A positive relationship may exist between pediatric psoriasis and the onset of depression and anxiety, and evidence suggests the causal relationship may go both ways. It is unknown how early comorbid psychiatric trends begin in patients with pediatric psoriasis. These are among the review findings published in Pediatric Dermatology.
An association between psoriasis and the onset of mood disorders in adults has been established, but there is a paucity of research in the pediatric population on the psychosocial influence of psoriasis. Investigators sought to elucidate the prevalence of anxiety and depression in patients with pediatric psoriasis and advocate for psychological screening and intervention as needed.
They conducted a systematic review of PubMed and Ovid Medline databases for studies published in English in the past 15 years on the association of psoriasis with depression and anxiety in a pediatric population (0-18 years of age) diagnosed with psoriasis. They included 10 studies: case-control, cross-sectional, cohort, and interview-based methods conducted primarily in the US, Turkey, Denmark, Libya, and Germany following a full-text review of 41 articles by a single reviewer.
Among the 7 studies assessing anxiety and depression as primary outcomes, all found depression to be significantly correlated with patients with pediatric psoriasis. Investigators noted 4 of these studies found a significant relationship between anxiety and patients with pediatric psoriasis. Studies (some large-scale) offered conflicting results. No significant differences were found between adolescent patients with psoriasis and adolescent patients without psoriasis in State-Trait Anxiety Inventory for Children (STAIC) assessment scores or in Children’s Depression Inventory (CDI) scores in 1 study. The same study found no significant differences in the child cohorts in STAIC scores but significantly higher CDI scores among child patients with psoriasis vs those without.
Another study with more than 7600 sex-, age-, and index matched patients with psoriasis to patients without psoriasis (3:1), mean age 12.9 years, found only the correlation between depression and psoriasis to be statistically significant. Another study also found increased rates of anxiety and depression in patients with pediatric psoriasis, with only the association between depression and pediatric psoriasis reaching significance, and a similar retrospective case-control study found pediatric psoriasis and anxiety to have a significant correlation.
Review limitations include the nature of review design, limited number of studies reviewed, using only 1 reviewer to assess relevance and eligibility, and limitations within the studies reviewed negating acceptance and generalization of results.
Investigators concluded, “Though limited in number, current investigations generally support a positive relationship between pediatric psoriasis and the onset of anxiety and depression.” They continued, “It is difficult to determine a causal relationship, however, because there is evidence that psoriasis and psychiatric illness exacerbate one another.” They urge mental health screening in patients with pediatric psoriasis.
Strouphauer E, Stolar A, Tollefson M. Manifestation of anxiety and depression among pediatric patients with psoriasis: a review. Pediatr Dermatol. Published online November 13, 2022. doi:10.1111/pde.15185
This article originally appeared on Dermatology Advisor