Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2024;14(4):e2024256 1 Psoriasis Is Associated With Increased Risk of Psychiatric Disorders and Sexual Dysfunction in a Case-Control Study of 29,912 Patients Priya Marella1, Shari R. Lipner2 1 New Jersey Institute of Technology, Newark, New Jersey 2 Department of Dermatology, Weill Cornell Medicine, New York, New York Key words: Comorbidities, Psoriasis, Psychiatric disorders, Risk factors, Skin disease Citation: Marella P, Lipner SR. Psoriasis Is Associated With Increased Risk of Psychiatric Disorders and Sexual Dysfunction in a Case-Control Study of 29,912 Patients. Dermatol Pract Concept. 2024;14(4):e2024256. DOI: https://doi.org/10.5826/dpc.1404a256 Accepted: May 15, 2024; Published: October 2024 Copyright: ©2024 Marella et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Shari R. Lipner, MD, PhD, Department of Dermatology, Weill Cornell Medicine, 1305 York Ave, New York, NY 10021. Phone: (646) 962-3376. E-mail: shl9032@med.cornell.edu Introduction Psoriasis is a chronic skin condition that may significantly impact patients’ quality of life and mental health [1]. It has been suggested that psoriasis is associated with psychiatric disorders, but this has been relatively understudied. There- fore, we aimed to explore potential associations between psoriasis and psychiatric disorders by conducting a nested matched case-control study using a national database. Case Presentation The National Institute of Health All of Us database was queried 8/31/23–9/13/23 for psoriasis cases using Interna- tional Classification of Diseases (ICD) and Systematized Nomenclature of Medicine (SNOMED): ICD10CM-L40 and SNOMED 9014022, and controls (1:3) matched across age, sex, race, ethnicity, and smoking status. Comor- bidity frequencies of psoriasis and control patients were determined for anxiety (concept code: 441542), depressive disorder (concept code: 440383), mood disorder (concept code: 444100), sleep apnea (concept code: 313459), sexual dysfunction (concept code: 4237140), personality disorder (concept code: 441838), somatoform disorder (concept code: 435784), eating disorder (concept code: 439002), insomnia (concept code: 436962), bipolar disorder (concept code: 436665), substance abuse (concept code: 4279309), schizophrenia (concept code: 435783), and dermatomyositis (concept code: 80182). Dermatomyositis was used as a neg- ative control comorbidity with no difference across control and psoriasis patients (P>0.05). Wald’s test compared the two groups (P<0.05). There were 7,478 psoriasis cases, with mean age 61.5 years, with 59% females, 72.7% White and 7.6% Black patients, and 22,434 matched controls, with similar demographics be- tween groups (all P>0.05, Table S1). Psoriasis patients had in- creased prevalence of anxiety (48.5%, OR 3.72 [3.52–3.93]), depression (45.1%, OR 3.61 [3.41–3.82]), sleep apnea 2 Research Letter | Dermatol Pract Concept. 2024;14(4):e2024256 (31.6%, OR 3.27 [3.07–3.48]), sexual dysfunction (3.9%, OR 3.17 [2.68–3.74]), somatoform disorder (3.0%, OR 3.10 [2.57–3.74]), eating disorder (2.2%, OR 2.92 [2.36–3.62]), insomnia (26.0%, OR 2.79 [2.61–2.98]), and schizophrenia (1.7%, OR 2.17 [1.72–2.72]) (Table 1, Figure 1). Discussion Our study shows associations between psoriasis and psy- chiatric disorders, including depression, anxiety, and schizophrenia, which reinforces findings from previous stud- ies. For example, a meta-analysis of population-based stud- ies reported an association between psoriasis and depression (OR 1.57 [1.40–1.76]) [2], a meta-analysis of case-control studies showed a correlation between psoriasis and anxiety (OR 1.48 [1.18–1.85]) [3], and a meta-analysis of observa- tional studies reported an association between psoriasis and schizophrenia (OR 1.41 [1.19–1.66]) [4]. We also found associations between psoriasis, sleep disorders, sexual dysfunction, and somatoform disorder, Table 1. Psychiatric Comorbidity Frequency of Psoriasis vs Control Patients. Co-diagnoses, n (%) Psoriasis Patients (n=7478) Case Controls (n=22,434) Odds Ratio p-value Anxiety 3628 (48.5) 4536 (20.2) 3.72 [3.52-3.93] < 2.2 x 10^-16 Depressive Disorder 3375 (45.1) 4166 (18.6) 3.61 [3.41-3.82] < 2.2 x 10^-16 Mood Disorder 3533 (47.2) 4474 (19.9) 3.60 [3.40- 3.80] < 2.2 x 10^-16 Sleep Apnea 2365 (31.6) 2779 (12.4) 3.27 [3.07-3.48] < 2.2 x 10^-16 Sexual Dysfunction 289 (3.9) 281 (1.3) 3.17 [2.68-3.74] < 2.2 x 10^-16 Personality Disorder 316 (4.2) 312 (1.4) 3.13 [2.67-3.67] < 2.2 x 10^-16 Somatoform Disorder 225 (3.0) 222 (1.0) 3.10 [2.57-3.74] < 2.2 x 10^-16 Eating Disorder 165 (2.2) 172 (0.8) 2.92 [2.36-3.62] < 2.2 x 10^-16 Insomnia 1948 (26.0) 2517 (11.2) 2.79 [2.61-2.98] < 2.2 x 10^-16 Bipolar Disorder 600 (8.0) 724 (3.2) 2.62 [2.34-2.93] < 2.2 x 10^-16 Substance Abuse 927 (12.4) 1293 (5.8) 2.31 [2.12-2.53] < 2.2 x 10^-16 Schizophrenia 128 (1.7) 179 (0.8) 2.17 [1.72-2.72] < 2.2 x 10^-16 Dermatomyositis 23 (0.31) 52 (0.23) 1.33 [0.81-2.17] 0.13 Figure 1. Proportion of patients with psychiatric comorbidities compared across psoriasis and control patients. All P<0.05 except for dermatomyositis, which serves as a negative control and had no significant difference in proportion in psoriasis and control patients with this comorbidity (P>0.05). Research Letter | Dermatol Pract Concept. 2024;14(4):e2024256 3 corroborating prior studies. A meta-analysis of 390 studies reported that sleep disorders and sexual dysfunction were the most common psychiatric comorbidities in psoriasis pa- tients, affecting 50% and 71.3% of patients, respectively [5]. A 12-year population-based cohort study reported in- creased somatoform disorder prevalence in psoriasis patients (HR 1.60 [1.26–2.03]) [6]. Limitations include retrospective design, lack of dis- ease severity information, lack of control for confounding variables, including socioeconomic status, and potential miscoding. Conclusions Our study strengthens previously reported associations between psoriasis and psychiatric disorders. We recom- mend that dermatologists screen for psychiatric comorbid- ities in psoriasis patients, including for depression, anxiety, somatoform disorder, schizophrenia, and sexual dysfunction, using the Patient Health Questionnaire, Positive and Nega- tive Syndrome Scale, and Sexual Functioning Questionnaire, which would allow for referral to psychiatrists or urologists, respectively, for improved treatment outcomes. References 1. Kantor J. January 2021: Skin disease, sleep, and mental health. J Am Acad Dermatol. 2021;84(1):36. DOI:10.1016/j.jaad .2020.10.058. 2. Dowlatshahi EA, Wakkee M, Arends LR, Nijsten T. The preva- lence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J Invest Dermatol. 2014;134(6):1542-1551. DOI: 10.1038/jid.2013.508. 3. Jalenques I, Bourlot F, Martinez E, et al. 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