Comparison of Anxiety and Depression Scores in Patients with Oral Lichen Planus and Normal Individuals

Abstract

Introduction: Oral lichen planus (OLP) is a common chronic inflammatory, psycho-mucocutaneous disease affecting about 1%–4% of the general population associated with psychoneuroendocrine and psychoimmunological comorbidities. Lichen planus although it is not an infectious disease, its cause is unknown, it is classified as an autoimmune disorder that may be precipitated or exacerbated by psychosocial stress. The Hospital Anxiety and Depression Scale (HADS) was originally developed to indicate the possible presence of anxiety and depressive states in the setting of a medical outpatient clinic and was found to perform well in assessing the anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population. Aims: The aim of this study is to evaluate the levels of psychological status and the impact of treatment on psychological status in OLP individuals and compare it with normal individuals. Materials and Methods: Forty OLP patients along with the same number of age- and gender-matched healthy controls were included in the study. HADS questionnaire was administered to all 40 OLP (start of therapy) and 40 non-OLP individuals. In the OLP Group (40 participants): 20 were given “active” intervention with Cyclosporine Oral Solution (Group A), 20 were given “placebo” intervention (Group P). HADS questionnaire was given to all the twenty participants of Group A and all twenty participants of Group P at the end of therapy. The questionnaire consisted of 14 questions; 7 questions pertaining to anxiety and 7 pertaining to depression. Results: High level of anxiety (47.5%) and depression (85%) was observed in participants with OLP as compared to non-OLP (0%). After the active intervention, 14 participants were relieved of anxiety as compared to 8. Comparison of the prevalence of depression in OLP individuals before and after getting “active” intervention revealed that on getting active intervention the depression present in all 20; 1 (10%) mild and 9 (90%) frank came down to 1 (10%), and 4 (40%) mild. Five (50%) participants were completely relieved of depression. Conclusion: Lichen planus is to some extent a psychosomatic or somatopsychic disease or both. The present study results matches with the majority of the studies, showing a positive association between anxiety and depression levels in OLP patients, suggesting counseling along with traditional treatment can be effective in reducing the size of the lesions. Oral healthcare providers should pay attention to the emotional state of their patients. Emotional factors are important as evidenced by higher frequency of psychiatric symptoms, poor quality of life, higher level of anxiety, and neuroendocrine and immune dysregulations. Counseling may help in ameliorating symptoms, improving quality of life, and enhancing recovery.