Psychological distress in psoriasis may lead to dissatisfaction with clinician

Among patients with psoriasis, poor mental health status correlated with dissatisfaction with physician care, according to a study.

“How patients’ mental health is associated with their satisfaction with physicians is rarely studied among adults with skin conditions,” April W. Armstrong, MD, MPH, professor of dermatology and associate dean for clinical research, and Charlotte Read, MBBS, BSc, clinical research fellow, both at the Keck School of Medicine of the University of Southern California, wrote.

Read and Armstrong aimed to evaluate whether mental health outcomes among patients with psoriasis relates to satisfaction with physicians.

The retrospective survey analysis included a weighted total of 8,876,767 U.S. adults with psoriasis, which was culled to an unweighted total of 652 patients. Longitudinal data from the 2004-2017 Medical Expenditure Panel Survey were used to gather information on mental health comorbidities experienced by patients with psoriasis.

The primary outcome of patient satisfaction with physician was measured by the patient-physician communication composite score, while mental health outcomes were assessed using the Kessler 6-Item Psychological Distress Scale.

Background data indicated that the cohort was 54% women, with an average age just older than 52 years. Moderate or severe symptoms of psychological distress were reported in 27% of the cohort at baseline, while 21% had moderate or severe symptoms of depression.

Patients who reported moderate or severe psychological distress reported lower rates of satisfaction with their physician compared with patients who had no or mild psychological distress. As assessed by the Kessler scale, those with no or mild symptoms scored a 14.3 (95% CI, 14.2-14.4) compared with 13.2 (95% CI, 13.0-13.4) for those with moderate symptoms and 13.1 (95% CI, 12.5-13.7) for those with severe symptoms (P < .001).

Patients with moderate psychological distress were nearly three times as likely to report low patient satisfaction compared with patients with moderate psychological distress (adjusted OR = 2.8; 95% CI, 1.5-4.9; P = .001). Similarly, patients with severe psychological distress were more than twice as likely as their counterparts with low or no distress to report low patient satisfaction (OR = 2.3; 95% CI, 1.1-4.7; P = .03).

Physician satisfaction rates were lower among patients with moderate (13.2) (95% CI, 12.9-13.6) or severe (13.0) (95% CI, 12.6-13.4) depression symptoms than those reported for patients with no or mild depression (14.3) (95% CI, 14.2-14.4) (P = .002).

Moderate depression was also associated with a more than fourfold increase in low patient satisfaction compared with no or mild depression (OR = 4.6; 95% CI, 2.1-10.0; P < .001).

“This study suggests that patients with greater psychological distress and depression report lower satisfaction with their clinicians than those without such mental health symptoms,” Read and Armstrong wrote. “Clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities. Evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.” – by Rob Volansky

Disclosures: Read reports she received grants from the National Psoriasis Foundation during the conduct of the study. Armstrong reports she receives grants and personal fees from AbbVie, Bristol-Myers Squibb, Dermavant, Eli Lilly, Janssen Pharmaceuticals, Leo Pharma, Novartis Pharmaceuticals, Regeneron Pharmaceuticals and UCB Pharma; personal fees from Boehringer Ingelheim, Celgene, Genentech, Merck, Modernizing Medicine, Ortho Dermatologics, Pfizer, Sanofi Genzyme; and grants from Dermira and Kyowa Hakko Kirin outside the submitted work.