Researcher investigates the links between mental health and psoriasis

“In my previous clinical psychiatric work, it was not uncommon to see patients who suffered from various physical illnesses alongside a mental health condition.   This is particularly true for people with psoriasis – a chronic, inflammatory skin disease which causes a red scaly rash.

Existing research into psoriasis has found that people with the condition are at higher risk of several psychiatric disorders such as depression, anxiety and alcohol use disorder.

In the UK, almost 1 in 5 people with psoriasis also suffers from clinical depression (equating to around 300,000 individuals) and, during Mental Health Awareness Week, it seems appropriate to shed some light on this issue.

Poor body image, this year’s focus for the awareness week, is already a feature of life with psoriasis for many people.   Their self-esteem may get low, they may feel embarrassed when exposing their skin or avoid activities, such as swimming, altogether.  This time of year, with the hotter weather, can make life even more challenging for sufferers, who may feel unable to wear summer clothes.

However, poor body image is only half the story. Increasingly, research is now looking for biological factors that might contribute to the development of depression in people with physical illnesses.

Psoriasis seems to be no exception as it can affect organs beyond the skin; importantly, the joints.  As a consequence, 5-30% of patients with psoriasis suffer from psoriatic arthritis.

It is believed that this extended inflammation might be able to reach the nervous system as well and trigger, or worsen, biological processes that lead to depression.

In my previous clinical role, I found the interaction between physical and mental conditions a great challenge.  The interplay between the two can complicate treatment for both elements and delay or, even, prevent recovery.

It was my work with patients, experiencing these difficulties, that led me to begin my PhD in Manchester.

The project, which I started in September 2018, is centred on the link between psoriasis, psoriatic arthritis and depression, in particular, when suicidal thoughts are present.

My research team, led by Dr Elise Kleyn, Senior Lecturer and Honorary Consultant Dermatologist, will start by surveying 250 patients, attending the Greater Manchester Psoriasis Service, in order to investigate their symptoms.  The survey will run for two years.

We will then take a close look for evidence of inflammatory processes that extend beyond the skin, in a group of patients with both psoriasis and depression.

My aim is to improve understanding of the psychological factors and the neurobiological mechanisms that mediate low mood and suicidal behaviours in psoriasis.  This will help identify patients who are at high risk and to develop more effective prevention strategies.

I hope it will also lead to more appropriate, tailored treatment for complex patients, reducing disability and death from psychiatric causes, improving the outcomes of skin disease and restoring quality of life.

Also, by increasing knowledge and awareness in the field, my colleagues and I can contribute to tackling stigma and encourage patients to open up and seek mental health support.

I would love to think that by next year’s mental health awareness drive we have made great strides to make this a reality.”

• Dr Lada will present information related to her PhD at the European Society for Dermatology and Psychiatry’s congress in Germany in June 2019.  Her presentation will focus on a historical review of her topic (psoriasis, psoriatic arthritis and depression) and the literature on the link between psoriasis and mood.