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Association of Patient Mental Health Status With the Level of Agreement Between Patient and Physician Ratings of Psoriasis Severity

Research output: Contribution to journalArticlepeer-review

Ewan Carr, Satveer K. Mahil, Anamaria Brailean, Tejus Dasandi, Andrew E. Pink, Jonathan Barker, Lauren Rayner, Mark Turner, Kimberley Goldsmith, Catherine H. Smith

Original languageEnglish
Pages (from-to)413-420
Number of pages8
JournalJAMA dermatology
Issue number4
Accepted/In press28 Dec 2020
PublishedApr 2021

Bibliographical note

Funding Information: La-Roche Posay as a lecturer; and personal fees from UCB as an advisor and speaker outside the submitted work. Dr Barker reported receiving personal fees from Amgen, Almirall, AbbVie, Janssen, Lilly, Novartis, Samsung, Boehringer-Ingelheim, Sun Pharma, and Bristol Myers Squibb outside the submitted work. Dr Goldsmith reported receiving grants from the National Institute for Health Research (NIHR), National Institutes of Health, Juvenile Diabetes Research Foundation, Stroke Association, and UK Research Innovation outside the submitted work. Dr Smith has received departmental research funding from AbbVie, GSK, Pfizer, Novartis, Regeneron, and Roche, and is coinvestigator on consortia with industry partners (see https:// and No other disclosures were reported. Funding Information: independent research part funded by the NIHR Biomedical Research Centre at South London and Maudsley National Health Service (NHS) Foundation Trust, King’s College London, and Guy's and St Thomas' NHS Foundation Trust. Dr Mahil is funded by a Medical Research Council Clinical Academic Research Partnership award (MR/T02383X/1). Publisher Copyright: © 2021 American Medical Association. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.


  • Accepted author manuscript

    revised_manuscript_clean.pdf, 129 KB, application/pdf

    Uploaded date:16 Feb 2021

    Version:Accepted author manuscript

King's Authors


IMPORTANCE The emerging paradigm of treat-to-target in psoriasis requires accurate monitoring of treatment response. The commonly used physician global assessment tool does not capture the patient’s perception of their disease. Patient assessments facilitate shared decision-making and foster patient-centered care; however, recent research reports a discordance between patient- and physician-reported psoriasis severity. Understanding the factors underlying this discordance may improve treatment satisfaction and disease outcomes.

OBJECTIVES To evaluate the discordance between patient- and physician-reported measures of psoriasis severity and assess the association with patient mental health status. DESIGN, SETTING, AND PARTICIPANTS A cohort study using repeated cross-sectional analysis of real-world longitudinal data was conducted at a large specialist psoriasis service serving London and Southeast England. A total of 502 patients attending the psoriasis service between May 12, 2016, and November 1, 2018, were included. Data analysis was conducted July 22 to October 22, 2019.

MAIN OUTCOMES AND MEASURES Psoriasis severity was assessed on each visit with identical 5-point physician and patient global assessment scales (clear/nearly clear, mild, moderate, severe, and very severe). Each patient completed validated self-report screens for depression and anxiety on each visit.

RESULTS Longitudinal data from 502 individuals with psoriasis (1985 total observations) were available. A total of 339 patients (68%) were men, 396 (79%) were White, mean (SD) age was 47 (13) years, and 197 patients (39%) had concurrent psoriatic arthritis, 43 (9%) screened positive for depression, and 49 (10%) screened positive for anxiety. There was discordance between physician and patient measures of disease severity in 768 of 1985 office appointments (39%); on 511 visits (26%) patients rated their psoriasis as less severe and on 257 visits (13%) patients rated their psoriasis as more severe compared with their physician. Individuals who screened positive for depression or anxiety were more likely to overestimate their psoriasis severity compared with their physician (relative risk ratio: depression, 2.7; 95% CI, 1.6-4.5; anxiety, 2.1; 95% CI, 1.3-3.4). These findings remained statistically significant after adjustment for age, ethnicity, sex, body mass index, smoking, number of comorbidities, treatment modality, and presence of psoriatic arthritis.

CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that discordance between patient and physician assessments of psoriasis severity is associated with patients’ mental health status. Recognition of anxiety and depression in individuals with psoriasis appears to be important when interpreting patient-reported outcome measures and informing appropriate treatment decisions.

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