For a cohort study, over 500 adult psoriasis outpatients were screened for depressive symptoms. Despite a low median PASI, the cut-off value for depression was exceeded in almost one in four patients.
The prevalence of mental disorders such as depression and anxiety disorders is increased in patients with psoriasis. Depending on the study, the prevalence of comorbid depression varies from 9% to 55% [1]. The odds ratio compared with the general population is 1.57 [2]. In addition to a disfigured appearance, stigmatization, and social isolation, systemic inflammation and the presence of other comorbidities are possible explanations for a clustered occurrence of depressive disorders [3]. The Whooley questions are a screening tool recommended for use in psoriasis patients [4,5]. An affirmative answer to either of the following questions detects depression with a sensitivity of 96% and a specificity of 57% [4]: (1) In the past month, have you often felt down, sad, depressed, or hopeless? (2) In the past month, have you had significantly less desire and pleasure in doing things you usually enjoy? The BDI-II is the German version of the revised Beck Depression Inventory, a self-rating questionnaire with 21 items [6]. Scores range from 0 to 63, with scores ≥13 indicating at least mild depression [7]. In the 2020 cohort study published in JDDG, a total of 538 patients (median PASI 3.0; mean DLQI 5.3) were screened for depressive symptoms. 24.2% of all patients achieved a BDI-II score ≥13 [3]. The results of the Whooley questions were positive in 28.2% of patients. The two methods showed a high correlation (p<0.001). In the subgroup with a BDI-II score ≥13, disease activity (median PASI 3.8 vs. 2.8; p=0.06) and DLQI scores (mean 10.1 vs. 3.7; p<0.0001) were higher, and psoriatic arthritis and diabetes were more common (52.6% vs. 37.8%; p=0.002 and 16.2% vs. 10.0%, respectively; p=0.04) than in the subgroup with a BDI-II score <13.
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