L E T T E R T O T H E E D I T O R
Psoriasis and depression: a commentary on ‘‘In psoriasis, levels
of hope and quality of life are linked’’
Barıs¸ O¨ nen U¨nsalver1•Alper Evrensel1• Mehmet Emin Ceylan1
Received: 14 December 2015 / Accepted: 17 June 2016 Ó Springer-Verlag Berlin Heidelberg 2016
Dear Editor,
In a previous issue of the Archives of Dermatological Research, we were very interested in the article by Hawro et al. entitled ‘‘In psoriasis, levels of hope and quality of1 life are linked’’ in which the investigators reported that the levels of hope and quality of life linked in patients with psoriasis [6]. However, we wish to make some comments on hope and quality of life in dermatological diseases especially psoriasis.
Psychiatric problems are common in many dermato-logical diseases. Approximately 95 % of the patients directed to a liaison center have been diagnosed with a psychiatric disorder. Most common diagnoses are depres-sion with 44 % and anxiety disorder with 55 % [8]. Pso-riasis is a chronic and immune-mediated skin disease. Psychiatric disorder comorbidity is high in psoriasis [3]. In many studies, depression has been identified at a high rate in patients with psoriasis. The frequency of depression has been identified as 51 % in a study [8]. Depression seen in half of the patients may affect the quality of life quite
negatively [7, 9]. In a study with a very large sample, depression risk in women with psoriasis has been found to be higher than those without psoriasis [4]. In a recent study, the quality of life of 3971 patients with psoriasis has been assessed with EuroQol-5 Dimension Questionnaire (EQ-5D). Most severely affected component of EQ-5D is anx-iety and depression [2].
In the study of Hawro et al., it has not been specified whether there is a comorbid psychiatric disorder in the study sample or not. However, depression is a confounding factor in this study. According to DSM-5, hopelessness (A.1. criteria) and quality of life impairment (B. criteria) are among the diagnostic criteria of depression [1]. The presence of hopelessness and quality of life impairment in a patient with depression at the same time would not be surprising. Depression can be the underlying reason that causes hopelessness and quality of life impairment in patients with depression. Therefore, the severity of depression affects both parameters.
Basic Hope Inventory-12 has been used in the study. This scale measures the level of basic hope. However, to measure the hopelessness related to comorbid depression, Beck Hopelessness Scale should have been used addi-tionally. It would be more appropriate to use the wording ‘‘basic hope’’ instead of ‘‘hope’’ at the article title.
In addition, recent studies demonstrate that the gut-brain axis disruption may lead to depression and psoriasis through immune mechanisms [5]. Gut microbiota dysbiosis may be the underlying problem that causes both depression and psoriasis in patients with psoriasis. This may be one of the reasons of high depression comorbidity rates in patients with psoriasis. This relationship could have been men-tioned in the discussion section of the article.
In the study of Dommasch et al., individuals diagnosed with depression or receiving antidepressant treatment have
This comment refers to the article available at doi:10.1007/s00403-014-1455-9.
An author’s reply to this comment is available at doi:10.1007/s00403-016-1669-0.
& Alper Evrensel
alperevrensel@gmail.com Barıs¸ O¨ nen U¨nsalver onenunsalver@gmail.com Mehmet Emin Ceylan m.eminceylan@yahoo.com
1 Department of Psychiatry, Uskudar University, Nisbetiye Cad. No: 19, Etiler, Besiktas, Istanbul, Turkey
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been excluded from the study [4]. In addition, in the study of Hawro et al., it would have been better to exclude those diagnosed with depression or receiving antidepressant treatment from the study.
Sincerely,
U¨ nsalver BO¨, Evrensel A, Ceylan ME.
References
1. APA (2013) Diagnostic and statistical manual of mental disorders, 5th edn. (DSM-5). American Psychiatric Association, Arlington 2. Atakan N, Yazici AC, O¨ zarmag˘an G, I˙nalO¨z HS, Gu¨rer MA,
Sabuncu I˙, Kiremitc¸i U¨ , Alper S, Aytekin S, Arican O¨, Polat M, Dog˘an S, Aldinc¸ E (2015) TUR-PSO: a cross-sectional, study investigating quality of life and treatment status of psoriasis patients in Turkey. J Dermatol. doi:10.1111/1346-8138.13081
3. Connor CJ, Liu V, Fiedorowicz JG (2015) Exploring the physi-ological link between psoriasis and mood disorders. Dermatol Res Pract 2015:409637. doi:10.1155/2015/409637
4. Dommasch ED, Li T, Okereke OI, Li Y, Qureshi AA, Cho E (2015) Risk of depression in women with psoriasis: a cohort study. Br J Dermatol 173(4):975–980. doi:10.1111/bjd.14032
5. Evrensel A, Ceylan ME (2015) The gut–brain axis: the missing link in depression. Clin Psychopharmacol Neurosci 13(3):239–244. doi:10.9758/cpn.2015.13.3.239
6. Hawro T, Maurer M, Hawro M, Kaszuba A, Cierpiałkowska L, Kro´likowska M, Zalewska A (2014) In psoriasis, levels of hope and quality of life are linked. Arch Dermatol Res 306(7):661–666. doi:10.1007/s00403-014-1455-9
7. Mease PJ, Menter MA (2006) Quality of life issues psoriasis and psoriatic arthritis: outcome measures and therapies from a dermatological perspective. J Am Acad Dermatol 54(4):685–704. doi:10.1016/j.jaad.2005.10.008
8. Russo PA, Ilchef R, Cooper AJ (2004) Psychiatric morbidity of psoriasis: a review. Austral J Dermatol 45(3):155–161. doi:10. 1111/j.1440-0960.2004.00078.x
9. Schmitt JM, Ford DE (2007) Role of depression in quality of life for patients with psoriasis. Dermatology 215(1):17–27. doi:10. 1159/000102029
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