Epidemiology of Depression and Suicide Ideation in Patients With Psoriasis: A Meta-analysis of Prospective Cohort Studies

Objective: Psoriasis is an immune-mediated inflammatory, chronic, recurrent skin disease associated with a high risk of developing psychiatric disorders, especially depression and suicidal ideation, leading to functional disability and poor quality of life. This study was conducted to comprehensively review and assess the epidemiologic association between psoriasis and the risk ratios (RRs) of depression or suicidal ideation. Methods: Five databases (PubMed, Wanfang Database, CNKI, The Cochrane Library, and EMBASE) were searched for prospective cohort studies on the prevalence of depression and/or suicidal ideation in patients with psoriasis updated to February 2, 2023. Two independent reviewers evaluated and extracted the data, which were then pooled into a summary RR with corresponding 95% confidence interval (CI) using random-effects models. Results: Sixteen cohort studies comprising 1,166,840 patients with psoriasis and 3,294,205 controls were eligible for the final analysis. The pooled RR for depression was 1.43 (95% CI = 1.13–1.81) in patients with psoriasis and1.55 (95% CI = 1.40–1.71) in patients with psoriatic arthritis. In the subgroup analysis, Asian patients with psoriasis (RR = 1.38, 95% CI =1.17–1.63) had a lower pooled RR for depression than non-Asian patients (RR = 1.45, 95% CI = 1.07–1.97), and patients with moderate-to-severe psoriasis (RR = 1.69, 95% CI = 1.15–2.50) showed a higher RR for depression than patients with mild psoriasis (RR = 1.60, 95% CI = 1.06–2.42). We also found no increase in the RR for suicidal ideation among people with psoriasis (RR = 1.25, 95% CI = 0.95–1.65). Conclusion: Patients with psoriasis are at an increased risk of depression. Among patients with psoriasis, those with psoriatic arthritis, those who are non-Asian, and those with moderate-to-severe psoriasis are at higher risk for depression. However, the available evidence does not support an association between psoriasis and suicidal ideation.