Relationship between Depression and Quality of Life in Patients with Psoriasis from Tijuana, Mexico

Research Article

J Fam Med. 2021; 8(3): 1251.

Relationship between Depression and Quality of Life in Patients with Psoriasis from Tijuana, Mexico

Angulo-Felix GC¹*, Bermudez-Villalpando VI¹ and Flores-Madrigal NL²

¹Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, Mexico

²Department of Dermatology, Regional General Hospital #20 (IMSS), Baja California Delegation, Mexico

*Corresponding author: Angulo-Felix Grecia Carolina, Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, México

Received: January 25, 2021; Accepted: April 19, 2021; Published: April 26, 2021

Abstract

Background: According to the World Health Organization (WHO), the world prevalence of psoriasis is between 0.9-11.4 % according to the geographical area, in Mexico the prevalence is 2%; the frequency is higher in the Caucasian population, this disease can appear at any age but is more common in the 50- 69 age group. The affectations of the physical, mental and social areas are frequent in this disease.

Aim: The purpose of this study is to know the relationship between depression and quality of life in patients with psoriasis from the family medicine unit #27 (FMU 27).

Design and Setting: Analytic cross-sectional study.

Methods: An analytical cross-sectional study was carried out in patients with psoriasis older than 18 years. Quality of life was measured using the Dermatology Life Quality Index (DLQI) questionnaire and depression using the Hamilton scale. The data was analyzed using the SPSS version 21; the chi-square test was used to determine the association between qualitative variables, the Shapiro-Wilk test was applied for data distribution and correlation using the Spearman test.

Results: 59.3% of the patients have an alteration in the quality of life, 85.2% with depression and a positive correlation between DLQI and Hamilton score.

Conclusion: There is a high prevalence of alterations in quality of life in patients with psoriasis and a high prevalence of depression; The impact on the quality of life is correlated with depression.

Keywords: Psoriasis; Depression; Quality of life

Introduction

Psoriasis is an immune-mediated and genetic disease that occurs in the skin, joints or both [1]. There are different types of psoriasis that vary according to the location and type of lesions, psoriasis vulgaris is the most common presentation where the lesions are well-defined, erythematous and pruritic plaques, the most frequent location is on the trunk, the extensor surfaces of the limbs and skull [2]. Among the triggers of psoriasis are physical or chemical trauma, bacterial infections, mycotic infections, viral infections, smoking, alcoholism and some medications such as systemic corticosteroids, chloroquine, angiotensin converting enzyme inhibitors. One of the best known and little studied factors that is related to the exacerbation of the disease is emotional stress [3].

The WHO defines health as a complete state of physical, mental and social well-being, and not only the absence of diseases or illnesses [4]. For this reason, the adequate quality of life (QoL) of a person is based on reaching that goal or at least being closer to that definition since they are related concepts. In psoriasis there are many questionnaires that evaluate QoL in a patient, the Dermatology Life Quality Index (DLQI) is one of the most widely used [5]. Just as the QoL is affected in the development of Psoriasis, a highly prevalent psychiatric illness in these patients is depression. One of the most widely used instruments to assess the presence of depression is the Hamilton Scale, with a a-Cronbach of 0.7 [6].

It is estimated that the worldwide prevalence of psoriasis is between 0.9-11.4% depending on the geographical area, it is higher in the Caucasian population as in Norway, this disease affects any age, but it is more common in the group of 50 to 69 years. In Mexico, according to the psoriasis clinical practice guide, the prevalence is 2% [7]. Studies of the association between psoriasis and QoL are limited, in Latin America 30% of patients with psoriasis had a mild effect on QoL, 26% a moderate effect and 21% a severe effect [8]. In Mexico there are not many studies that carry out this association, in the city of Puebla, the prevalence was 57% in men and 43% in women with an average age of 51 years, the DLQI was used as an instrument to measure the affectation of quality of life, a higher prevalence of moderate impact on quality of life was found in 33%, 29% small effect, 18% without impact, 16% large effect and only 2.8% very serious effect [9]. In the United Kingdom, a study was carried out in which depression and quality of life were correlated, finding a prevalence of depression of 39%, increasing these percentages according to the severity of the disease in a total of 146,042 patients with psoriasis [10]. The objective of the research was to determine the relationship between depression and quality of life in patients with psoriasis in a primary care center in Tijuana, Mexico.

Material and Methods

Study design and population

An analytical cross-sectional study was carried out at FMU 27 of the Instituto Mexicano del Seguro Social (IMSS), in Tijuana, Baja California, Mexico between January and February 2020. Patients with diagnosis of psoriasis older than 18 years who agreed to participate in the study using informed consent, those with neurological pathology or any condition that prevented compression of the instrument were excluded.

Variables

The collection of variables was done with a standardized data form, the variables were the following: age, sex, occupation and marital status, which were collected directly from the patients. Quality of life was evaluated using the DLQI test, which was validated with a cronbach's alpha of 0.83, it consists of 10 questions, and each item has 4 possible answers according to the Likert scale, taking as a cut-off point a score of 10 to classify the affectation [11]. The diagnosis of depression was made with the Hamilton depression scale, which has 17 items, it has a Cronbach's alpha of 0.7 and the patient was classified according to the score obtained [6].

Statistical analysis

Qualitative variables were expressed in frequencies and percentages, the chi-square test was used to determine the association between dichotomous variables. The quantitative variables as mean and standard deviation; Spearman's correlation test was used to establish correlation between two quantitative variables and the data were analyzed using the SPSS version 21 program, a p-value <0.05 was considered significant.

Results

The study analyzed 27 psoriasis patients with a mean age of 36 years of which 22 are active workers. The predominant sex was female and the marital status was found in its 3 options in almost the same proportion, 37% married, 37% single and 25.9% divorced. We evaluated the quality of life in patients with psoriasis by applying the DLQI (Graphic 1), 59.3% (n=16) had an alteration in the quality of life based on the index obtained, the category of greatest affectation was the area of symptoms and feelings with an average score of 3.7 (maximum 6).