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Psychiatric morbidity in dermatological outpatients: an issue to be recognized
A Picardi1, D Abeni, C F Melchi
1Clinical Epidemiology Unit, 2nd Division of Clinical Dermatology and Dermatoimmunology Department, Dermatological Institute IDI-IRCCS, Via dei Monti di Creta 104, 00167 Rome, Italy. angelo.picardi@flashnet.it
Background:
There is a high prevalence of psychiatric disorders in dermatological outpatients.
Objectives:
To estimate the magnitude of this problem and to identify a set of variables associated with the presence of psychiatric disorder.
Methods:
All adults attending the outpatient clinics of a dermatological hospital on predetermined days were given a questionnaire comprising the Skindex-29 and the 12-item General Health Questionnaire (GHQ-12).
Results:
In total, 4268 questionnaires were given at admission, and 3125 were returned. Of these, 546 were blank or incomplete, leaving 2579 respondents (response rate 60.4%). Using a stringent cut-off threshold (> or = 5) for psychiatric case identification with the GHQ-12, scored in the conventional way, the overall prevalence of psychiatric morbidity was 25.2% (95% confidence interval 23.6-27.0%). We found a higher prevalence of psychiatric disorders in women and in widows/widowers, controlling for age. Health-related quality of life was a much stronger predictor of psychiatric morbidity than physician-rated clinical severity. High prevalence rates (> 30%) were observed among patients with acne, pruritus, urticaria, alopecia and herpesvirus infections, and in subjects without objective signs of dermatological disease.
Conclusions:
Our study has depicted the situation that is actually faced by dermatologists in their everyday practice, where they are in a unique position to recognize psychiatric morbidity and to take appropriate measures. The GHQ-12, being easy for patients to compile and for physicians or nurses to score, may be a practical tool to increase identification of patients with substantial psychological distress or formal psychiatric disorder in order to provide more comprehensive and appropriate intervention.