Dermatological disease has been shown to be associated with psychological comorbidity. The aim of this observational study is to describe the distribution of skin disease and the prevalence of ...depression, anxiety and stress among Norwegian dermatological outpatients. Thirteen percent of outpatients had clinical anxiety compared with 3.7% of healthy controls, and 5.8% had clinical depression compared with 0.9% of controls. Adjusted odds ratio for clinical anxiety was 4.53 in patients compared with controls, and for clinical depression 6.25, which is much higher than previously described in a larger European study. Patients with tumours had less depression. Chronic inflammatory skin conditions had an especially high impact on patient's psychological wellbeing and should not be undervalued relative to, for instance, skin cancer in health strategies. These results argue strongly for including skin disease prevention and treatment in future health strategies.
Itch is the most common dermatological symptom and worsens with stress. The general belief of a person in their own ability to cope in stressful situations, known as self-efficacy, is relevant in the ...management of chronic diseases other than skin diseases. The aim of this study was to explore the association between perceived self-efficacy, itch and stress among late-stage adolescents. The study was cross-sectional and questionnaire-based. Information on psycho-social factors and skin symptoms among late adolescents was collected in a sample of the general population in Oslo, Norway. In this sample of 2,489 boys and girls, the prevalence of current itch was 7% among adolescents with high self-efficacy and low stress, and 17% among adolescents with low self-efficacy (p = 0.028). Adolescents with low self-efficacy under higher stress were twice as likely to report itch than those with high self-efficacy (30% vs. 15%, p = 0.072). In the adjusted logistic regression the report of current itch was significantly associated with low self-efficacy, with an odds ratio of 2.85 (1.71; 3.82). In conclusion, current itch was significantly associated with low self-efficacy among adolescents. Further clinical research is needed to determine whether improvement in self-efficacy could contribute positively to the management of patients with itch.
Mood disorders in dermatology consultations Dalgard, F.J.; Svensson, Å.; Gieler, U. ...
British journal of dermatology (1951),
August 2018, 20180801, Volume:
179, Issue:
2
Journal Article
Peer reviewed
Summary
Recent research has suggested that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. However, dermatologists are trained to ...diagnose skin diseases but are not necessarily trained in diagnosing and treating mental health concerns that might be triggered by their patients’ skin diseases. In this study, 3635 patients attending dermatology clinics in 13 European countries completed detailed questionnaires, using a scale called HADS, designed to assess depression and anxiety. Each patient was then examined by a dermatologist who recorded the skin diagnosis and also answered the following two questions: ‘Do you see depressive signs in the patient?’ and ‘Do you see anxiety signs in the patient?’. The possible answers were ‘yes’ or ‘no’. Comparing the results of the questionnaires completed by the patients with the responses to these two questions by the doctors, the dermatologists underestimated depression in 5.8% of the consultations and anxiety in 11.2% of the consultations. On the other hand, dermatologists overestimated depression and anxiety in 10% and 11.8% of the consultations, respectively. The authors conclude that overall the agreement between clinician and patient assessment of mood symptoms was poor, suggesting that mood symptoms are under‐recognized by dermatologists in a routine care setting.
Linked Article: Dalgard et al. Br J Dermatol 2018; 179:464–470
Itch is known to be associated with psychological factors in adults, but has not been explored among adolescents. A cross-sectional, questionnaire-based population study involving adolescents born ...mostly in 1986 was carried out in 2004. A total of 4744 individuals were invited and the participation rate was 80%. The Hopkins Symptom Checklist-10 was used to measure mental distress. The prevalence of itch was 8.8%. Itch was associated with mental distress, gender, socio-demographic factors, asthma, rhinoconjunctivitis and eczema. In a logistic regression model adjusting for possible confounders (including eczema), an association between itch and mental distress was found (odds ratio=3.1). In a subgroup analysis of those without eczema, the association was stronger. When the severity of itch increased, in both genders mental distress also increased. Mental distress and eczema are the variables in the study that contributes most to the distribution of itch at population level among adolescents in Oslo, Norway.
There are limited data on the differences in the impact of psoriasis between various countries with respect to quality of life (QoL). The aim of this study was to explore the psychosocial health of ...patients with psoriasis in different European countries. A total of 682 patients were recruited in 13 European countries. All patients completed a questionnaire regarding socio-demographic information, negative life events, suicidal ideation and satisfaction with their dermatologist. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS), and QoL with the Dermatology Life Quality Index (DLQI) and EuroQoL (EQ-5D). The lowest anxiety and depression scoring was noted in patients from Denmark, the lowest level of impairment in QoL in subjects from Spain, and the highest level of impairment in QoL in patients from Italy. The most relevant parameters influencing patients' well-being were severity of pruritus and satisfaction with their dermatologist. The level of anxiety and depression symptoms correlated significantly with suicidal ideation.
Life-quality studies among dermatologic patients have shown that chronic skin diseases have an impact on patients' lives. The purpose of this study was to assess the burden of skin morbidity at a ...community level. This was presented as prevalence of self-reported skin morbidity and dermatologic life-quality items. The association of skin disease and general health measures like feeling depressed and self-reported general health were measured. The method used was a questionnaire on self-reported skin complaints, including variables such as demographic, psychosocial, general health, dermatologic life-quality items. The design of the study was cross-sectional, with answers from 18,770 adult responders. The results confirmed that skin morbidity is common; itch was the dominating symptom. Younger adults reported more social problems as a result of skin problems than older. The life-quality domain most affected by skin disease was the social one. In a regression model skin disease was as well as rheumatism more strongly associated with feeling depressed than asthma, diabetes, and angina pectoris. Skin disease was also strongly associated with reporting poor general health, although less than other nondermatologic chronic diseases. In conclusion, in this study skin morbidity was strongly associated with general health measures among adults in a population-based setting. To the best of our knowledge these associations have not been described previously at a community level.
SARS-CoV-2 infection is benign in most individuals but, in around 10% of cases, it triggers hypoxaemic COVID-19 pneumonia, which leads to critical illness in around 3% of cases. The ensuing risk of ...death (approximately 1% across age and gender) doubles every five years from childhood onwards and is around 1.5 times greater in men than in women. Here we review the molecular and cellular determinants of critical COVID-19 pneumonia. Inborn errors of type I interferons (IFNs), including autosomal TLR3 and X-chromosome-linked TLR7 deficiencies, are found in around 1-5% of patients with critical pneumonia under 60 years old, and a lower proportion in older patients. Pre-existing auto-antibodies neutralizing IFNα, IFNβ and/or IFNω, which are more common in men than in women, are found in approximately 15-20% of patients with critical pneumonia over 70 years old, and a lower proportion in younger patients. Thus, at least 15% of cases of critical COVID-19 pneumonia can be explained. The TLR3- and TLR7-dependent production of type I IFNs by respiratory epithelial cells and plasmacytoid dendritic cells, respectively, is essential for host defence against SARS-CoV-2. In ways that can depend on age and sex, insufficient type I IFN immunity in the respiratory tract during the first few days of infection may account for the spread of the virus, leading to pulmonary and systemic inflammation.
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