“I think most rheumatologists who deal with chronic conditions, whether it be psoriatic arthritis or lupus, are really mindful that chronic diseases can, at certain times, cause mental health issues,” says Dr. Husni.
Dr. Ogdie strongly suggests rheumatologists screen for depression and related symptoms at every patient visit. It could be the first step toward putting patients at ease so they are ready to talk about their mental health challenges in relation to their disease.
“I do that for two reasons,” says Dr. Ogdie, referring to regular depression-related screening. “One is to catch it, the other is to normalize it, and that this is just part of what I’m going to be asking about.
“Some of our therapies may affect depression as well, so we want to be careful that we’re identifying it,” she says. “It just kind of becomes part of the routine.”
A review of 56 studies of patients with psoriasis and PsA conducted in 2019 examined the patients’ perspectives and experiences to uncover gaps in patient-centered care.3 Suggestions to improve outcomes and satisfaction included support of a patient’s psychosocial needs.
“Sometimes it helps to actually manage the depression or mental health component as well as the physical health,” says Dr. Ogdie, “because if you’re depressed, you’re also probably not exercising very much or doing other things to take care of yourself.”
The quality of life for patients with PsA is adversely affected by the psychosocial burden of the disease, which can show up as sleep disorders, fatigue, depression, poor body image and reduced work productivity. Ideally, management of the disease involves a multidisciplinary medical team and algorithms that account for psychological and physical concerns of the patient, according to a study co-authored by Dr. Husni.4
Because rheumatologists are not typically trained in mental health, there’s a chance that depression, anxiety or other mental distress in a patient could be overlooked. Yet there are many reasons clinicians should pay close attention to a patient’s mental health status.
For example, research suggests the prevalence of suicide ideation is higher among people with psoriasis than among general medical patients.2 According to the National Psoriasis Foundation, ideas or thoughts of suicide have been reported in about 10% of people living with psoriasis.
In addition, patients with psoriasis or PsA may be more likely to stop therapy for their rheumatic conditions when they are depressed. Researchers note that both depression and anxiety can influence treatment adherence, health behaviors and perceived health.2
