Background & Objectives
 ■ Psoriasis (PsO) is an inflammatory skin disease associated with a variety of psychiatric comorbidities 

such as anxiety and depression. 
 ■ Psychiatric comorbidities are associated with higher healthcare resource utilization and costs in PsO 

patients.1 
 ■ This study aimed to evaluate trends in the prevalence of psychiatric comorbid conditions for patients 

with moderate-to-severe PsO in a commercially-insured US population.

Methods
Study Design and Data Sources

 ■ This was a retrospective, cross-sectional study among a commercially insured population in the US.
 ■ De-identified US administrative claims were extracted from the Truven Health MarketScan Commercial 

claims database in the calendar years of 2014, 2015 or 2016, respectively.

Figure 1. Patient Selection

Members 
≥18 years of age
with continuous 

enrollment
(N=19,343,284)

Patients with ≥1 
medical claim with 
a diagnosis of PsO

(n=148,774)

Patients with ≥1 PsO
diagnosis plus ≥1

systemic or biologic
PsO medication

(n=22,999) 

2014 Members 
≥18 years of age
with continuous 

enrollment
(N=14,749,130)

Patients with ≥1 
medical claim with a

diagnosis of PsO
(n=119,136)

Patients with ≥1 PsO
diagnosis plus ≥1 

systemic or biologic 
PsO medication

(n=27,300) 

2015 Members 
≥18 years of age
with continuous 

enrollment
(N=14,716,660)

Patients with ≥1 
medical claim with 
a diagnosis of PsO

(n=122,143)

Patients with ≥1 PsO
diagnosis plus ≥1 

systemic or biologic 
PsO medication

(n=30,380) 

2016

Study Cohorts
 ■ Moderate to severe PsO cohort: Patients with ≥1 PsO diagnosis and ≥1 prescribed systemic or biologic 

PsO medication were selected in each calendar year (2014, 2015 or 2016).
 ■ Non-PsO (control) cohort: Members with no diagnosis of PsO, or disorders similar to PsO, were 

randomly selected from 2014-2016 and matched to PsO patients in a 1:1 ratio on age, gender, health 
plan type and region.

Study Measures
 ■ The number of patients with the following psychiatric comorbidities were described in each calendar year 

 — Anxiety and/or depression: ≥1 diagnosis of anxiety or depression
 — Treated anxiety and/or depression: ≥1 diagnosis of anxiety or depression plus a prescription for 

anxiolytics, antipsychotics, or antidepressants filled within ±30 days of diagnosis
• Treated major depressive disorder (MDD) - a subset of treated anxiety and/or depression:  

≥1 MDD diagnosis
 — Untreated anxiety and/or depression: ≥1 diagnosis of anxiety or depression but without a 

prescription for any of the above pharmacotherapies filled during each calendar year 
 — Other psychiatric conditions: bipolar disorder, dementia, schizophrenic disorder, substance abuse 

disorder, and suicidal ideation 

Statistical Analysis
 ■ Differences between the two study cohorts, across the 3 years respectively, were assessed for 

statistical significance using the t-test for continuous variables, and chi-square or Fisher's exact test 
for categorical variables. 

 ■ All statistical analyses were conducted using SAS Enterprise Guide 7 (SAS Institute Inc.;  
Cary, NC).

Results
Demographic Characteristics 

 ■ A total of 29,999 patients with moderate to severe PsO in 2014, 27,300 patients in 2015, and 30,380 
patients in 2016 were selected. 

 ■ Demographic characteristics were similar between patients with moderate-to-severe PsO and their 
matched controls, and were similar across cohorts from each of the 3 years included. 

 ■ The mean age of patients was 48 years for all cohorts; slightly more than half of the patients were 
males, the majority resided in the South or West regions, and most patients were primarily covered 
by a PPO health plan (Table 1).

Table 1. Demographic Characteristics of the Study Patients
2014 2015 2016

Matched  
Moderate to 
Severe PsO

Matched 
Non-PsO

Matched  
Moderate to 
Severe PsO

Matched 
Non-PsO

Matched  
Moderate to 
Severe PsO

Matched 
Non-PsO

N patients 29,999 29,999 27,300 27,300 30,380 30,380

Age (mean, SD) 47.8 11.2 47.8 11.2 48.0 11.2 48.0 11.2 47.9 11.4 47.9 11.4

18-44 (n, %) 10,620 35.4% 10,620 35.4% 9,379 34.4% 9,379 34.4% 10,474 34.5% 10,474 34.5%

45-64 19,337 64.5% 19,337 64.5% 17,887 65.5% 17,887 65.5% 19,862 65.4% 19,862 65.4%

65+ 42 0.1% 42 0.1% 34 0.1% 34 0.1% 44 0.1% 44 0.1%

Gender (n, %)             

Male 15,853 52.8% 15,853 52.8% 14,153 51.8% 14,153 51.8% 15,697 51.7% 15,697 51.7%

Female 14,146 47.2% 14,146 47.2% 13,147 48.2% 13,147 48.2% 14,683 48.3% 14,683 48.3%

Region (n, %)             

Northeast 6,100 20.3% 6,100 20.3% 4,939 18.1% 4,939 18.1% 5,082 16.7% 5,082 16.7%

North central 5,884 19.6% 5,884 19.6% 5,340 19.6% 5,340 19.6% 5,903 19.4% 5,903 19.4%

South 12,850 42.8% 12,850 42.8% 13,248 48.5% 13,248 48.5% 15,229 50.1% 15,229 50.1%

West 4,264 14.2% 4,264 14.2% 3,708 13.6% 3,708 13.6% 4,062 13.4% 4,062 13.4%

Unknown 901 3.0% 901 3.0% 65 0.2% 65 0.2% 104 0.3% 104 0.3%

Commercial Plan Type (n, %)             

HMO 2,872 9.6% 2,872 9.6% 2,506 9.2% 2,506 9.2% 2,745 9.0% 2,745 9.0%

PPO 18,179 60.6% 18,179 60.6% 16,787 61.5% 16,787 61.5% 18,219 60.0% 18,219 60.0%

POS 1,725 5.8% 1,725 5.8% 1,923 7.0% 1,923 7.0% 2,026 6.7% 2,026 6.7%

CDHP/HDHP 4,408 14.7% 4,517 15.1% 4,593 16.8% 4,649 17.0% 5,621 18.5% 5,756 18.9%

Others* 1,089 3.6% 980 3.3% 1,139 4.2% 1,083 4.0% 1,375 4.5% 1,240 4.1%

Unknown 1,726 5.8% 1,726 5.8% 352 1.3% 352 1.3% 394 1.3% 394 1.3%

*Includes Comprehensive/Indemnity, EPO, missing or Unknown.

Clinical Characteristics [Figure 2]
 ■ Compared with matched controls, patients with moderate-to-severe PsO across each of the 3 years 

studied had a significantly higher overall burden of comorbidity, as measured by the Quan-Charlson 
Comorbidity index (all p<0.001).

 ■ The moderate-to-severe PsO cohort had a significantly higher percentage of patients with hypertension, 
hyperlipidemia, diabetes, obesity, and thyroid disease (all p<0.001).

 ■ Compared with matched controls, the moderate-to-severe PsO cohort also had a significantly higher 
percentage of patients with concomitant medication use, including opioids, antihypertensives and 
anticholinergics (all p<0.001), across the 3-year study period. 

Figure 2. Top Five Most Frequently Occurring Comorbid Conditions and Concomitant Medications 
Among Study Patients

35% 36%
37%

35% 35% 34%

15% 16% 16%
13%

16%
20%

13% 13% 14%

26% 27%
27% 27% 27% 27%

9% 10% 10%
7%

10%
12%

10% 11% 10%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

2014 2015 2016 2014 2015 2016 2014 2015 2016 2014 2015 2016 2014 2015 2016

2014 2015 2016 2014 2015 2016 2014 2015 2016 2014 2015 2016 2014 2015 2016

Matched Moderate to Severe PsO Matched Non-PsO

Matched Moderate to Severe PsO Matched Non-PsO

Hypertension Hyperlipidemia Diabetes Obesity Thyroid Disease

35.30% 36.3%
37.0%

34.6% 34.9% 34.2%

15.4% 15.7% 15.7%
12.9%

16.0%
19.5%

13.0% 13.5% 13.7%

25.70% 27.0%
27.2% 26.7% 27.3% 26.6%

9.2% 9.8% 10.1%
7.4%

9.7%
11.9%

9.6% 10.5% 10.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%
Opioids Respiratory medication Antihypertensives Anticholinergics Antihyperlipidemics

Prevalence of Anxiety and/or Depression [Figure 3]
 ■ The prevalence of patients with an anxiety and/or a depression diagnosis among moderate to severe 

PsO patients increased from 18.3% in 2014 to 19.7% in 2016, as compared with 12.2% (p<0.001) 
in 2014 and 13.1% (p<0.001) in 2016 for matched controls.

 ■ Similarly, the prevalence of treated anxiety and/or depression among moderate to severe PsO patients 
increased from 14.5% in 2014 to 15.9% in 2016, as compared with 9.0% (p<0.001) in 2014 and 
9.7% (p<0.001) in 2016 for matched controls.

 — The prevalence of treated MDD among moderate to severe PsO patients increased from 3.4% in 
2014 to 8.6% in 2016, as compared with 2.0% (p<0.001) in 2014 and 2.9% (p<0.001) in 2016 
for matched controls.

 ■ The percentage of patients with untreated anxiety and/or depression was about 2-3% for both cohorts 
across the 3-year study period.

Figure 3. Prevalence of Anxiety and/or Depression Among Study Patients

 

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

2014 2015 2016

Treated Anxiety/Depression

Matched Moderate to Severe PsO Matched Non-PsO

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

2014 2015 2016

Untreated Anxiety/Depression

Matched Moderate to Severe PsO Matched Non-PsO

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

2014 2015 2016

Anxiety/Depression Diagnosis

Matched Moderate to Severe PsO Matched Non-PsO

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

2014 2015 2016

Treated MDD

Matched Moderate to Severe PsO Matched Non-PsO

Prevalence of Other Psychiatric Conditions [Table 2]
 ■ Across the 3-year study period, a significantly higher percentage of patients with moderate-to-severe 

PsO had bipolar or substance abuse disorders compared with controls (all p<0.001).
 ■ No substantial difference in the prevalence of dementia, schizophrenic disorders, and suicidal ideation 

was observed between the two cohorts over the 3-year study period.

Table 2. Prevalence of Other Psychiatric Conditions Among Study Patients
2014 2015 2016

Matched 
Moderate 
to Severe 

PsO
Matched 
Non-PsO p-value

Matched 
Moderate 
to Severe 

PsO
Matched 
Non-PsO p-value

Matched 
Moderate 
to Severe 

PsO
Matched 
Non-PsO p-value

n=29,999 n=29,999 n=27,300 n=27,300 n=30,380 n=30,380

Bipolar Disorders 1.4% 0.7% <.001 1.4% 0.8% <.001 1.3% 0.8% <.001

Dementia 0.1% 0.1% 0.527 0.1% 0.1% 0.647 0.1% 0.1% 1.000

Schizophrenic/Delusional 
Disorders

0.1% 0.1% 0.808 0.1% 0.1% 0.805 0.1% 0.1% 0.622

Substance Abuse Disorder 7.5% 4.8% <.001 7.9% 5.0% <.001 7.3% 4.5% <.001

Suicidal Ideation 0.2% 0.1% 0.058 0.2% 0.1% 0.035 0.3% 0.2% 0.011

Limitations
 ■ Administrative claims data were collected for facilitating payment for healthcare services; therefore, 

definitive diagnoses are not available and the true prevalence of treated anxiety and/or depression 
may be underestimated.

 ■ The study was composed of patients covered by commercial insurance; therefore, the results may 
not be generalizable to PsO patients with other or no insurance coverage.

Conclusions
 ■ The prevalence of anxiety and/or depression was significantly higher among patients with moderate-

to-severe PsO compared with matched controls without PsO over the period spanning 2014-2016.
 ■ The prevalence of MDD among patients with moderate-to-severe PsO more than doubled over the 

years 2014-2016.
 ■ Compared with matched controls, the moderate-to-severe PsO cohort had a significantly higher 

percentage of patients with concomitant medication use, including opioids, antihypertensives and 
anticholinergics. 

 ■ These findings suggest that PsO, as a systemic disease, is associated with higher rates of comorbid 
psychiatric disorders, such as anxiety and depression than for patients without PsO.

 ■ While further research is needed, PsO treatments that improve psychiatric symptoms, such as anxiety 
and depression, may provide additional incremental benefit to patients and the healthcare system.

REFERENCE
1. Feldman SR, Tian H, Gilloteau I, et al. BMC Health Serv Res. 2017; 17: 337.

This study was supported by Janssen Scientific Affairs, LLC.

Trends in Prevalence of Psychiatric Comorbidities among Patients with Moderate to Severe Psoriasis
Q. Cai, MS, MSPH1; A. Teeple, PharmD1; B. Wu, MS1; S. Shrivastava, BEng2; E. Muser, PharmD, MPH1
1Janssen Scientific Affairs, Titusville, NJ; 2Mu-Sigma, Bengaluru, India