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Psoriasis in Adolescents Takes a Toll on Mental Health

—Investigators used Danish data to determine whether adolescents with psoriasis experience worse mental health than those without psoriasis.

By Deborah L. Ungerleider, MD, FAAP

Psoriasis is associated with poor mental health in adolescents, according to a cross sectional study using data from the Danish National Birth Cohort.1

Past studies have shown that psoriasis in adults is associated with increased mental health issues, such as anxiety and depression, in addition to decreased quality of life.2,3 But the research assessing mental in adolescents with psoriasis is lacking.

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To determine if there is a difference in self-reported mental health between adolescents with and without psoriasis, Sandra L. Brandi, MD, of the Department of Dermatology and Allergy, Copenhagen University Hospital, Copenhagen, Denmark and Section of Epidemiology, Department of Public Health University of Copenhagen, and colleagues, used data with an 18-year follow-up from the Danish National Birth Cohort. They contacted adolescents between 2016 and 2022, who were 18 years and 3 months old, to answer an online questionnaire regarding psoriasis and mental health.1

Their report was published online in the Journal of Affective Disorders in May 2024.1

Measuring aspects of mental health

Adolescents with psoriasis were defined as those who answered yes to ever having psoriasis. These patients were also asked if they had been diagnosed by a doctor and if they had joint pain. Mental health was measured in:

  • Overall health (good vs poor)
  • Life satisfaction (by an adapted Cantril Self-Anchoring Striving Scale, rating life as high or low satisfaction) 
  • Overall mental well-being (by the Short Warwick-Edinburgh Mental Well-Being Scale as low or moderate/high) 
  • Loneliness (how often they felt that way from “often” to “never”) 
  • Behavioral difficulties (by the Strengths and Difficulties Questionnaire; the total difficulties score and the internalizing difficulties score were used)
  • Depressive symptoms (by the Major Depression Inventory evaluating frequency of depressive symptoms over the prior 2 weeks)
  • Anxiety symptoms (social phobia subscale and panic/agoraphobia scale of the Spence Children’s Anxiety Scale evaluating the frequency of anxiety symptoms)

Psoriasis linked to worse mental health

Out of 44,838 participants included in the study, 1147 (2.6%) had psoriasis; 60.6% of those had a diagnosis confirmed by a doctor and 23.3% reported joint pain. Additionally, the patients with psoriasis were more often female, overweight, from lower-income families, and had mothers with lower educational levels compared with the adolescents without psoriasis. 

More adolescents with psoriasis had low mental health compared to those without psoriasis. This was true in all the specific measures listed above. For measures reflecting general mental health, participants with psoriasis were more likely to report poor self-rated health (odds ratio [OR], 95% confidence interval [CI] 1.33–1.84), low life satisfaction (OR 1.19, 95% CI 1.03–1.36), low mental wellbeing, feeling lonely (OR 1.29, 95% CI 1.10-1.50), and overall behavioral difficulties (OR 1.50, 95% CI 1.28-1.74).

Adolescents with psoriasis also demonstrated similar results with measures of internalizing difficulties, such as depression and anxiety. Notably, both males and females reported higher odds of panic and agoraphobia (males OR 1.72, 95% CI 1.33–2.19; females OR 1.60, 95% CI 1.33–1.92).

In sensitivity analyses, when limiting the psoriasis group to those diagnosed by a physician, the only measures that remained statistically significant were poor self-rated health, overall behavioral difficulties, and male panic/agoraphobia. It also appeared that the presence of joint pain had a strong mediating effect on mental health in the psoriasis group, but the authors “interpret these results with caution” due to not having data on joint pain in the psoriasis-free group.

The authors noted several limitations. Since they used self-reported data, there may have been misclassifications related to the definition of psoriasis. Additionally, they did not have access to data registered after 2024. Finally, they only used 2 subscales for anxiety, which may have underestimated the level of anxiety.1

The authors concluded, “… adolescents with psoriasis participating in the DNBC 18-year follow-up reported poorer mental health across all dimensions compared with their psoriasis-free peers. The associations appeared driven by adolescents with psoriasis reporting joint pain.” 

Additionally, they said, “Future studies should assess joint pain in the whole study population to be able to fully distinguish between those with and without psoriasis. Among the adolescents reporting a doctor-confirmed diagnosis, associations were weaker, which may indicate a potential benefit to diagnosis, or a fundamental difference in healthcare-seeking behavior between self-reporting adolescents with psoriasis and psoriasis patients.”1

Published:

Deborah Ungerleider is a New Jersey-based pediatrician and freelance medical writer and editor who covers numerous aspects of medical practice.

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