Epidemiology of depression and suicidal ideation in patients with psoriasis: A meta-analysis of prospective cohort studies

Abstract

Background: Psoriasis is an immune-mediated inflammatory, chronic, recurrent skin disease associated with a high risk of developing psychiatric disorders, especially depression and suicidal ideation, leading to functional disability and poor quality of life. Objective: To comprehensively review and assess the epidemiologic association between psoriasis and the risk ratios (RRs) of depression or suicidal ideation. Methods: Five databases (PubMed, Wanfang Database, CNKI, The Cochrane Library, and EMBASE) were searched for prospective cohort studies on the prevalence of depression and/or suicidal ideation in patients with psoriasis updated to 2 February 2023. Two independent reviewers evaluated and extracted the data, which were then pooled into a summary RR with corresponding 95% confidence interval (CI) using random-effects models in Stata/MP14.0. Results: Sixteen cohort studies comprising 1,166,840 patients with psoriasis and 3,294,205 controls were eligible for the final analysis. The pooled RR for depression was 1.43 (95% CI = 1.13–1.81) in patients with psoriasis and1.55 (95% CI = 1.40–1.71) in patients with psoriatic arthritis. In the subgroup analysis, Asian patients with psoriasis (RR=1.38, 95% CI =1.17–1.63) had a lower pooled RR for depression than non-Asian patients (RR=1.45, 95% CI = 1.07–1.97), and patients with moderate to severe psoriasis (RR=1.69, 95% CI = 1.15–2.50) showed a higher RR for depression than patients with mild psoriasis (RR=1.60, 95% CI= 1.06–2.42). We also found no increase in the RR for suicidal ideation among people with psoriasis (RR=1.25, 95% CI =0.95–1.65). Conclusions: Patients with psoriasis are at increased risk of depression. Among patients with psoriasis, those with psoriatic arthritis, those who are non-Asian, and those with moderate to severe psoriasis are at higher risk for depression. However, the available evidence does not support an association between psoriasis and suicidal ideation.