Stressful Life Events and Depression in Patients Suffering from Psoriasis Vulgaris

Abstract

Background: Psoriasis is a chronic inflammatory skin disease. Its pathogenesis is not completely clear; there are some suggestions that psychological factors may play an important pathogenic role. Objective: To evaluate the influence of stressful life events on exacerbation of psoriasis and comorbidity of depression. Patients and Methods: 77 psoriatic individuals, aged 18–78 years, were included in the study. Stress was assessed according to the Social Readjustment Rating Scale by Holmes and Rahe. All patients underwent psychiatric examination for depression (according to ICD-10). Intensity of depression was evaluated by Hamilton and Beck scales. Results: 61% of psoriatic patients reported having experienced stressful life events in the month before exacerbation of the disease. Severity of psoriasis (Psoriasis Area and Severity Index, PASI) in patients with stressful life events (22.8 ±9.3 points) was significantly higher (p < 0.0001) compared to those without stress (14.0 ±9.2 points). There was no correlation between intensity of stress and severity of psoriasis. Depression was diagnosed in 16.9% of the patients. Psoriatic individuals suffering from depression were significantly younger (p < 0.05). No significant relationship was found between intensity of depression and the PASI score, nor between intensity of stress and severity of depression. Conclusions: More than half of the psoriatic patients studied had experienced at least one stressful life event in the month before psoriasis exacerbation. Moreover, the severity of psoriasis is significantly increased in patients with preceding stressful life events. Depression could be diagnosed in less than 20% of psoriatic patients, the majority of them suffering from reactive disorders.