Psychological burden and its correlates in patients with chronic plaque psoriasis attending three tertiary care centers in Sri Lanka.

Psoriasis is associated with psychological distress among the affected due to unsightly skin lesions, chronicity and the cultural and social stigma linked with the disease. The pathophysiological link between psoriasis and depression creates a vicious cycle in the skin and brain axis. This study evaluates the psychological comorbidity of patients with chronic plaque psoriasis (CPP). A cross-sectional study was conducted among 297 patients aged 18 years or more attending dermatology clinics at National Hospital, Galle and General Hospitals at Matara and Hambantota. The Sinhala validated Kessler Psychological Distress Scale (K10), and patient health questionnaire (PHQ-9) were used to assess psychological status and depression, respectively. The quality of life (QoL) was assessed using the Dermatology Life Quality Index (DLQI) and Psoriasis Disability Index (PDI). Mean (SD) age of patients was 52(12) years and 57.6% were males. According to the K10 score, 73% (n = 218) were likely to be mentally robust while 15% (n = 45) had mild mental disorder and 11% (n = 34) had moderate to severe mental disorder. Screening using PHQ-9 showed 17%(n = 51) prevalence of depression and 14% (n = 42) reported to have had suicidal ideation at some stage of the illness. Psychological distress showed weak correlations with age (ρ= -0.19, p < 0.01), degree of itch (ρ = 0.16, p < 0.01), disease severity (body surface area ρ = 0.16, p < 0.01 and psoriasis area severity index ρ=+0.15, p < 0.05). Both K10 and PHQ-9 showed significant correlations with PDI (ρ = 0.51 and ρ = 0.48, p < 0.01) and DLQI (ρ = 0.34 and ρ = 0.39, p = < 0.001). The presence of arthralgia was associated with psychological distress and depression (OR 1.8, 95% CI: 1.09, 3.05: p = 0.019, and OR 2.48, 95% CI: 1.32, 4.65: p = 0.004, respectively). There was no association between the psychological distress with gender, duration of the disease, or smoking status. Psychological distress is common in patients with CPP and it is associated with reduced QoL. Depression and suicidal ideation were notable concerns, and arthralgia was linked to higher levels of distress. These findings highlight the importance of addressing both physical and mental health in managing psoriasis.