algılanan Stres

Öz

Amaç: Psoriazis kronik inflamatuar bir deri hastalığıdır ve bu hastalarda psikiyatrik komorbiditeler sıktır. Deri lezyonları psoriasis hastalarında utanç, kaygı, sosyal kaçınma, sinirlilik ve depresif belirtilere neden olabilir. Bu çalışmada psoriazis hastalarında anksiyete, depresyon, sosyal anksiyete, anksiyete duyarlılığı ve algılanan stresin hastalık şiddeti ve süresi ile ilişkisinin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışmamıza 40 hasta ve 40 sağlıklı kontrol dahil edildi. Tüm katılımcılara Beck Anksiyete Envanteri (BAE), Beck Depresyon Envanteri (BDE), Liebowitz Sosyal Anksiyete Ölçeği (LSAÖ), Algılanan Stres Ölçeği (ASÖ-14) ve Anksiyete Duyarlılık İndeksi (ADI-3) uygulandı. Hasta grubuna hastalık şiddeti için PASI uygulandı.
Bulgular: Psoriazis hastalarında anksiyete, depresyon, sosyal anksiyete, algılanan stres ve anksiyete duyarlılığı sağlıklı kontrollere göre anlamlı derecede yüksekti. PASI puanları ile BAÖ, BDÖ, LSAÖ, ASÖ-14 ve ADI-3 puanları arasında korelasyon yoktu. Ayrıca hastalık süresi ile BAÖ, BDÖ, LSAÖ, ASÖ-14 ve ADI-3 puanları arasında ilişki bulunmadı.
Sonuç: Sonuçlarımız, hastalık süresi ve şiddetinden bağımsız olarak, psoriazis hastalarında anksiyete, depresyon, sosyal anksiyete, anksiyete duyarlılığı ve algılanan stresin yüksek olduğunu göstermektedir. Bildiğimiz kadarıyla, bu çalışma, psoriasis hastalarında anksiyete duyarlılığını inceleyen ilk çalışmadır. Klinisyenler, psoriazis hastalarında hastalığın tüm evrelerinde olası psikiyatrik komorbiditeyi göz önünde bulundurmalıdır. Dermatoloji ve psikiyatri disiplinleri arasındaki işbirliği, tam iyileşmeyi sağlamak ve hastanın iyiliğini sürdürmek için gereklidir. 

Anahtar Kelimeler

Algılanan stres, anksiyete, anksiyete duyarlılığı, depresyon, psoriasis, sosyal anksiyete

Kaynakça

• 1. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol 2013;133(2):377-85.
• 2. Farber EM. History of the treatment of psoriasis. J Am Acad Dermatol 1992;27(4):640-5.
• 3. Kundakci N, Türsen U, Babiker MO, Gürgey E. The evaluation of the socio-demographic and clinical features of Turkish psoriasis patients. Int J Dermatol 2002; 41: 220-224.
• 4. Consoli SM, Rolhion S, Martin C, Ruel K, Cambazard F, Pellet J, Misery L. Low levels of emotional awareness predicts a better response to dermatological treatment in patients with psoriasis. Dermatology 2006; 212:128-36.
• 5. Szepietowski J, Pacan P. Dermatoses requiring psychiatric and psychological help [Polish]. Adv Clin Exp Med 2001; 10 (Suppl. 1): 25-28.
• 6. Hrehorow E, Salomon E, Matusiak L, Reich A, Szepietowski JC. Patients with psoriasis feel stigmatized. Acta Dermatol Venereol 2012;92:67–77.
• 7. Kimball AB, Jacobson C, Weiss S, Vreeland MG, Wu Y. The psychosocial burden of psoriasis. Am J Clin Dermatol 2005;6:383–92.
• 8. Jankowiak B, Kowalewska B, Krajewska- Kulak E. Stigmatization and Quality of Life in Patients with Psoriasis. Dermatol Ther (Heidelb) . 2020 Apr;10(2):285-296.
• 9. Remröd C, Sjöström K, Svensson Å. Subjective stress reactivity in psoriasis — a cross sectional study of associated psychological traits. BMC Dermatol 2015; 15: 6.
• 10. Chernyshov P.V. Entwicklung und Anwendung der Lebensqualitätserfassung in der Dermatologie. Karger Kompass Dermatologie. 2020; 8 (1); 6–10.
• 11. Gaston L, Lassonde M, Bernier-Buzzanga J, Hodgins S, Crombez JC. Psoriasis and stress: a prospective study. J Am Acad Dermatol 1987;17(1):82-86.
• 12. Sathyanarayana Rao TS, Basavaraj KH, Das K. Psychosomatic paradigms in psoriasis: Psoriasis, stress and mental health. Indian J Psychiatry. 2013 Oct-Dec; 55(4): 313–315.
• 13. Gupta MA, Gupta AK, Haberman HF. Psoriasis and psychiatry: an update. Gen Hosp Psychiatry. 1987;9:157-66.
• 14. Schmitt JM, Ford DE. Role of depression in quality of life for patients with psoriasis. Dermatology. 2007;215(1):17-27.
• 15. Mercan S. Deri hastalıklarının psikojenik sonuçları ve komorbiditeler. Türkderm. 2010;44(1):25-35.
• 16. Sesliokuyucu C, Şahpolat M, Arı M. Psöriazisli Hastaların Depresyon, Anksiyete, Çocukluk Çağı Ruhsal Travması ve Yaşam Kalitesi ile Sosyodemografik Özelliklerinin Araştırılması. Journal of Mood Disorders 2017;7(1):28-40.
• 17. Romiti, R., Amone, M., Menter, A., & Miot, H. A.. Prevalence of psoriasis in Brazil— A geographical survey. International Journal of Dermatology 2017;56(8):e167–e168.
• 18. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed. Arlington, VA: 2013.
• 19. Bez Y, Yesilova Y, Kaya MC, Sir A. High social phobia frequency and related disability in patients with acne vulgaris. Eur J Dermatol 2011;21:756–760.
• 20. Yarpuz AY, Saadet ED, Şanli HE, Özgüven HD. Social anxiety level in acne vulgaris patients and its relationship to clinical variables. Türk Psikiyatri Dergisi 2008;19:1–8.
• 21. Montgomery K, Norman P, Messenger AG, Thompson AR. The importance of mindfulness in psychosocial distress and quality of life in dermatology patients. Br J Dermatol 2016;175:930–936.
• 22. Güz H, Ay M, Dilbaz N. Bir Grup Dermatolojik Hastalarda Aleksitimi, Depresyon ve Anksiyete. Düşünen Adam 2000;13(3):161-165.
• 23. Schneider G, Heuft G, Hockmann J. Determinants of social anxiety and social avoidance in psoriasis outpatients. J Eur Acad Dermatol Venereol 2013;27:383–386.
• 24. Avallone KM, McLeish AC, Luberto CM, Bernstein JA. Anxiety sensitivity, asthma control, and quality of life in adults with asthma J Asthma 2012;49(1):57-62.
• 25. Bravo IM, Silverman W. Anxiety sensitivity, anxiety, and depression in older patients and their relation to hypochondriacal concerns and medical illnesses Aging Ment Health 2001;5(4)349-357.
• 26. Dixon LJ, Lee AA, Viana AG, McCowan NK, Brodell RT, Tull MT. Anxiety Sensitivity in Dermatological Patients. Psychosomatics 2016;57(5):498-504.
• 27. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol 1988;56:893-7.
• 28. Ulusoy M, Şahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cognitive Psychother 1998;12:163-72.
• 29. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
• 30. Hisli N. Beck Depresyon Ölçeği’nin bir Türk örnekleminde geçerlilik ve güvenilirliği. Psikoloji Dergisi 1988;6:118-22.
• 31. Heimberg G., Hornerk J, Justerh R, Safrens, A., Browne J, Scheiırf R, et al. Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine 1999;29:199-212.
• 32. Soykan C, Ozguven HD, Gencoz T. Liebowitz Social Anxiety Scale: the turkish version. Psychol Rep 2003; 93: 1059-1069.
• 33. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychol Assess 2007;19:176-88.
• 34. Mantar A, Yemez B, Alkın T. Anksiyete Duyarlılığı İndexi-3’ün Türkçe formunun geçerlik ve güvenilirlik çalışması. Türk Psikiyatri Dergisi 2010; 21: 225-234. 35. Nielsen MG, Ørnbøl E, Vestergaard M, et al. The construct validity of the Perceived Stress Scale. J Psychosom Res 2016;84:22–30.
• 36. Eskin M, Harlak H, Demirkıran F, Dereboy Ç. Algılanan Stres Ölçeğinin Türkçeye Uyarlanması: Güvenirlik ve Geçerlik Analizi. Yeni Symposium 2013;51:132–140.
• 37. Parafianowicz K, Sicińska J, Moran A, Szumański J, Staniszewski K, Rudnicka L, Kokoszka A. Psychiatric comorbidities of psoriasis: pilot study. Psychiatr Pol 2010;44(1):119-126.
• 38. Jin W, Zhang, S, Duan Y. Depression Symptoms Predict Worse Clinical Response to Etanercept Treatment in Psoriasis Patients. Dermatology 2019;235(1):55–64.
• 39. Akay A, Pekcanlar A, Bozdag KE, Altintas L, Karaman A. Assessment of depression in subjects with psoriasis vulgaris and lichen planus. J Eur Acad Dermatol Venereol 2002;16(4):347-352.
• 40. Golpour M, Hosseini SH, Khademloo M, Ghasemi M, Ebadi A, Kookhan F, Shahmohammadi S. Depression and Anxiety Disorders among Patients with Psoriasis: A Hospital-Based Case-Control Study. Dermatol Res Pract 2012;2012:381905.
• 41. Köşger F, Bilgili ME, Genek M, Yıldız B, Saraçoğlu N, Eşsizoğlu A. Psoriasis Hastalarında Depresyon, Anksiyete ve Yaşam Kalitesinin Hastalığın Şiddeti ile İlişkisi. Journal of Mood Disorders 2014;4(4):157-62.
• 42. Özguven DH, Kundakçı N, Kumbasar H, Boyvat A. The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. JEADV 2000;14:267-271.
• 43. Kilic A, Gulec MY, Gul U, Gulec H. Temperament and character profile of patients with psoriasis. J Eur Acad Dermatol Venereol 2008; 22(5):537-542.
• 44. Taner E, Coşar B, Burhanoğlu S, Çalıkoğlu E, Önder M, Arikan Z. Depression and anxiety in patients with Behçet's disease compared with that in patients with psoriasis. International Journal of Dermatology 2007;46:1118-1124.
• 45. Gupta MA, Schork NJ, Gupta AK, Kirkby S, Ellis CN. Suicidal ideation in psoriasis. Int J Dermatol 1993;32(3):188-90.
• 46. Tee SI, Lim ZV, Theng CT, Chan KL, Giam YC. A prospective cross-sectional study of anxiety and depression in patients with psoriasis in Singapore. J Eur Acad Dermatol Venereol 2016;30(7):1159-1164.
• 47. Heydendael VM, de Borgie CA, Spuls PI, Bossuyt PM, Bos JD, de Rie MA. The burden of psoriasis is not determined by disease severity only. J Investig Dermatol Symp Proc 2004;9:131–135.
• 48. Özgüven DH, Kundakçı N, Boyvat A. Psöriyazis Hastalarında İkincil Sosyal Anksiyete. Türk Psikiyatri Dergisi 2000;11:121-126.
• 49. Yıldırım FE, Şeremet S, Afşar FŞ, Yıldız İ, İyidoğan E. Evaluation of Social Anxiety Levels and Related Factors in Psoriasis Patients: A Controlled, Cross-Sectional Study. Noro Psikiyatr Ars 2020;57(2):148–153.
• 50. Hayes J, Koo J. Psoriasis: depression, anxiety, smoking, and drinking habits. Dermatol Ther 2010;23(2):174-80.
• 51. Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R. Quality of life in patients with psoriasis. Health Qual Life Outcomes 2006;4:35.
• 52. Finzi A, Colombo D, Caputo A, Andreassi L, Chimenti S, Vena G, Simoni L, Sgarbi S, Giannetti A; PSYCHAE Study Group. Psychological distress and coping strategies in patients with psoriasis: the PSYCHAE Study. J Eur Acad Dermatol Venereol 2007;21:1161–1169
• 53. Rapp SR, Cottrell CA, Leary MR. Social coping strategies associated with quality of life decrements among psoriasis patients. Br J Dermatol 2001;145:610–616
• 54. Jankovic S, Raznatovic M, Marinkovic J, Maksimovic N, Jankovic J, Djikanovic B. Relevance of psychosomatic factors in psoriasis: a case control study. Acta Derm Venereol 2009;89:364–368.
• 55. Łakuta P, Przybyła-Basista H. Toward a better understanding of social anxiety and depression in psoriasis patients: The role of determinants, mediators, and moderators. J Psychosom Res 2017;94:32–38.
• 56. Evers AW, Verhoeven EW, Kraaimaat FW, et al. How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol 2010;163:986–991.
• 57. Manolache L, Petrescu-Seceleanu D, Benea V. Life events involvement in psoriasis onset/recurrence. Int J Dermatol 2010; 49: 636–641.
• 58. Orion E, Wolf R. Psychological factors in skin diseases: stress and skin: facts and controversies. Clin Dermatol 2013;31(6):707-711.
• 59. Arnetz BB, Fjellner B, Eneroth P, Kallner A. Stress and psoriasis: psychoendocrine and metabolic reactions in psoriatic patients during standardized stressor exposure. Psychosom Med 1985;47(6):528-541.
• 60. Pancar Yüksel E, Durmuş D, Sarısoy G. Perceived stress, life events, fatigue and temperament in patients with psoriasis. J Int Med Res 2019;47(9):4284–4291.
• 61. Kumbasar H, Yılmaz A. Psoriyazis patogenezinde psikonöroimmünolojik mekanizmalar ve hastalığın yaşam kalitesi üzerine etkileri. Türkiye Klinikleri Dermatoloji Psoriasis Özel Sayısı 2005;1:50-55.
• 62. Fortune DG, Richards HL, Kirby B, et al. Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy. Arch Dermatol 2003;139:752–756.
• 63. Avallone KM, McLeish AC, Luberto CM, Bernstein JA. Anxiety sensitivity, asthma control, and quality of life in adults with asthma. J Asthma 2012;49(1):57-62.
• 64. Bravo IM, Silverman W. Anxiety sensitivity, anxiety, and depression in older patients and their relation to hypochondriacal concerns and medical illnesses. Aging Ment Health 2001;5(4):349-357.
• 65. Orion E, Wolf R. Psychological factors in skin diseases: stress and skin: facts and controversies. Clin Dermatol 2013;31(6):707-711.
• 66. Dixon LJ, Lee AA, Viana AG, McCowan NK, Brodell RT, Tull MT. Anxiety Sensitivity in Dermatological Patients. Psychosomatics 2016;57(5):498-504.
• 67. Ellison L, Witcraft SM, Dixon LJ. Anxiety sensitivity and social anxiety in adults with psychodermatological symptoms. Arch Dermatol Res 2020 Aug 28. doi: 10.1007/s00403-020-02130-w. Online ahead of print