Depression and anxiety in inflammatory skin diseases

La psychodermatologie témoigne des intrications multiples entre le système cutané et le système nerveux. Ces deux systèmes présentent en effet des liens très étroits, en particulier sur les plans clinique et physiopathologique. La littérature montre des résultats de prévalence des troubles dépressifs et anxieux chez les patients souffrant de dermatoses inflammatoires plus élevés qu’en population générale. Ils sont cependant très hétérogènes concernant certaines dermatoses et, pour la majorité d’entre eux, ne différencient pas les résultats concernant les troubles et les symptômes. Par ailleurs, le nombre limité d'études de certaines méta-analyses n'a pas permis d’obtenir un résultat avec une forte puissance. Il existe aussi peu de données sur l’identification des facteurs qui affectent les résultats de prévalence. Notre premier objectif est la réalisation d’une estimation groupée de la prévalence et des odds ratios des troubles et des symptômes de la dépression et de l’anxiété chez les patients atteints de quatre dermatoses inflammatoires. Nos études ont montré des résultats plus précis en distinguant les résultats concernant les troubles et les symptômes. Elles ont permis aussi d’analyser la relation entre les variations de la prévalence et les caractéristiques des études. L’une des dermatoses les plus fréquentes, le psoriasis, présente des symptômes physiques tels que le prurit, les douleurs cutanées et articulaires et la fatigue. En raison de ces symptômes, l'identification de la dépression est une réelle difficulté dans cette population car ils peuvent être liés à la maladie dermatologique comme à la dépression. Les auto-questionnaires psychiatriques sont très utilisés pour l'évaluation de la dépression dans la population générale car ils sont faciles à utiliser et permettent donc un dépistage rapide. Cependant, ces auto-questionnaires n'ont pas été validés dans le psoriasis. Certains items de dépression peuvent être cotés à cause des symptômes du psoriasis et surestimer le score de dépression. La présence de symptômes de psoriasis conduit à évaluer la nécessité d'ajuster la valeur seuil de ces échelles. Notre deuxième objectif est donc l’évaluation de la validité des auto-questionnaires de dépression les plus utilisés chez les patients atteints de psoriasis et la détermination de l’outil le mieux adapté. Nos résultats montrent la validité des différents auto-questionnaires dans cette population spécifique. Ils possèdent tous de bonnes propriétés psychométriques. Les seuils habituellement utilisés montrent une sensibilité/spécificité correctes mais pouvant être améliorées. Deux d’entre eux se distinguent par leur excellente sensibilité et l’un d’eux fonctionne de manière optimale à la valeur seuil habituelle. La meilleure prise en charge de ces comorbidités psychiatriques pourrait permettre un meilleur contrôle de la dépression et de l’anxiété, une meilleure observance des patients et une amélioration des symptômes dermatologiques. L’altération majeure de la qualité de vie et le rôle possible de l’inflammation chez les patients atteints de dermatoses peuvent être une explication de la dépression et de l’anxiété. Un approfondissement des connaissances de l’impact des cytokines sur les symptômes dépressifs et anxieux pourrait permettre d’ouvrir vers de nouvelles pistes thérapeutiques de la dépression et de l’anxiété chez les patients souffrant de dermatoses.Psychodermatology bears witness to the multiple interactions between the cutaneous system and the nervous system. These two systems are very closely linked, particularly at the clinical and pathophysiological levels. The literature shows that the prevalence of depressive and anxiety disorders in patients suffering from inflammatory dermatoses is higher than in the general population. However, results are very heterogeneous for certain dermatoses and for the majority of them, do not differentiate the results concerning disorders and symptoms. Furthermore, the limited number of studies in some of the meta-analyses did not allow a result with high power to be obtained. There is also little data on the identification of factors that affect prevalence results. Our first objective is to perform a pooled estimate of the prevalence and odds ratios of depression and anxiety disorders and symptoms in patients with four inflammatory dermatoses. Our studies showed more precise results by distinguishing prevalence of disorders and symptoms. They also allowed us to analyse the relationship between variations in prevalence and study characteristics. One of the most common dermatoses, psoriasis, has physical symptoms such as pruritus, skin and joint pain and fatigue. Because of these symptoms, identifying depression is a real difficulty in this population as they can be related to the dermatological disease as well as to depression. Psychiatric self-questionnaires are widely used for the assessment of depression in the general population as they are easy to use and therefore allow rapid screening. However, these self-questionnaires have not been validated in psoriasis. Some depression scales may be rated on the basis of psoriasis symptoms and may overestimate the depression score. The presence of psoriasis symptoms leads to an assessment of the need to adjust the cut-off value of these scales. Our second objective is to assess the validity of the most commonly used depression self-questionnaires in the psoriatic population and to determine the most appropriate tool. Our results show the validity of the different self-questionnaires in this specific population. They all have good psychometric properties. The commonly used cut-offs show a correct sensitivity/specificity but could be improved. Two of these self-questionnaires stand out for their excellent sensitivity, and one of them has an optimal functioning at the usual threshold value. Better management of these psychiatric comorbidities could lead to better control of depression and anxiety, better patient compliance and improvement of dermatological symptoms. The major impairment of quality of life and the possible role of inflammation in patients with dermatoses may be an explanation for depression and anxiety. A deeper understanding of the impact of cytokines on depressive and anxiety symptoms could open up new therapeutic avenues for depression and anxiety in patients with dermatoses

Health-related quality of life among community-dwelling people aged 80 years and over: a cross-sectional study in France.

International audienceThe proportion of people living to a very old age is continuously increasing. One of the possibilities explored in policies and services to meet this health and societal challenge is to encourage the very old to continue living at home. This initiative is in line with the wishes of most elderly people. However, owing to the great changes that occur during old age attention should be paid to health-related quality of life (HRQoL). The aims of this study were to assess HRQoL in French community-dwelling people aged 80 years and over and to investigate the sociodemographic and health characteristics and life events associated with HRQoL

The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: Systematic review and meta-analysis

International audienceHidradenitis suppurativa (HS) is a chronic inflammatory skin disorder. Previous studies have yielded divergent results on the prevalence of depression and anxiety in patients with HS

Prevalence and Odds of Signs of Depression and Anxiety in Patients with Lichen Planus: Systematic Review and Meta-analyses

International audienceThe association between certain chronic inflammatory skin diseases and psychiatric disorders or conditions has been well documented. However, the exact magnitude of the association between lichen planus and depression/anxiety symptoms and disorders is un-known. A systematic review and pooled meta-analyses were performed to examine the prevalence and odds of depression and anxiety in patients with lichen planus. The meta-analyses showed a high prevalence of signs of depression (27% [19-36%]) and anxiety (28% [21-36%]). The geographical location of the study may partly explain these vari-ations, but method-ological differences could also be involved. Case-control studies showed a strong association between lichen planus and signs of depression (odds ratio 3.79, 95% confidence interval [2.35; 6.12]) or anxiety (odds ratio 2.54, 95% confidence interval [1.73; 3.72]). These results raise the necessity of screening for the presence of depressive and anxiety symptoms or disorders in patients with lichen planus, and of referring such patients for psychiatric evaluation and appropriate treatment, if necessary

Prevalence and Odds of Depressive and Anxiety Disorders and Symptoms in Children and Adults With Alopecia Areata

Importance Two recent meta-analyses reported a high prevalence of both anxiety and depression in patients with alopecia areata (AA), as well as a positive association of AA with anxiety and depression, without distinguishing between disorders and symptoms. Yet, depression and anxiety can manifest either as symptoms identified in questionnaires or as specific diagnoses defined by Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria. Objective To perform a large meta-analysis separating the prevalence of depressive and anxiety disorders from that of depressive and anxiety symptoms in patients with AA. Data Sources PubMed, ScienceDirect, the Cochrane Library, Embase, and PsycINFO databases were searched from inception through August 1, 2020. Study Selection Studies that contained data on the prevalence of depressive or anxiety disorders or symptoms were included. Data Extraction and Synthesis The Meta-analysis of Observational Studies in Epidemiology ( MOOSE ) reporting guidelines were used. Pooled prevalence was calculated with a random effects model meta-analysis that took into account between- and within-study variability. Meta-regressions were used to study the association between variations in prevalence and study characteristics. Main Outcomes and Measures The prevalence of depressive and anxiety disorders and symptoms in patients with AA. Results Thirty-seven articles (29 on depression and 26 on anxiety) that met the inclusion criteria were identified. By distinguishing between disorders and symptoms, the prevalence of both depressive disorders (9%) and unspecified anxiety disorders (13%) in patients with AA was shown to be greater than that in the general population. The prevalence and odds ratio (OR) of depressive disorders (prevalence, 9%; OR, 1.38) and anxiety disorders of which each category had been specifically studied (prevalence, 7%-17%; OR, 1.51-1.69) were markedly lower than that of depressive symptoms (prevalence, 37%; OR, 2.70) and anxiety symptoms (prevalence, 34%; OR, 3.07). Meta-regressions showed that variations in prevalence were mainly associated with methodological differences between studies. Conclusions and Relevance In this systematic review and meta-analysis, the separate analyses showed that 7% to 17% of patients with AA had depressive or anxiety disorders that require psychiatric care, including specific medication. Additionally, more than one-third of patients had symptoms that are warning signs and that need monitoring because they can develop into disorders

Psychiatric symptomatology in skin-restricted lupus patients without axis I psychiatric disorders: A post-hoc analysis

Background Skin-restricted lupus is a chronic inflammatory disease associated with high rates of depression and anxiety disorders. Patients without psychiatric disorders can experience anxiety and depressive symptoms at a subclinical level, which could be risk factors for progression towards psychiatric disorders. It was decided, therefore, to investigate the presence of specific symptoms in skin-restricted lupus patients without axis I psychiatric disorders and their impact on the occurrence of axis I psychiatric disorders during the study follow-up. Methods Longitudinal data of 38 patients and 76 matched controls without active axis I psychiatric disorders from the LuPsy cohort were used. Depressive, neurovegetative, psychic and somatic anxiety symptom scores were established from the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating scale (HAMA). Results None of the participants had any current active axis I psychiatric disorders but the patients had personality disorders more frequently and had received more past psychotropic treatments than the controls. They also had higher MADRS and HAMA scores than the controls, in particular neurovegetative, psychic anxiety and somatic symptoms scores. No dermatological factor tested was associated with these scores, whereas being a lupus patient was associated with higher neurovegetative and somatic symptoms scores, having a current personality disorder with higher depressive and neurovegetative scores and receiving more past psychotropic treatments with psychic anxiety and somatic symptoms scores. The occurrence of psychiatric disorders during the study follow-up was associated with an elevated psychic anxiety score at baseline and past psychotropic treatment but not with history of psychiatric disorder. Limitations The LuPsy cohort included a large number of patients with axis I psychiatric disorders, the sample without axis I psychiatric disorders is therefore limited. Conclusions We observed numerous psychiatric symptoms among the skin-restricted lupus patients. They should therefore receive special attention in the management of their subclinical symptoms before they progress towards full psychiatric disorders

Agreement between self-, mother and father proxy-reports on health-related quality of life in adolescents with Tourette Syndrome

International audienceThis study aimed to investigate agreement and discrepancies between parent proxy- and adolescent self-reports on assessments of adolescents’ health-related quality of life (HRQoL), and the role that individual factors may play in parent-adolescent agreement, in a sample of adolescents with Tourette syndrome (TS) compared to a control group of healthy adolescents. Adolescents aged 12–18 years diagnosed with TS were recruited with their parents from primary and secondary referral centres. Adolescent healthy controls were matched for gender and age. Adolescents and each of their parents completed a set of questionnaires including a HRQoL evaluation of adolescent, the ‘Vécu et Santé Perçue de l’Adolescent’. Mother-adolescent, father-adolescent and mother-father agreements on adolescents’ HRQoL scores were investigated at individual and group level, both in TS and control groups. Data were available for 75 adolescents, 75 mothers and 63 fathers, in the TS group. Agreement between mother, father proxy-reports and TS adolescents self-reports of HRQoL varied from poor to good, without significant difference with the control group. In TS group, mothers and fathers underestimated adolescents’ HRQoL in ‘Psychological well-being’ subscale and mothers underestimated it in ‘Physical ‘well-being’ subscale, while controls overestimated adolescents’ HRQoL in these subscales. Larger mother-adolescent discrepancies for ‘Psychological well-being’ and ‘Physical well-being’ subscales were associated with internalizing symptoms. Regarding future studies, comprehensive evaluation of the various dimensions of adolescents’ HRQoL with TS requires the integration of the perspectives of both adolescents, mothers and fathers. Clinicians should take into account this point to provide comprehensive care and services

The French version of the Gilles de la Tourette Syndrome Quality of Life Scale for adolescents (GTS-QOL-French-Ado): Adaptation and psychometric evaluation

International audienceIntroduction: The aim of this study was to create a new version of the French GTS-QOL adapted to adolescents with GTS aged 12-16 years (GTS-QOL-French-Ado) and to evaluate its psychometric properties.Methods: We assessed the psychometric properties of the GTS-QOL-French-Ado in 84 adolescents (mean age 13.6 years, standard deviation 1.2) in terms of factor structure, internal consistency, reliability and convergent validity with the Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC), the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES) and the French “Vécu et Santé Perçue de l’Adolescent” (VSP-A), a generic self-administered measure of health-related quality of life (HRQoL) in adolescents.Results: Exploratory factor analysis of the GTS-QOL-French-Ado resulted in a 5-factor solution. The GTS-QOL-French-Ado demonstrated good acceptability with missing values per subscale ranging from 0% to 1.2%, good internal consistency for four of the five subscales with Cronbach’s alpha ranging from 0.56 to 0.87 and good test–retest reliability with intraclass correlation coefficients ranging from 0.74 (95% CI: 0.52-0.86) to 0.82 (95% CI: 0.66-0.91). Convergent validity was supported by correlations with CDI, MASC, MOVES, VSP-A and clinical variables. Discussion: The GTS-QOL-French-Ado is the first disease-specific HRQoL tool for French-speaking adolescents with GTS aged 12-16 years, and shows good psychometric properties. Further psychometric testing on responsiveness to change would be of great interest

Cross-cultural evaluation of the French version of the Delusion Assessment Scale (DAS) and Psychotic Depression Assessment Scale (PDAS)

International audienceBackground Major depressive disorder with psychotic features (MDDPsy), compared to nonpsychotic MDD, involves an increased risk of suicide and failure to achieve treatment response. Symptom scales can be useful to assess patients with MDDPsy. The aim of the present study was to validate French versions of the Delusion Assessment Scale (DAS) and Psychotic Depression Assessment Scale (PDAS). Methods One hundred patients were included. The scales were filled out by psychiatrists. Data from participants who accepted a second interview were used for inter-judge reliability. The scalability and psychometric properties of both scales were assessed

Cross-cultural adaptation and psychometric evaluation of the French version of the Gilles de la Tourette Syndrome Quality of Life Scale (GTS-QOL)

International audienceIntroduction: The Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL) is a self-rated disease-specific questionnaire to assess health-related quality of life of subjects with GTS. Our aim was to perform the cross-cultural adaptation of the GTS-QOL into French and to assess its psychometric properties.Methods: The GTS-QOL was cross-culturally adapted by conducting forward and backward translations, following international guidelines. The psychometric properties of the GTS-QOL-French were assessed in 109 participants aged 16 years and above with regard to factor structure, internal consistency, reliability and convergent validity with the MOVES (Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey) and the WHOQOL-BREF (World Health Organization Quality of Life Brief).Results: Exploratory factor analysis of the GTS-QOL-French resulted in a 6-factor solution and did not replicate the original structure in four subscales. The results showed good acceptability (missing values per subscale ranging from 0% to 0.9%), good internal consistency (Cronbach's alpha ranging from 0.68 to 0.94) and good test-retest reliability (intraclass correlation coefficients ranging from 0.70 to 0.81). Convergent validity with the MOVES and WHOQOL-BREF scales showed high correlations.Discussion: Our study provides evidence of the good psychometric properties of the GTS-QOL-French. The cross-cultural adaptation and validation of this specific instrument will make it possible to assess health-related quality of life in French-speaking subjects with GTS. The GTS-QOL-French could be recommended for use in future research