Dermatologists fail to screen patients for depression

Dermatologists should take ownership of screening patients for mental health concerns associated with their skin condition.

Skin conditions can lead to psychiatric disorders in 30 percent of patients, particularly adolescents, patients being treated for facial lesions and scars, patients suffering from insomnia or patients with severe or recalcitrant skin disease, wrote the authors of a Viewpoint article in JAMA Dermatology.

“When the psychiatric concern is related to skin disease, dermatologists are in a unique position to identify the problem and help patients seek treatment,” wrote the authors who were led by Mohammad Jafferany, M.D., of Central Michigan University.

In dermatology, there are psychiatric conditions can fall into one of two categories:  primary or secondary. Primary skin conditions include disorders of self-induced skin lesions due to an underlying emotional disturbance, such as acne excoriee. Secondary psychiatric disorders, such as depression, usually arise as a result of a primary health condition, such as severe psoriasis.

“When these dermatologic-specific risk factors are paired with additional high-risk features, depression and suicidal ideation screening become increasingly necessary,” the authors wrote.

Symptoms should be tracked and documented, the authors suggest. “We recommend that dermatologists maintain an appropriate index of suspicion for psychiatric disease, apply brief standardized mental health questionnaires, and refer patients to appropriate services when needed,” the authors wrote.

DERMATOLOGISTS DON’T OFTEN FOLLOW-UP

Dermatologists do not always follow-up appropriately when they do identify mental health problems in a patient consultation. “It is unclear if this is owing to lack of clear guidelines, lack of time in busy clinics, or the perception that secondary psychiatric disorders fall outside of the dermatology domain,” the authors wrote.

Some dermatologists may have difficulty perceiving a patient’s psychological distress, and may feel uncertain regarding psychiatric diagnoses, particularly in patients that may not volunteer mental health information in a dermatology visit.

The Patient Health Questionnaire-2 (PHQ-2) is a recommended resource that may help identify patients. Questions include:

1.      Over the past 2 weeks, how often have you been bothered by (a) little interest or pleasure in doing things or (2) feeling down, depressed, or hopeless.

2.      To gauge whether an immediate follow-up is necessary, “Do you ever think about ending your own life?”  If so, do you currently have a plan to commit suicide?”

REFERENCES

Katherine McDonald, BScH; Amanda Shelley, BScH; Mohammad Jafferany, MD, FAPA. “The PHQ-2 in Dermatology-Standardized Screening for Depression and Suicidal Ideation,” Dec. 27, 2017. JAMA Dermatology. DOI:10.1001/jamadermatol.2017.5540

Kroenke K, Spitzer RL, Williams JBW. “The Patient Health Questionnaire-2: validity of a two-item depression screener,” Nov. 2003. Medical Care. Nov. 2003. DOI:10.1097/01.MLR.0000093487.78664.3C

Connor CJ. “Management of the psychological comorbidities of dermatological conditions,” Apr. 20, 2017. Clinical, Cosmetic and Investigational Dermatology. DOI:10.2147/CCID.S111041