F J Dalgard1, Å Svensson1, U Gieler2, L Tomas-Aragones3, L Lien4, F Poot5, G B E Jemec6, L Misery7, C Szabo8, D Linder9, F Sampogna10, A W M Evers11, J Anders Halvorsen12, F Balieva13, J Szepietowski14, A Lvov15, S E Marron16, I K Alturnay17, A Y Finlay18, S S Salek19, J Kupfer20. 1. Department of Dermatology and Venereology, Skåne University Hospital, Lund University, Malmö, Sweden. 2. Department of Dermatology, Justus Liebig University, Giessen, Germany. 3. Department of Psychology, University of Zaragoza, Spain. 4. National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway. 5. Department of Dermatology, Universite libre de Bruxelles, Brussels, Belgium. 6. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 7. Department of Dermatology, University Hospital of Brest, Brest, France. 8. Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary. 9. Section of Biostatistics, University of Oslo, Oslo, Norway. 10. Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy. 11. Department of Health, Medical and Neuropsychology, Faculty of Social and Behavioral Science, the Netherlands. 12. Department of Dermatology, University of Oslo, Oslo, Norway. 13. Department of Dermatology, Stavanger University Hospital, Stavanger, Norway. 14. Department of Dermatology, Wroclav Medical University, Wroclav, Poland. 15. Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia. 16. Department of Dermatology, Royo Villanova Hospital, Zaragoza, Spain. 17. University of Health Science, Istanbul Sisli Hamidiye Efdal Health Training and Research Centre, Istanbul, Turkey. 18. Department of Dermatology, Cardiff University School of Medicine, Cardiff, U.K. 19. School of Life and Medical Sciences, University of Herdfordshire, Hatfield, U.K. 20. Institute of Medical Psychology, Justus Liebig University, Giessen, Germany.
Abstract
BACKGROUND: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists. OBJECTIVES: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale (HADS). METHODS: The study was an observational cross-sectional multicentre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in outpatient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders. RESULTS: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0·4) for all diagnosis categories. The true-positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in patients with depression or anxiety as defined by a HADS value ≥ 11) was 44·0% for depression and 35·6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined by HADS-value < 11) was 88.8% for depression and 85.7% for anxiety. CONCLUSIONS: Dermatologists in Europe tend to underestimate mood disorders. The results suggest that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. When present, the psychological suffering of patients with dermatological conditions needs to be addressed.
BACKGROUND: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists. OBJECTIVES: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale (HADS). METHODS: The study was an observational cross-sectional multicentre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in outpatient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders. RESULTS: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0·4) for all diagnosis categories. The true-positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in patients with depression or anxiety as defined by a HADS value ≥ 11) was 44·0% for depression and 35·6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined by HADS-value < 11) was 88.8% for depression and 85.7% for anxiety. CONCLUSIONS: Dermatologists in Europe tend to underestimate mood disorders. The results suggest that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. When present, the psychological suffering of patients with dermatological conditions needs to be addressed.
Authors: Sofia Tsiori; Natalia Rompoti; Konstantinos Kontoangelos; Christos Papageorgiou; Charalabos Papageorgiou; Alexander Stratigos; Dimitrios Rigopoulos Journal: Int J Environ Res Public Health Date: 2022-03-29 Impact factor: 3.390