Children With Psoriasis Should Be Screened for Mental Health Conditions, Say Researchers

The importance of screening children with psoriasis for mental health conditions was underscored in a new study published in Pediatric Dermatology.

A review of available literature, while still limited, has pointed to a link between pediatric psoriasis and anxiety and depression, although it’s not clear if there is a causal relationship, as evidence suggests they exacerbate one another. Previous research has made a clear association between psoriasis and mood disorders in adults resulting from psoriatic involvement of the face and palms, as well as scalp involvement.

“One in 3 cases of psoriasis begins in early childhood, with a prevalence of approximately 2% in the pediatric population worldwide,” explained the researchers. “Additionally, published incidence rates in children have more than doubled since the late 20th century. Consequently, there exists a need to better understand the psychosocial manifestations of psoriasis in pediatric patients, with a particular focus on susceptibility to anxiety and depression.”

The researchers noted difficulties in conducting such research among children, as they may not be able to understand or express their feelings about their psoriasis.

Across the scarce data that are available on the risk of anxiety and depression among children with the conditions, findings have been inconsistent. For example, a review of the Market-Scan Commercial Claims and Encounters Database (CCEA) of over 7000 patients with psoriasis found that the condition was associated with both anxiety (incident rate ratio [IRR], 1.31) and depression (IRR, 1.17), although only depression comorbidity achieved significance (P < .05).

Meanwhile, data from a similar retrospective, case-control study demonstrated contrasting findings. The study included 7000 children with psoriasis and 37,000 matched controls, which showed that those with psoriasis were 1.34 times more likely to develop an anxiety disorder (P < .0025). The group noted that although retrospective data like these provide valuable insight, they’re limited in their generalizability due to certain limitations.

“Use of the CCEA and other insurance claims databases to extrapolate data indicates all participants had adequate access to health care for both dermatologic and psychiatric needs,” explained the group. “As of 2021, 23.7 million children aged 0 to 17 are uninsured or underinsured, with disproportionately high shares of Black and Hispanic individuals. If approximately 2% of children are diagnosed with psoriasis, nearly 500,000 children with psoriasis remain unaccounted in insurance claims database studies, particularly children of ethnic backgrounds historically underrepresented in research.”

Certain research has circumvented these limitations by using data from the National Inpatient Sample Database of US Hospitalizations, which analyzed hospitalizations resulting from mental health disorders in patients younger than 18 years. Compared with patients without psoriasis, those with the condition were significantly more likely to visit the emergency department for anxiety disorders (odds ratio [OR], 1.95; 95% CI, 1.490-2.62; P < .0001) and for depression and mood disorders (OR, 2.54; 95% CI, 2.04-3.17; P < .0001).

The researchers also wrote of the limitations associated with observational studies, which provide limited data from medical claims data coming from various sources using various diagnostic criteria. The data also lack insights into family history, severity of disease, and overall health of patients.

Reference

Strouphauer E, Stolar A, Tollefson M. Manifestation of anxiety and depression among pediatric patients with psoriasis: a review. Pedeatr Dermatol. Published online November 13, 2022. doi:10.1111/pde.15185