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There is a high prevalence of mental health comorbidities in individuals with chronic psoriasis, including depression, anxiety, and suicidality. The causal relationship between the disease burden of psoriasis and mental health comorbidities is unclear, though studies suggest that there may be a link between psychosocial stress and exacerbation of psoriasis symptoms.1
Here, we summarize key data from a study investigating the cause-effect relationships between psoriasis and mental health comorbidities.
The forward-direction MR analyses suggested that psoriasis was significantly associated with an increased risk of broad depression but only suggestively associated with risk of major depressive disorder (Figure 1).
Figure 1. Association of psoriasis with the risk of A broad depression and B major depressive disorder in forward MR analyses*
IVW, inverse-variance weighted model; MR, Mendelian randomization; MR-PRESSO, MR-Pleiotropy residual sum and outlier; OR, odds ratio.
*Adapted from Chu, et al.1
Psoriasis was found not to be significantly associated with the risk of anxiety or suicidality (Table 1).
Table 1. Association of psoriasis with the risk of anxiety in forward MR analysis*
Model |
Odds ratio (anxiety) |
p value |
Odds ratio (suicidality) |
p value |
---|---|---|---|---|
IVW |
1.109 |
0.160 |
1.014 |
0.648 |
MR-PRESSO |
1.109 |
0.178 |
1.014 |
0.654 |
Weighted median |
1.106 |
0.221 |
1.015 |
0.721 |
MR Egger |
1.430 |
0.080 |
1.011 |
0.845 |
MR, Mendelian randomization; IVW, effects inverse-variance weighted model; MR-PRESSO, MR-Pleiotropy residual sum and outlier. |
The reverse-direction MR analyses suggested that psoriasis was significantly associated with an increased risk of broad depression and major depressive disorder (Figure 2).
Figure 2. A Broad depression and B major depressive disorder associated with risk of psoriasis in reverse MR analyses*
MR, Mendelian randomization; IVW, effects inverse-variance weighted model; MR-PRESSO, MR-Pleiotropy residual sum and outlier; OR, odds ratio.
*Adapted from Chu, et al.1
There was no evidence for a causal effect of anxiety or suicidality on an increased risk of psoriasis.
The results of this study suggest a causal link between psoriasis and the risk of depression and vice versa. This bidirectional relationship warrants further investigation. Screening for depression in patients with psoriasis, along with appropriate management, may lead to improved clinical outcomes.
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