Mental health status associated with discordance in psoriasis severity assessments

Patients who evaluate their psoriasis severity more severely than their health care providers are more likely to have depression or anxiety, according to a study.

“Physician Global Assessment and Psoriasis Area Severity Index are physician-rated disease activity measures commonly used in real-world practice and clinical trials and recommended in treatment guidelines,” Ewan Carr, PhD, of the department of biostatistics and health informatics, Institute of Psychiatry, Psychology & Neuroscience at King’s College London, and colleagues wrote. “Although data are limited in psoriasis, studies have identified discordance between physician and patient measures of disease severity in chronic inflammatory diseases.”

The cohort study of 502 patients with psoriasis used repeated cross-sectional analysis of real-world longitudinal data.

Patients completed questionnaires regarding global assessment, depression and anxiety before seeing a physician for clinical assessment. All patients completed multiple appointments, totaling 1,985 appointments.

Discordance between physician and patient disease severity was recorded in 768 appointments (39%), with patients rating their psoriasis as less severe than their physicians for 511 visits (26%) and more severe for 257 visits (13%).

Patients who had positive screenings for depression and anxiety were more likely to rate their disease severity to be worse than their physicians (relative risk ratio: depression, 2.7; 95% CI, 1.6-4.5; anxiety, 2.1; 95% CI, 1.3-3.4).

“These data have important clinical relevance. Shared decision-making between patients and their physicians is necessary for safe and effective care of psoriasis, which often requires lifelong treatment,” the authors wrote. “Taken together, our results suggest that discordance between patient and physician measures of psoriasis severity is associated with patient mental health status.”