Psychological distress, well-being and personality traits in patients with different severity of psoriasis: a clinimetric assessment approach

Introduction: Psoriasis is a chronic dermatologic disease that negatively impacts not only the physical health of patients but also their mental health and social and work life. Indeed, it has been estimated that at least 30% of dermatologic patients present significant psychiatric comorbidities. A number of studies have found a correlation between the occurrence of psoriasis and psychiatric disorders such as depression and anxiety. However, major psychiatric disorders and life dissatisfaction have not been proved to differ across severity levels of the illness. The aim of this study is to illustrate, according to a clinimetric approach, the presence of differences between patients with mild versus moderate to severe psoriasis in psychological distress and well-being. Methods: A total of 70 patients suffering with psoriasis were recruited during follow up visits at Dermatology Clinic of Florence. Patients were evaluated using the Structured Clinical Interview for DSM-IV (SCID-I), the Diagnostic Criteria for Psychosomatic Research (DCPR) interview, along with the following self-report instruments: the Symptoms Questionnaire (SQ), the Psychological Well-being scales (PWB), and the Temperament and Character Inventory (TCI). Illness severity was evaluated as mild or moderate to severe using the Psoriasis Area and Severity Index (PASI). Results: According to PASI (> 10), 18.6% (n = 13) of patients reported moderate to severe psoriasis while 81.4% (n = 57) did not. No differences were reported between groups in rates of mood and anxiety disorders, but patients with greater severity presented greater rates of demoralization (61.5%; p < 0.05) and Type A behavior (53.8%; p < 0.05) than subjects with mild severity (17.5% and 21.1%, respectively). Patients with moderate/severe psoriasis also reported impaired levels of psychological well-being in terms of lower autonomy (p< 0.05), environmental mastery (p < 0.05), personal growth (p < 0.05) and purpose in life (p < 0.05), along with greater anxiety (p < 0.05), depressive (p < 0.05) and somatic symptoms (p < 0.05) than patients with milder severity of illness. Furthermore, according to TCI, severe patients reported greater harm avoidance (p< 0.05) and lower self-directness (p < 0.05) than individuals with milder psoriasis levels. Conclusions: Overall results highlighted the need in patients suffering with psoriasis of a more comprehensive psychological and psychosomatic assessment not limited to the customary diagnostic criteria.