Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study

  1. SK Mahil
  2. M Yates
  3. ZZN Yiu
  4. SM Langan
  5. T Tsakok
  6. N Dand
  7. KJ Mason
  8. H McAteer
  9. F Meynell
  10. B Coker
  11. A Vincent
  12. D Urmston
  13. A Vesty
  14. J Kelly
  15. C Lancelot
  16. L Moorhead
  17. H Bachelez
  18. F Capon
  19. CR Contreras
  20. C De La Cruz
  21. P Di Meglio
  22. P Gisondi
  23. D Jullien
  24. J Lambert
  25. L Naldi
  26. S Norton
  27. L Puig
  28. P Spuls
  29. T Torres
  30. RB Warren
  31. H Waweru
  32. J Weinman
  33. MA Brown
  34. JB Galloway
  35. CM Griffiths
  36. JN Barker
  37. CH Smith
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Abstract

Background

Indirect excess morbidity has emerged as a major concern in the COVID-19 pandemic. People with psoriasis may be particularly vulnerable to this because of prevalent anxiety and depression, multimorbidity and therapeutic use of immunosuppression.

Objective

Characterise the factors associated with worsening psoriasis in the COVID-19 pandemic, using mental health status (anxiety and depression) as the main exposure of interest.

Methods

Global cross-sectional study using a primary outcome of self-reported worsening of psoriasis. Individuals with psoriasis completed an online self-report questionnaire (PsoProtectMe; Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection Me) between May 2020 and January 2021. Each individual completed a validated screen for anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-2). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression.

Results

4,043 people with psoriasis (without COVID-19) from 86 countries self-reported to PsoProtectMe (mean age 47.2 years [SD 15.1]; mean BMI 27.6kg/m2 [SD 6.0], 2,684 [66.4%] female and 3,016 [74.6%] of white European ethnicity). 1,728 (42.7%) participants (1322 [77%] female) reported worsening of their psoriasis in the pandemic. A positive screen for anxiety or depression associated with worsening psoriasis in age and gender adjusted (OR 2.04, 95% CI 1.77-2.36), and fully adjusted (OR 2.01, 95% CI 1.72-2.34) logistic regression models. Female sex, obesity, shielding behaviour and systemic immunosuppressant non-adherence also associated with worsening psoriasis. The commonest reason for non-adherence was concern regarding complications related to COVID-19.

Conclusions

These data indicate an association between poor mental health and worsening psoriasis in the pandemic. Access to holistic care including psychological support may mitigate potentially long-lasting effects of the pandemic on health outcomes in psoriasis. The study also highlights an urgent need to address patient concerns about immunosuppressant-related risks, which may be contributing to non-adherence.

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