Addressing Sleep & Mental Health in Patients With Psoriasis

Photo Credit: AntonioGuillem

Authors of an abstract presented at the 2025 AAD Annual Meeting said collaborating with patients “is essential” for addressing sleep disturbances and mental health comorbidities, which are under-recognized in patients with psoriasis.

“Psoriasis is a chronic immune-mediated skin disease with known physical and mental health comorbidities, such as cardiovascular disease, depression, and anxiety,” said Andrea Leung, MPH, and colleagues. “Patients with psoriasis are also at an increased risk of sleep disturbance, due to factors like itch and pain.”

Validated questionnaires like the Pittsburg Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) can be used to assess sleep, as can the Patient-Reported Outcomes Measurement Information System (PROMIS) 8a and 8b, which may be more precise in measuring sleep impairments and disturbances.

However, the authors noted these questionnaires have been under-used in psoriasis research.

To bridge the gap, the researchers conducted a cross-sectional cohort study, using the ISI, PROMISE8a, and PROMIS8b to evaluate sleep and the Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7) to measure depression and anxiety.

Psoriasis Linked to Worse Sleep & Mental Health

The study included 487 patients with psoriasis, largely sourced from the National Psoriasis Foundation and UCSF Psoriasis Center clinic, and 69 healthy controls.

According to the findings, patients with psoriasis scored worse across all sleep and mental health domains. In the psoriasis group, the authors found that greater sleep impairment, sleep disturbance, and insomnia significantly correlated with anxiety (ORa, 1.22; 95% CI, 1.16-1.30; ORa, 1.26; 95% CI, 1.16-1.80; ORa, 5.13; 95% CI, 2.91-9.33; respectively) and depression (ORa, 1.42; 95% CI, 1.32-1.56; ORa, 1.16; 95% CI, 1.08-1.26; ORa, 7.04; 95% CI, 4.01-12.77; respectively).

Using linear regression, the researchers found the following measures were positively associated with psoriasis:

• Insomnia severity (β=5.33, P<0.001)
• Sleep impairment (β=5.13, P<0.001)
• Sleep disturbance (β=2.25, P<0.001)
• Depression (β=4.63, P<0.001)
• Anxiety (β=2.20, P=0.012)

“Logistic regression of the PSO cohort showed that greater sleep impairment (PROMIS 8a), sleep disturbance (PROMIS 8b), and insomnia (ISI) were significantly associated with anxiety and depression, before and after adjustment for demographics, psoriasis severity, history of psoriatic arthritis, and history of psoriasis treatment,” the researchers said.

Addressing Psoriasis’s Comorbidities

The authors noted their findings were consistent with previous studies. In addition, they emphasized the importance of fostering a collaborative patient-clinician relationship to ensure appropriate treatment for psoriasis and its related comorbidities.

“Building a collaborative relationship between patients and providers is essential in addressing the under-recognized comorbidities of psoriasis. These findings underscore the importance of recognizing the impact of psoriasis on mental health and sleep and establishing a connection between sleep quality and mental health outcomes,” the researchers concluded.