Abstract
This study investigates (a) the prevalence of psychological distress, alexithymia and alcohol misuse in psoriasis patients; and (b) the relationship between psoriasis severity, alexithymia, alcohol and psychological distress in patients with psoriasis. A cross-sectional study was conducted. Outpatients (n = 184) with moderate to severe psoriasis completed a psychological screening battery. Measures included the Hospital Anxiety and Depression Scale, the Penn State Worry Questionnaire, the twenty-item Toronto Alexithymia Scale, the Dermatology Life Quality Index, the Psoriasis Area and Severity Index, the Self-Administered Psoriasis Area and Severity Index, and the Alcohol Use Disorders Identification Test. Demographic, clinical details and information on knowledge of psychosocial issues, alcohol and confidence on coping with distress and talking to others about psoriasis was also gathered. Alexithymia was associated with anxiety, depression and worry; subjective psoriasis severity was associated with worry. Alcohol misuse was related to anxiety and worry, but not to depression. Appropriate identification and treatment of alcohol difficulties and psychological distress of patients with psoriasis is needed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adamzik, K., McAleer, M. A., & Kirby, B. (2013). Alchol and psoriasis: Sobering thoughts. Clinical Dermatology, 38(8), 819–822. https://doi.org/10.1111/ced.12013.
Akay, A., Pekcanlar, A., Bozdag, K. E., Altintas, L., & Karaman, A. (2002). Assessment of depression in subjects with psoriasis vulgaris and lichen planus. Journal of European Academy of Dermatology and Venereology, 16, 347–352. https://doi.org/10.1046/j.1468-3083.2002.00467.x.
Alpsoy, E., Polat, M., Fettahlioglu-Karaman, B., Karadag, A. S., Kartal-Durmazlar, P., Yalcin, B., … Senol, Y. (2017) Internalised stigma in psoriasis: A multicenter study. Journal of Dermatology, 44, 885–891. https://doi.org/10.1111/1346-8138.13841.
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994a). The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32. https://doi.org/10.1016/0022-3999(94)90005-1.
Bagby, R. M., Taylor, G. J., & Parker, J. D. A. (1994b). The twenty-item Toronto Alexithymia Scale-II. Convergent, discriminant and concurrent validity. Journal of Psychosomatic Research, 38, 33–40. https://doi.org/10.1016/0022-3999(94)90006-X.
Bahmer, J., Kuhl, J., & Bahmer, F. A. (2007). How do personality systems interact in patients with psoriasis, atopic dermatitis and urticaria. Acta Dermato-Venerologica, 87, 317–324. https://doi.org/10.2340/00015555-0246.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman.
Barry, R., Dudley, J., Tobin, A. M., O’ Brien, E., Rogers, S., Collins, P., & Kirby, B. (2005). The effects of alcohol intake and psychological distress on time to clearance of psoriasis treated with narrowband ultraviolet B. British Journal of Dermatology, 153, 43–44. https://doi.org/10.1111/j.1365-2133.2005.06628.x (Supplement Material).
Basra, M. K., Fenech, R., Gatt, R. M., Salek, M. S., & Finlay, A. Y. (2008). The Dermatology Life Quality Index 1994–2007: A comprehensive review of validation data and clinical results. Birtish Journal of Dermatology, 159, 997–1035. https://doi.org/10.1111/j.1365-2133.2008.08832.x.
Behar, E., Alcaine, O., Zuellig, A. R., & Borkovec, T. D. (2003). Screening for generalized anxiety disorder using the Penn State Worry Questionnaire: A receiver operating characteristic analysis. Journal of Behaviour Therapy and Experimental Psychiatry, 34, 25–43. https://doi.org/10.1016/S0005-7916(03)00004-1.
Betka, S., Pfeifer, G., Garfinkel, S., Prins, H., Bond, R., Sequeira, H., … Critchley, H. (2018). How do self-assessment of alexithymia and sensitivity to bodily sensations relate to alcohol consumption? Alcoholism. Clinical and Experimental Research, 42, 81–88. https://doi.org/10.1111/acer.13542.
Bilevicius, E., Single, A., Bristow, L. A., Foot, M., Ellery, M., Keough, M. T., & Johnson, E. A. (2018). Shame mediates the relationship between depression and addictive behaviours. Addictive Behaviours, 82, 94–100. https://doi.org/10.1016/j.addbeh.2018.02.023.
Braathen, L. R., Botten, G., & Bjerkedal, T. (1989) Psoriatics in Norway. A questionnaire study on health status, contact with paramedical professions, and alcohol and tobacco consumption. Acta Dermato-Venereologica, 142, 9–12.
Brenaut, E., Horreau, C., Pouplard, C., Barnetche, T., Paul, C., Richard, M. A., … Misery, L. (2013). Alcohol consumption and psoriasis: A systematic literature review. Journal of the European Academy of Dermatology and Venereology, 27(3), 30–35. https://doi.org/10.1111/jdv.12164.
Buckner, J. D., & Heimberg, R. G. (2010). Drinking behaviours in social situations account for alcohol-related problems among socially anxious individuals. Psychology of Addictive Behaviours, 24, 640–648. https://doi.org/10.1037/a00209868.
Burden, A. D., & Kirby, B. (2016). Psoriasis and related disorders. In C. Griffiths, J. Barker, T. Bleiker, C. Chalmers & D. Creamer (Eds.), Rook’s textbook of dermatology (9th ed., Vol. 2). Hoboken: Wiley-Blackwell.
Camisa, C. (2004). Handbook of psoriasis. Oxford: Blackwell Publishing.
Cohen, B. E., Martires, K. J., & Ho, R. S. (2016). Psoriasis and the risk of depression in the US population: National health and nutrition examination survey 2009–2012. JAMA Dermatology, 152(1), 73–79. https://doi.org/10.1001/jamadermatol.2015.3605.
Consoli, S. M., Rolhion, S., Martin, C., Ruel, K., Cambazard, F., Pellet, J., & Misery, L. (2006). Low levels of emotional awareness predict a better response to dermatological treatment in patients with psoriasis. Dermatology, 212, 128–136. https://doi.org/10.1159/000090653.
Dalgard, F. J., Gieler, U., Tomas-Aragones, L., Lien, L., Poot, F., Jemec, G. B. E., … Kupfer, J. (2015). The psychological burden of skin diseases; a cross-sectional multicenter study among dermatological outpatients in 13 European countries. Journal of Investigative Dermatology. https://doi.org/10.1038/jid.2014.530.
Devrimci-Ozguven, H., Kundakci, N., Kumbasar, H., & Boyvat, A. (2000). The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. Journal of the European Academy of Dermatology and Venereology, 14, 267–271. https://doi.org/10.1046/j.1468-3083.2000.00085.x.
Dowlatshahi, E. A., Wakkee, M., Arends, L. R., & Nijsten, T. (2014). The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: A systematic review and meta-analysis. Journal of Investigative Dermatology, 136(6), 1542–1551. https://doi.org/10.1038/jid.2013.508.
Esposito, M., Saraceno, R., Giunta, A., Maccarone, M., & Chimenti, S. (2006). An Italian study on psoriasis and depression. Dermatology, 212, 123–126. https://doi.org/10.1159/000090652.
Fava, G. A., Perini, G. I., Santonastaso, P., & Formasa, C. V. (1980). Life events and psychological distress in dermatologic disorders: Psoriasis, chronic urticaria, and fungal infections. British Journal of Medical Psychology, 53, 277–282. https://doi.org/10.1111/j.2044-8341.1980.tb02551.x.
Feldman, S. R., Fleischer, A. B., Reboussin, D. M., Rapp, S. R., Vanarthos, J. C., Exum, M. L., … Nurree, L. (1996). The self-administered psoriasis area and severity index is valid and reliable. Journal of Investigative Dermatology, 106, 183–186. https://doi.org/10.1111/1523-1747.ep12329912.
Ferreira, B. R., Pio-Abreu, J. L., Reis, J. P., & Figueiredo, A. M. (2016). Psoriasis and associated psychiatric disorders: A systematic review on etiopathogenesis and clinical correlation. Journal of Clinical and Aesthetic Dermatology, 9(6), 36–43.
Ferreira, B. R., Pio-Abreu, J. L., Reis, J. P., & Figueiredo, A. M. (2017). Analysis of the prevalence of mental disorders in psoriasis: The relevance of psychiatric assessment in dermatology. Psychiatria Danubina, 29(4), 401–406. https://doi.org/10.24869/psyd.2017.401.
Finlay, A. Y., & Coles, E. C. (1995). The effect of severe psoriasis on the quality of life of 369 patients. British Journal of Dermatology, 132, 236–244. https://doi.org/10.1111/j.1365-2133.1995.tb05019.x.
Finlay, A. Y., & Khan, G. K. (1994). Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use. Journal of Experimental Dermatology, 19, 210–216. https://doi.org/10.1111/j.1365-2230.1994.tb01167.x.
Finzi, A., Colombo, D., Caputo, A., Andreassi, L., Chimenti, S., Vena, G., & Gianneti, A. (2007). Psychological distress an coping strategies in patients with psoriasis: The PSYCHAE study. European Academy of Dermatology and Venereology, 21, 1161–1169. https://doi.org/10.1111/j.1468-3083.2007.02079.x.
Fleischer, A. B., Rapp, S. R., Reboussin, D. M., Varnathos, J. C., & Feldman, S. R. (1994). Patient measurement of psoriasis severity with a structured measurement. Journal of Investigative Dermatology, 102, 967–969. https://doi.org/10.1111/1523-1747.ep12384205.
Fleming, P., Bai, J. W., Pratt, M., Sibbald, C., Lynde, C., & Gulliver, W. P. (2017). The prevalence of anxiety in patients with psoriasis: A systematic review of observational studies and clinical trials. Journal of the European Academy of Dermatology and Venereology, 31, 798–807. https://doi.org/10.1111/jdv.13891.
Fleming, P., Roubille, C., Richer, V., Starnino, T., McCourt, C., McFarlane, A., … Gulliver, W. P. (2015). Effects of biologics on depressive symptoms in patients with psoriasis; a systematic review. Journal of the European Academy of Dermatology and Venereology, 29(6), 1063–1070. https://doi.org/10.1111/jdv.12909.
Fortune, D. G., Main, C., O’Sullivan, T., & Griffiths, C. E. M. (1997). Assessing illness related stress in psoriasis: The psychometric properties of the Psoriasis Life Stress inventory. Journal of Psychosomatic Research, 42, 467–475. https://doi.org/10.1016/S0022-3999(97)00036-6.
Fortune, D. G., Richards, H. L., & Griffiths, C. (2005a). Psychological factors in psoriasis: Consequences, mechanisms and interventions. Dermatology Clinics, 23, 681–694. https://doi.org/10.1016/j.det.2005.05.022.
Fortune, D. L., Richards, H. L., Griffiths, C. E. M., & Main, C. J. (2002a). Psychological stress, distress and disability in patients with psoriasis: Consensus and variation in the contribution of illness perceptions, coping and alexithymia. British Journal of Clinical Psychology, 41, 157–174. https://doi.org/10.1348/014466502163949.
Fortune, D. G., Richards, H. L., Griffiths, C. E. M., & Main, C. J. (2004). Targeting cognitive-behavioural therapy to patients’ implicit model of psoriasis: Results from a patient preference controlled trial. British Journal of Clinical Psychology, 43, 65–82. https://doi.org/10.1348/014466504772812977.
Fortune, D. L., Richards, H. L., Griffiths, C. E. M., & Main, C. J. (2005b). Worry and pathological worry in patients with psoriasis: Cross sectional analyses of the Penn State Worry Questionnaire (PSWQ) in four samples of patients. Journal of Clinical Psychology in Medical Settings, 12, 143–152. https://doi.org/10.1007/s10880-005-3274-9.
Fortune, D. L., Richards, H. L., Griffiths, C. E. M., & Main, C. J. (2005c). Adversarial growth in patients undergoing treatment for psoriasis: A prospective study of the ability of patients to construe benefits from negative events. Psychology, Health & Medicine, 10, 44–56. https://doi.org/10.1080/13548500512331315352.
Fortune, D. G., Richards, H. L., Kirby, B., Bowcock, S., Main, C. J., & Griffiths, C. E. M. (2002c). A cognitive-behavioural symptom management as an adjunct in psoriasis therapy. British Journal of Dermatology, 146, 458–465. https://doi.org/10.1046/j.1365-2133.2002.04622.x.
Fortune, D. G., Richards, H. L., Kirby, B., McElhone, K., Markham, T., Rogers, S., & Griffiths, C. E. M. (2003). Psychological distress impairs the rate of clearance of psoriasis in patients treated with photochemotherapy (PUVA). Archives of Dermatology, 139, 752–756. https://doi.org/10.1001/archderm.139.6.752.
Fortune, D. L., Richards, H. L., Main, C. J., & Griffiths, C. E. M. (2000). Pathological worrying, illness perceptions and disease severity in patients with psoriasis. British Journal of Health Psychology, 5, 71–82. https://doi.org/10.1348/135910700168775.
Fortune, D. L., Richards, H. L., Main, C. J., & Griffiths, C. E. M. (2002b). Patients’ strategies for coping with psoriasis. Clinical and Experimental Dermatology, 27, 177–184. https://doi.org/10.1046/j.1365-2230.2002.01055.
Fortune, D. L., Richards, H. L., Main, C. J., O’Sullivan, T. M., & Griffiths, C. E. M. (1998). Developing clinical psychology services in an outpatient dermatology specialist clinic: What factors are associated with non-uptake of the service? Clinical Psychology Forum, 115, 34–36.
Fredriksson, T., & Pettersson, U. (1978). Severe psoriasis: Oral therapy with a new retinoid. Dermatologica, 157, 238–244.
Gaston, L., Lassonde, M., Bernier-Buzzanga, J., Hodgins, S., & Crombez, J. C. (1987). Psoriasis and stress: A prospective study. Journal of American Academy of Dermatology, 17, 82–86. https://doi.org/10.1111/j.1468-3083.2008.02642.x.
Gelfand, J. M., Neimann, A. L., Shin, D. B., Wang, X., Margolis, D. J., & Troxel, A. B. (2006). Risk of myocardial infarction in patients with psoriasis. JAMA, 296, 1735–1741.
Gelfand, J. M., Weinstein, E., Porter, S. B., Neimann, A. L., Berlin, J. A., & Margolis, D. J. (2005). Prevalence and treatment of psoriasis in the United Kingdom: A population-based study. Archives of Dermatology, 141, 1537–1541.
Ghorbani, F., Khosravani, V., Bastan, S. F., & Ardakani, J. A. (2017). The alexithymia, emotion regulation difficulties, positive and negative affects and suicidal risk in alcohol-dependent outpatients. Psychiatry Research, 252, 223–230. https://doi.org/10.1016/j.psychres.2017.03.005.
Ginsburg, I. H., & Link, B. G. (1989). Feelings of stigmatization in patients with psoriasis. Journal of American Academy of Dermatology, 20, 53–63. https://doi.org/10.1016/S0190-9622(89)70007-4.
Ginsburg, I. H., & Link, B. G. (1993). Psychosocial consequences of rejection and stigma feelings in psoriasis patients. International Journal of Dermatology, 32, 587–591. https://doi.org/10.1111/j.1365-4362.1993.tb05031.x.
Golpour, M., Hosseini, S. H., Khademloo, M., Ghasemi, M., Ebadi, A., Koohkan, F., & Shahmohammadi, S. (2012). Depression and anxiety disorders among patients with psoriasis: A hospital-based case control study. Dermatology Research and Study. https://doi.org/10.1155/2012/381905.
Gordon, K. B., Armstrong, A. W., Han, C., Foley, P., Song, M., Wasfi, Y., … Reich, K. (2018). Anxiety and depression in patients with moderate-to-severe psoriasis and comparison of change from baseline after treatment with guselkumab versus adalimumab: Results from the Phase 3 VOYAGE 2 study. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.15012.
Gupta, M. A., & Gupta, A. K. (1997). Psoriasis and sex: A study of moderately to severely affected patients. International Journal of Dermatology, 56, 259–262.
Gupta, M. A., & Gupta, A. K. (1998). Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. British Journal of Dermatology, 139, 846–850. https://doi.org/10.1046/j.1365-2133.1998.02511.x.
Gupta, M. A., & Gupta, A. K. (2003). Psychiatric and psychological co-morbidity in patients with dermatologic disorders: Epidemiology and management. American Journal of Clinical Dermatology, 4, 833–842.
Gupta, M. A., Gupta, A. K., & Watteel, G. N. (1998). Perceived deprivation of social touch in psoriasis is associated with greater psychologic morbidity: An index of the stigma experience in dermatologic disorders. Cutis, 61, 339–342.
Gupta, M. A., Schork, N. J., Gupta, A. K., & Ellis, C. N. (1993). Alcohol intake and treatment responsiveness of psoriasis: A prospective study. Journal of the American Academy of Dermatology, 28, 730–732. https://doi.org/10.1016/0190-9622(93)70101-X.
Hartka, E., Johnstone, B., Leino, V. E., Motoyoshp, M., Temple, M., & Fillmore, K. M. (1991). A meta-analysis of depressive symptomatology and alcohol consumption over time. British Journal of Addiction, 86, 1283–1298.
Hermann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results. Journal of Psychosomatic Research, 42, 17–41. https://doi.org/10.1016/S0022-3999(96)00216-4.
Hill, L., & Kennedy, P. (2002). The role of coping strategies in mediating subjective disability in people who have psoriasis. Psychology, Health and Medicine, 7, 261–267. https://doi.org/10.1080/13548500220139340.
Hrehorow, E., Salomon, J., Matusiak, L., Reich, A., & Szepietowski, J. C. (2012). Patients with psoriasis feel stigmatised. Acta Dermato-Venereologica, 92, 67–72. https://doi.org/10.2340/00015555-1193.
Hughes, J. E., Barraclough, L., Hamblin, G., & White, J. E. (1983). Psychiatric symptoms in dermatology patients. British Journal of Psychiatry, 143, 51–54. https://doi.org/10.1192/bjp.143.1.51.
Innamorati, M., Quinto, R. M., Imperatori, C., Lora, V., Graceffa, D., Fabbricatore, M., … Bonifati, C. (2016). Health-related quality of life and its association with alexithymia and difficulties in emotion regulation in patients with psoriasis. Comprehensive Psychiatry, 70, 200–208. https://doi.org/10.1016/j.comppsych.2016.08.001.
Janowski, K., Steuden, S., Pietzrak, A., Krasowska, D., Kacmarek, L., Gradus, I., & Chodorowska, G. (2012). Social support and adaptation to the disease in men and women in psoriasis. Archives of Dermatological Research, 304, 431–432. https://doi.org/10.1007/s00403-012-1235-3.
Jensen, P., Ahlehoff, O., Egeberg, A., Gislason, G., Hansen, P. R., & Skov, L. (2016). Psoriasis and new-onset depression: A Danish nationwide cohort study. Acta Dermato-Venerologica, 96, 39–42. https://doi.org/10.2340/00015555-2183.
Jowett, S., & Ryan, T. (1985). Skin disease and handicap: An analysis of the impact of skin conditions. Social Science and Medicine, 20, 425–429.
Kauhanen, J., Kaplan, G. A., Julkunen, J., & Salonen, J. T. (1994). The association of alexithymia with all cause mortality: Prospective epidemiological evidence. Psychosomatic Medicine, 56, 149.
Kent, G., & Keohane, S. (2001). Social anxiety and disfigurement: the moderating effects of fear of negative evaluation and past experience. British Journal of Clinical Psychology, 40, 23–34.
Kim, S. J., Park, M. Y., Pak, K., Han, J., Kim, G. W., Kim, H. S., … Kim, B. S. (2018). Improvement of depressive symptoms in patients with moderate-to-severe psoriasis treated with ustekinumab: An open label trial validated using beck depression inventory, Hamilton depression rating scale measures and 18fluorodeoxyglucose (FDG) positron emission tomography (PET). Journal of Dermatological Treatment, 7, 1–8. https://doi.org/10.1080/09546634.2018.1466021.
Kimball, A. B., Jacobson, C., Weiss, S., Vreeland, M. G., & Wu, Y. (2005). The psychosocial burden of psoriasis. American International Journal of Dermatology, 6, 383–392.
Kirby, B., Richards, H. L., Mason, D. L., Fortune, D. G., Main, C. J., & Griffiths, C. E. M. (2008). Alcohol consumption and psychological distress in patients with psoriasis. British Journal of Dermatology, 158, 138–140. https://doi.org/10.1111/j.1365-2133.2007.08299.x.
Koo, J. (1996). Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatology Clinics, 14, 485–496. https://doi.org/10.1016/S0733-8635(05)70376-4.
Korkoliakou, P., Christodoulou, C., Kouris, A., Porichi, P., Efstathiou, V., Kaloudi, E., … Douzenis, A. (2014). Alexithymia, anxiety and depression in patients with psoriasis: A case–control study. Annals of General Psychiatry, 13, 38. https://doi.org/10.1186/s12991-014-0038-7.
Korkoliakou, P., Efstathiou, V., Giannopoulou, I., Christodoulou, C., Kouris, A., Rigopoulos, D., & Douzenis, A. (2017). Psychopathology and alexithymia in patients with psoriasis. Anais Brazileiros De Dermatologia, 92(4), 510–515. https://doi.org/10.1590/abd1806-4841.20175660.
Krueger, G., Koo, J., Lebwohl, M., Menter, A., Stern, R. S., & Rolstad, T. (2001). The impact of psoriasis on quality of life. Results of a 1198 national psoriasis foundation patient-membership survey. Archives of Dermatology, 137, 280–284.
Kurd, S. K., Troxel., A. B., Crits-Christoph, P., & Gelfand, J. M. (2010). The risk of depression, anxiety and suicidality in patients with psoriasis. Archives of Dermatology, 146, 891–895. https://doi.org/10.1001/archdermatol.2010.186.
Lakshmy, S., Balasundaram, S., Sarkar, S., Audhya, M., & Subramaniam, E. (2015). A cross-sectional study of prevalence and implications of depression and anxiety in psoriasis. Indian Journal of Psychological Medicine, 37(4), 434–440. https://doi.org/10.4103/0253-7176.168587.
Lakuta, P., Marcinkiewicz, K., Bergler-Czop, B., & Brzezinska-Wcislo, L. (2016). The relationship between psoriasis and depression: A multiple mediation model. Body Image, 19, 126–132. https://doi.org/10.1016/j.bodyim.2016.08.004.
Lakuta, P., Marcinkiewicz, K., Bergler-Czop, B., Brzezinska-Wcislo, L., & Stomian, A. (2018). Associations between site of skin lesions and depression, social anxiety, body-related emotions and feelings of stigmatisation in psoriasis patients. Advances in Dermatology and Allergology, 1, 60–66. https://doi.org/10.5114/pdia.2016.62287.
Lamb, R. C., Matcham, M. A., Turner, M. A., Rayner, L., Simpson, A., Hotopf, M., … Smith, C. H. (2017). Screening for anxiety and depression in people with psoriasis: A cross sectional study in a tertiary referral setting. British Journal of Dermatology, 176, 1028–1034. https://doi.org/10.1111/bjd.14833.
Lambert, J., Bostoen, J., Geusens, B., Bourgois, J., Boone, J., De Smedt, D., & Annemans, L. (2011). A novel multidisciplinary educational programme for patients with chronic skin diseases: Ghent pilot project and first results. Archives of Dermatology Research, 303, 57–63. https://doi.org/10.1007/s00403-010-1082-z.
Larsen, M. H., Krogstad, A. L., & Wahl, A. K. (2017). Alexithymia, illness perception and self-management competency in Psoriasis. Acta Dermato-Venereologica, 97(8), 934–940. https://doi.org/10.2340/00015555-2707.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.
Leary, M. R., Rapp, S. R., Herbst, K. C., Exum, M. L., & Feldman, S. R. (1998). Interpersonal concerns and psychological difficulties of psoriasis patients: Effects of disease severity and fear of negative evaluation. Health Psychology, 17, 530–536. https://doi.org/10.1037/0278-6133.17.6.530.
Lesner, K., Reich, A., Szepietowski, J. C., Dalgard, F. J., Gieler, U., Tomas-Aragones, L., … Kupfer, J. (2017). Determinants of psychosocial health in psoriasis patients; a multinational study. Acta Dermato-Venereologica, 97(10), 1182–1188. https://doi.org/10.2340/00015555-2760.
Leventhal, H., Leventhal, E. A., & Cameron, L. (2001). Representations, procedures, and affect in illness self-regulation: A perceptual-cognitive model. In A. Baum, T. A. Revenson & J. E. Singer (Eds.), Health psychology (pp. 19–47). New Jersey: Lawrence Erlbaum Associates.
Lindegard, B. (1986). Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. Dermatologica, 172, 298–304.
Luminet, O., Cordovil de Sousa Uva, M., Fantini, C., & de Timary, P. (2016). The association between depression and craving in alcohol dependency is moderated by gender and by alexithymia factors. Psychiatry Research, 239, 28–38. https://doi.org/10.1016/j.psychres.2016.02.062.
Luminet, O., Zech, E., Rime, B., & Wagner, H. (2000). Predicting cognitive and social consequences of emotional episodes: The contribution of emotional intensity, the five factor model and alexithymia. Journal of Research in Personality, 34, 471–497. https://doi.org/10.1006/jrpe.2000.2286.
Maes, S., Leventhal, H., & de Ridder, D. T. D. (1996). Coping with chronic illness. In M. Zeidner, & N. S. Endler (Eds.), Handbook of coping: Theory, research, applications (pp. 221–252). New York: Willey.
McAleer, M. A., Mason, D. L., Cummingham, S., O’Shea, S. J., McCormick, P. A., Stone, C., & Kirby, B. (2011). Alcohol misuse in patients with psoriasis: Identification and relationship to disease severity and psychological distress. British Journal of Dermatology, 164, 1256–1261. https://doi.org/10.1111/j.1365-2133.2011.10345.x.
McDonough, E., Ayearst, R., Eder, L., Chandran, V., Rosen, C. F., Thavaneswaran, A., & Gladman, D. D. (2014). Depression and anxiety in psoriatic disease: Prevalence and associated factors. Journal of Rheumatology, 41(5), 887–896. https://doi.org/10.3899/jrheum.130797.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovek, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research Therapy, 28, 487–495.
Mizara, A., Papadopoulos, L., & McBride, S. R. (2012). Core beliefs and psychological distress in patients with psoriasis and atopic eczema attending secondary care: The role of schemas in chronic skin disease. British Journal of Dermatology, 166(5), 986–993. https://doi.org/10.1111/j.1365-2133.2011.10799.x.
Molina, S., & Borkovek, T. D. (1994). The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. In G. G. L. Davey & F. Tallis (Eds.), Worrying: Perspectives on theory, assessment and treatment (pp. 265–283). Chichester: Wiley.
Nichol, M. B., Margolies, J. E., Lippa, E., Rowe, M., & Quell, J. (1996). The application of multiple quality of life instruments in individual with mild-to-moderate psoriasis. Pharmacoeconomics, 10, 644–653.
Niemeier, V., Nippesen, M., Kupfer, J., Schill, W.-B., & Gieler, U. (2002). Psychological factors associated with hand dermatoses: Which subgroup needs psychological care? British Journal of Dermatology, 146, 1031–1037.
Papadopoulos, L., & Walker, C. (2003). Understanding skin problems: Acne, eczema, psoriasis and related conditions. Chistester: Willey.
Parisi, R., Symmons, D. P., Griffiths, C. E., Ashcroft, D. M., & Identification and management of Psoriasis and Associated Comorbidity (IMPACT) Project Team. (2013). Global epidemiology of psoriasis: A systematic review of incidence and prevalence. Journal of Investigative Dermatology, 133, 377–385. https://doi.org/10.1038/jid.2012.339.
Parker, G., & Brotchie, H. (2010). Gender differences in depression. International Review Psychiatry, 22, 429–436.
Picardi, A., Abeni, D., Melchi, C. F., Puddu, P., & Pasquini, P. (2000). Psychiatric morbidity in dermatological outpatients: An issue to be recognized. British Journal of Dermatology, 143, 983–991. https://doi.org/10.1046/j.1365-2133.2000.03831.x.
Picardi, A., Abeni, D., Renzi, C., Braga, M., Puddu, P., & Pasquini, P. (2001). Increased psychiatric morbidity in female outpatients with skin lesion on visible parts of the body. Acta Dermatolo-Venereologica, 81, 410–414. https://doi.org/10.1080/000155501317208345.
Picardi, A., Mazzoti, E., Gaetano, P., Cattaruzza, M. S., Baliva, G., Melchi, C. F., & Pasquini, P. (2005). Stress, social support, emotional regulation and exacerbation of diffuse plaque psoriasis. Psychosomatics, 46, 556–564. https://doi.org/10.1176/appi.psy.46.6.556.
Picardi, A., Mazzoti, E., & Pasquini, P. (2006). Prevalence and correlates of suicidal ideation among patients with skin disease. American Journal of Dermatology, 54, 420–426. https://doi.org/10.1016/j.jaad.2005.11.1103.
Picardi, A., Pasquini, P., Cattaruzza, M. S., Gaetano, P., Baliva, G., Melchi, C. F., … Biondi, M. (2003a). Only limited support for a role of psychosomatic factors in psoriasis. Results from a case-control study. Journal of Psychosomatic Research, 55, 189–196. https://doi.org/10.1016/S0022-3999(02)00574-3.
Picardi, A., Pasqioni, P., Cattaruzza, M. S., Gaetano, P., Melchi, C. F., Baliva, G., … Biondi, M. (2003b). Stressful life events, social support, attachment and alexithymia in vitiligo. Psychotherapy and Psychosomatics, 73, 150–158. https://doi.org/10.1159/000069731.
Picardi, A., Porcelli, P., Mazzoti, E., Fassone, G., Lega, I., Ramieri, L., … Pasquini, P. (2007). Alexithymia and global psychosocial functioning: A study on patients with skin disease. Journal of Psychosomatic Research, 62, 223–229. https://doi.org/10.1016/j.jpsychores.2006.09.002.
Pietrzak, A., Jastrzebaska, I., Chodorowska, G., Maciejewski, R., Mosiewicz, J., Krupski, W., & Herogova, J. (2011). Psoriasis and unreported excessive alcohol intake, a simple screening approach. Journal of European Dermatology and Venereology, 25, 1261–1268. https://doi.org/10.1111/j.1468-3083.2011.04101.x.
Poikolainen, K., Reunala, T., & Karvonen, J. (1994). Smoking, alcohol and life events related to psoriasis among women. British Journal of Dermatology, 130, 437–477. https://doi.org/10.1111/j.1365-2133.1994.tb03380.x.
Poikolainen, K., Reunala, T., Karvonen, J., Lauharanta, J., & Karkainen, P. (1990). Alcohol intake: A risk factor for young and middle aged men? British Medical Journal, 300, 780–783.
Pompili, M., Innamorati, M., Trovarelli, S., Narcisi, A., Bellini, S., Orsini, D., … Costanzo, A. (2016). Suicide risk and psychiatric comorbidity in patients with psoriasis. Journal of International Medical Research, 44(1), 61–66. https://doi.org/10.1177/0300060515593253.
Porter, J. R., Beuf, A. H., & Lerner, A. (1986). Psychosocial effects of vitiligo: A comparison with ‘normal’ control subjects, with psoriasis patients, and with patients with other pigmentary disorders. Journal of American Academy of Dematology, 15, 220–224.
Qureshi, A., Dominquez, P. L., Choi, H., Han, J., & Curhan, G. (2010). Alcohol intake and risk of incident psoriasis in US women: A prospective study. Archives of Dermatology, 146, 1364–1369. https://doi.org/10.1001/archdermatol.2010.204.
Ramsay, B., & O’Reagan, O. (1988). A survey of the social and psychological effects of psoriasis. British Journal of Dermatology, 118, 195–201. https://doi.org/10.1111/j.1365-2133.1988.tb01774.x.
Rapp, S. R., Cottrell, C. A., & Leary, M. R. (2001). Coping strategies associated with quality of life decrements among psoriasis patients. British Journal of Dermatology, 145, 610–616. https://doi.org/10.1046/j.1365-2133.2001.04444.x.
Rapp, S. R., Feldman, S. R., Exum, L., Fleischer, A. B., & Rebousin, D. M. (1999). Psoriasis causes as much disability as other major medical diseases. Journal of American Academy of Dermatology, 41, 401–407. https://doi.org/10.1016/S0190-9622(99)70112-x.
Reinert, D. F., & Allen, J. P. (2007). The alcohol use disorders identification test: An update of research findings. Alcoholism: Clinical and Experimental Research, 31, 185–199. https://doi.org/10.1111/j.1530-0277.2006.00295.x.
Renzi, C., Picardi, A., Abeni, D., Agostini, E., Baliva, G., Pasquini, P., & Braga, M. (2002). Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. Archives of Dermatology, 138, 337–342.
Richards, H. L., & Fortune, D. G. (2006). Psychological distress and adherence in patients with psoriasis. European Academy of Dermatology and Venereology, 20, 33–41. https://doi.org/10.1111/j.1468-3083.2006.01912.x.
Richards, H. L., Fortune, D. G., Chong, S. L., Mason, D. L., Sweeney, S. K., Main, C. J., & Griffiths, C. E. (2004). Divergent beliefs about psoriasis are associated with increased psychological distress. Journal of Investigative Dermatology, 123, 49–56.
Richards, H. L., Fortune, D. G., Griffiths, C. E. M., & Main, C. (2001). The contribution of perceptions of stigmatisation to disability in patients with psoriasis. Journal of Psychosomatic Research, 50, 11–15. https://doi.org/10.1016/S0022-3999(00)00210-5.
Richards, H. L., Fortune, D. G., Griffiths, C. E. M., & Main, C. (2005). Alexithymia in patients with psoriasis: Clinical correlates and psychometric properties of the Toronto Alexithymia Scale-20. Journal of Psychosomatic Research, 58, 89–96. https://doi.org/10.1016/j.jpsychores.2004.03.009.
Rodgers, B., Korten, A. E., Jorm, A. F., Jacomb, P. A., Christensen, H., & Henderson, A. S. (2000). Non-linear relationships in associations of depression and anxiety with alcohol use. Psychological Medicine, 30, 421–432.
Root, S., Kent, G., & Al-Abadie, M. S. (1994). The relationship between disease severity, disability and psychological distress in patients undergoing PUVA treatment for psoriasis. Dermatology, 189, 234–237. https://doi.org/10.1159/000246844.
Russo, P. A., Ilchef, R., & Cooper, A. J. (2004). Psychiatric morbidity in psoriasis: A review. Australian Journal of Dermatology, 45, 155–159. https://doi.org/10.1111/j.1440-0960.2004.00078.x.
Ryan, C., Sadlier, M., De Vol, E., Patel, M., Lloyd, A. A., Day, A., … Menter, A. (2015). Genital psoriasis is associated with significant impairment in quality of life and sexual functioning. Journal of the American Academy of Dermatology, 72, 978–983. https://doi.org/10.1016/j.jaad.2015.02.1127.
Sampogna, F., Chren, M. M., Melchi, C. F., Pasquini, P., Tabolli, S., Abeni, D., & The Italian Multipurpose Psoriasis Research on Vital Experiences (improve) Study Group. (2006). Age, gender, quality of life and psychological distress in patients hospitalized with psoriasis. British Journal of Dermatology, 154, 325–331. https://doi.org/10.1111/j.1365-2133.2005.06909.x.
Sampogna, F., Puig, L., Spuls, P., Girolomoni, G., Radtke, M. A., Kirby, B., … EPIDEPSO Investigators. (2017). Prevalence of alexithymia in patients with psoriasis and its association with disease burden; a multicentre observational study. British Journal of Dermatology, 176(5), 1195–1203. https://doi.org/10.1111/bjd.15243.
Sampogna, F., Tabolli, S., & Abeni, D. (2007). The impact of changes in clinical severity on psychiatric morbidity in patients with psoriasis: A follow-up study. British Journal of Dermatology, 157, 508–513. https://doi.org/10.1111/j.1365-2133.2007.08071.x.
Saunders, J. B., Aasland, O. G., Babor, T. F., De la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO Collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88, 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x.
Scharloo, M., Kaptein, A. A., Weinman, J., Bergman, W., Vermeer, B. J., & Rooijmans, H. G. M. (2000). Patients’ illness perceptions and coping as predictors of functional status in psoriasis: A 1-year follow up. British Journal of Dermatology, 142, 899–907. https://doi.org/10.1046/j.1365-2133.2000.03469.x.
Schmid-Ott, G., Schallmayer, S., & Calliess, I. T. (2007). Quality of life in patients with psoriasis and psoriasis arthritis with a special focus on stigmatisation experience. Clinical Dermatology, 25, 547–554.
Schmitt, J., & Ford, D. E. (2007a). Role of depression in quality of life for patients with psoriasis. Dermatology, 215, 17–25. https://doi.org/10.1159/000102029.
Schmitt, J., & Ford, D. (2007b). Understanding the relationship between objective disease severity, psoriatic symptoms, illness-related stress, health-related quality of life and depressive symptoms in patients with psoriasis—a structural equations modelling approach. General Hospital Psychiatry, 29, 134–140. https://doi.org/10.1016/j.genhosppsych.2006.12.004.
Schmitt, J., & Ford, D. E. (2010). Psoriasis is independently associated with psychiatric morbidity and adverse cardiovascular risk factors, but not with cardiovascular events in a population-based sample. Journal of European Academy of Dermatology and Venereology, 24, 885–892. https://doi.org/10.1111/j.1468-3083.2009.03537.x.
Singh, S., Taylor, C., Kornmehl, H., & Armstrong, A. W. (2017). Psoriasis and suicidality: A systematic review and meta-analysis. Journal of American Academy of Dermatology, 77(3), 425–440. https://doi.org/10.1016/j.jaad.2017.05.019.
Smith, K. E., & Fenske, N. A. (2000). Cutaneous manifestations of alcohol abuse. Journal of American Academy of Dermatology, 43, 1–16. https://doi.org/10.1067/mjd.2000.104512.
Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press.
Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (2003). The 20-item Toronto Alexithymia Scale. IV. Reliability and factorial validity in different languages and cultures. Journal of Psychosomatic Research, 55, 277–283. https://doi.org/10.1016/S0022-3999(02)00578-0.
Thompson, A. (2005). Coping with chronic skin conditions: Factors important in explaining individual variation in adjustment. In C. Walker & L. Papadopoulos (Eds.), Psychodermatology: The psychological impact of skin disorders (pp. 57–71). Cambridge: Cambridge University Press.
Tsai, T. F., Wang, T. S., Hung, S. T., Tsai, P. I. C., Schenkel, B., Zhang, M., & Tang, C. H. (2011). Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan. Journal of Dermatology Science, 63, 40–46. https://doi.org/10.1016/j.j.dermsci.2011.03.002.
Vladut, C. I., & Kallay, E. (2010). Psychosocial implications of psoriasis-theoretical review. Cognition, Brain, Behavior. An Interdisciplinary Journal, 14, 23–35.
Wahl, A. K., Gjengedal, E., & Hanestad, B. R. (2002). The bodily suffering of living with severe psoriasis: In depth interviews with 22 hospitalized patients with psoriasis. Qualitative Health Research, 12(2), 250–261. https://doi.org/10.1177/104973202129119874.
Wojtuna, E., Lakuta, P., Marcinkiewicz, K., Bergler-Czop, B., & Brzezinska-Wcislo, L. (2017). Gender, body image and social support: Biopsychosocial determinants of depression among patients with psoriasis. Acta Dermato-Venereologica, 97, 91–97. https://doi.org/10.2340/00015555-2483.
Wu, J. J., Feldman, R., Koo, J., & Marangell, B. (2017). Epidemiology of psoriasis. Journal of Dermatological Treatment, 10, 1–9. https://doi.org/10.1080/09546634.2017.1395800.
Wu, S., Cho, E., Li, W. Q., Han, J., & Qureshi, A. A. (2015). Alcohol Intake and risk of psoriatic arthritis in women. Journal of Rheumatology, 42(5), 835–840. https://doi.org/10.3899/jrheum.140808.
Yang, Y., Koh, D., Khoo, L., Nyunt, S. Z., Ng, V., & Goh, C. L. (2005). The psoriasis disability index in Chinese patients: Contribution of clinical and psychological variables. International Journal of Dermatology, 44, 925–929. https://doi.org/10.1111/j.1365-4632.2004.02237.x.
Zachariae, R., Zachariae, H., Blomqvist, K., Davidsson, S., Molin, L., Mork, C., & Sigurgeirsson, B. (2004). Self reported stress reactivity and psoriasis-related stress of Nordic psoriasis sufferers. European Academy of Dermatology and Venereology, 18, 27–36. https://doi.org/10.1111/j.1468-3083.2004.00721.x.
Zieciak, T., Rzepa, T., Krol, J., & Zaba, R. (2017). Feelings of stigmatization and depressive symptoms in psoriasis patients. Psychitria Polska, 51(6), 1153–1163. https://doi.org/10.12740/pp/68848.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Ourania Founta, Karoline Adamzik, Anne-Marie Tobin, Brian Kirby and David Hevey declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Founta, O., Adamzik, K., Tobin, AM. et al. Psychological Distress, Alexithymia and Alcohol Misuse in Patients with Psoriasis: A Cross-Sectional Study. J Clin Psychol Med Settings 26, 200–219 (2019). https://doi.org/10.1007/s10880-018-9580-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-018-9580-9