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Research ArticleArticle

Depression and Anxiety in Psoriatic Disease: Prevalence and Associated Factors

Emily McDonough, Renise Ayearst, Lihi Eder, Vinod Chandran, Cheryl F. Rosen, Arane Thavaneswaran and Dafna D. Gladman
The Journal of Rheumatology April 2014, jrheum.130797; DOI: https://doi.org/10.3899/jrheum.130797
Emily McDonough
From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E. McDonough was supported by a Canadian Rheumatology Association Roche Summer Scholarship. Dr. V. Chandran was supported by a New Emerging Team grant from the Canadian Institutes of Health Research. The Psoriatic Arthritis Program is supported, in part, by a grant from The Krembil Foundation. E. McDonough, Medical Student, University of Toronto; A. Thavaneswaran, MMath, Research Associate, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; R. Ayearst, BSc, Database Manager, Psoriatic Arthritis Program, Toronto Western Hospital; L. Eder, MD, Postdoctoral Fellow; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Co-Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Head, Division of Dermatology, Toronto Western Hospital, Professor, Department of Medicine, University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute, Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, University Health Network, Toronto Western Hospital. Address correspondence to Dr. D.D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst, 1E-410B, Toronto, Ontario M5T 2S8, Canada. E-mail: dafna.gladman@utoronto.ca. Accepted for publication January 9, 2014.
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Renise Ayearst
From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E. McDonough was supported by a Canadian Rheumatology Association Roche Summer Scholarship. Dr. V. Chandran was supported by a New Emerging Team grant from the Canadian Institutes of Health Research. The Psoriatic Arthritis Program is supported, in part, by a grant from The Krembil Foundation. E. McDonough, Medical Student, University of Toronto; A. Thavaneswaran, MMath, Research Associate, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; R. Ayearst, BSc, Database Manager, Psoriatic Arthritis Program, Toronto Western Hospital; L. Eder, MD, Postdoctoral Fellow; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Co-Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Head, Division of Dermatology, Toronto Western Hospital, Professor, Department of Medicine, University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute, Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, University Health Network, Toronto Western Hospital. Address correspondence to Dr. D.D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst, 1E-410B, Toronto, Ontario M5T 2S8, Canada. E-mail: dafna.gladman@utoronto.ca. Accepted for publication January 9, 2014.
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Lihi Eder
From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E. McDonough was supported by a Canadian Rheumatology Association Roche Summer Scholarship. Dr. V. Chandran was supported by a New Emerging Team grant from the Canadian Institutes of Health Research. The Psoriatic Arthritis Program is supported, in part, by a grant from The Krembil Foundation. E. McDonough, Medical Student, University of Toronto; A. Thavaneswaran, MMath, Research Associate, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; R. Ayearst, BSc, Database Manager, Psoriatic Arthritis Program, Toronto Western Hospital; L. Eder, MD, Postdoctoral Fellow; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Co-Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Head, Division of Dermatology, Toronto Western Hospital, Professor, Department of Medicine, University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute, Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, University Health Network, Toronto Western Hospital. Address correspondence to Dr. D.D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst, 1E-410B, Toronto, Ontario M5T 2S8, Canada. E-mail: dafna.gladman@utoronto.ca. Accepted for publication January 9, 2014.
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Vinod Chandran
From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E. McDonough was supported by a Canadian Rheumatology Association Roche Summer Scholarship. Dr. V. Chandran was supported by a New Emerging Team grant from the Canadian Institutes of Health Research. The Psoriatic Arthritis Program is supported, in part, by a grant from The Krembil Foundation. E. McDonough, Medical Student, University of Toronto; A. Thavaneswaran, MMath, Research Associate, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; R. Ayearst, BSc, Database Manager, Psoriatic Arthritis Program, Toronto Western Hospital; L. Eder, MD, Postdoctoral Fellow; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Co-Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Head, Division of Dermatology, Toronto Western Hospital, Professor, Department of Medicine, University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute, Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, University Health Network, Toronto Western Hospital. Address correspondence to Dr. D.D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst, 1E-410B, Toronto, Ontario M5T 2S8, Canada. E-mail: dafna.gladman@utoronto.ca. Accepted for publication January 9, 2014.
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Cheryl F. Rosen
From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E. McDonough was supported by a Canadian Rheumatology Association Roche Summer Scholarship. Dr. V. Chandran was supported by a New Emerging Team grant from the Canadian Institutes of Health Research. The Psoriatic Arthritis Program is supported, in part, by a grant from The Krembil Foundation. E. McDonough, Medical Student, University of Toronto; A. Thavaneswaran, MMath, Research Associate, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; R. Ayearst, BSc, Database Manager, Psoriatic Arthritis Program, Toronto Western Hospital; L. Eder, MD, Postdoctoral Fellow; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Co-Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Head, Division of Dermatology, Toronto Western Hospital, Professor, Department of Medicine, University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute, Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, University Health Network, Toronto Western Hospital. Address correspondence to Dr. D.D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst, 1E-410B, Toronto, Ontario M5T 2S8, Canada. E-mail: dafna.gladman@utoronto.ca. Accepted for publication January 9, 2014.
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Arane Thavaneswaran
From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E. McDonough was supported by a Canadian Rheumatology Association Roche Summer Scholarship. Dr. V. Chandran was supported by a New Emerging Team grant from the Canadian Institutes of Health Research. The Psoriatic Arthritis Program is supported, in part, by a grant from The Krembil Foundation. E. McDonough, Medical Student, University of Toronto; A. Thavaneswaran, MMath, Research Associate, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; R. Ayearst, BSc, Database Manager, Psoriatic Arthritis Program, Toronto Western Hospital; L. Eder, MD, Postdoctoral Fellow; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Co-Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Head, Division of Dermatology, Toronto Western Hospital, Professor, Department of Medicine, University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute, Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, University Health Network, Toronto Western Hospital. Address correspondence to Dr. D.D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst, 1E-410B, Toronto, Ontario M5T 2S8, Canada. E-mail: dafna.gladman@utoronto.ca. Accepted for publication January 9, 2014.
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Dafna D. Gladman
From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E. McDonough was supported by a Canadian Rheumatology Association Roche Summer Scholarship. Dr. V. Chandran was supported by a New Emerging Team grant from the Canadian Institutes of Health Research. The Psoriatic Arthritis Program is supported, in part, by a grant from The Krembil Foundation. E. McDonough, Medical Student, University of Toronto; A. Thavaneswaran, MMath, Research Associate, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; R. Ayearst, BSc, Database Manager, Psoriatic Arthritis Program, Toronto Western Hospital; L. Eder, MD, Postdoctoral Fellow; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Co-Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Head, Division of Dermatology, Toronto Western Hospital, Professor, Department of Medicine, University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute, Director, Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, University Health Network, Toronto Western Hospital. Address correspondence to Dr. D.D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst, 1E-410B, Toronto, Ontario M5T 2S8, Canada. E-mail: dafna.gladman@utoronto.ca. Accepted for publication January 9, 2014.
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Abstract

Objective (1) To determine the prevalence of depression and anxiety in patients with psoriatic arthritis (PsA) and to identify associated demographic and disease-related factors. (2) To determine whether there is a difference in the prevalence of depression and anxiety between patients with PsA and those with psoriasis without PsA (PsC).

Methods Consecutive patients attending PsA and dermatology clinics were assessed for depression and anxiety using the Hospital Anxiety and Depression Scale. Patients underwent a clinical assessment according to a standard protocol and completed questionnaires assessing their health and quality of life. T tests, ANOVA, and univariate and multivariate models were used to compare depression and anxiety prevalence between patient cohorts and to determine factors associated with depression and anxiety.

Results We assessed 306 patients with PsA and 135 with PsC. There were significantly more men in the PsA group (61.4% vs 48% with PsC) and they were more likely to be unemployed. The prevalence of both anxiety and depression was higher in patients with PsA (36.6% and 22.2%, respectively) compared to those with PsC (24.4% and 9.6%; p = 0.012, 0.002). Depression and/or anxiety were associated with unemployment, female sex, and higher actively inflamed joint count as well as disability, pain, and fatigue. In the multivariate reduced model, employment was protective for depression (OR 0.36) and a 1-unit increase on the fatigue severity scale was associated with an increased risk of depression (OR 1.5).

Conclusion The rate of depression and anxiety is significantly higher in patients with PsA than in those with PsC. Depression and anxiety are associated with disease-related factors.

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Depression and Anxiety in Psoriatic Disease: Prevalence and Associated Factors
Emily McDonough, Renise Ayearst, Lihi Eder, Vinod Chandran, Cheryl F. Rosen, Arane Thavaneswaran, Dafna D. Gladman
The Journal of Rheumatology Apr 2014, jrheum.130797; DOI: 10.3899/jrheum.130797

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Depression and Anxiety in Psoriatic Disease: Prevalence and Associated Factors
Emily McDonough, Renise Ayearst, Lihi Eder, Vinod Chandran, Cheryl F. Rosen, Arane Thavaneswaran, Dafna D. Gladman
The Journal of Rheumatology Apr 2014, jrheum.130797; DOI: 10.3899/jrheum.130797
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