Suicidality among psoriasis patients: a critical evidence synthesis

Psoriasis is a chronic inflammatory skin disease with under-investigated and underappreciated links to psychiatric comorbidities, including anxiety, depression, and suicidality. In this review, we synthesize and discuss the literature investigating the association between psoriasis and three measures of suicidality: suicidal ideation, suicide attempts, and completed suicide. Studies have shown that psoriasis is significantly linked to all three measures of suicidality, but the available data on suicide attempts and completed suicides is limited and less consistent. Studied risk factors for suicidality in psoriasis patients include age, gender, and severity of psoriasis. Younger patients and patients with more severe psoriasis are at significantly higher risk of suicidality; gender was not associated with suicidality in most studies. Higher levels of psoriasis-related stressors and decrements to quality of life were significantly associated with suicidality in psoriasis patients. Most biologic treatments for psoriasis appear to be helpful in decreasing rates of depression, but data on their impact on suicidality is less well known. Understanding the risk of suicidality in psoriasis patients is key to engaging all stakeholders to screen psoriasis patients for mental health conditions. Clinicians may incorporate simple screening tools to screen for suicidal ideation and refer appropriately.