https://orcid.org/0000-0003-3291-2381
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Abstract
Introduction
Previous research has shown associations between eczema and psoriasis and anxiety and depression. We investigated whether associations are consistent across different settings of ascertainment for depression and anxiety, including interview and survey responses from UK Biobank (a large longitudinal cohort recruiting individuals aged 40–69 years between 2006–2010), and linked primary care data, with the aim of drawing more reliable conclusions through triangulation.
Methods
In cross-sectional studies, we estimated associations between eczema or psoriasis and anxiety or depression, defining anxiety or depression as 1) self-reported previous diagnosis at UK Biobank recruitment interview; 2) PHQ-9/GAD-7 score indicating depression or anxiety from a UK Biobank mental health follow-up survey in 2016; and 3) diagnosis in linked primary care electronic health record data.
Results
We analysed 230,047 people with linked Biobank and primary care data. We found poor agreement between the data sources for eczema, psoriasis, anxiety, and depression. Eg, 9474 had a previous eczema diagnosis in primary care data, 4069 self-reported previous eczema diagnosis at the UK biobank interview, and 1536 had eczema in both data sources (for depression 40,455; 13,320; and 9588 respectively). Having eczema or psoriasis (recorded in primary care or baseline interview) was associated with higher odds of anxiety and depression. Eg, the adjusted odds ratio for depression comparing those with eczema to those without was greater than 1 when defining the outcome from 1) the recruitment interview (1.36, 95% confidence interval 1.27–1.45); 2) the follow-up survey (1.24, 1.09–1.39), and 3) primary care records (1.56, 1.50–1.62).
Discussion
Our findings support increased prevalence of mental illness in people with psoriasis and eczema across multiple data sources, which should be considered in planning of mental health services. However, we found poor agreement in disease ascertainment between settings, with implications for data interpretation in electronic health records.
Acknowledgments
This study has been approved by the London School of Hygiene & Tropical Medicine Research Ethics Committee (LSHTM Ethics Ref: 17815) and UK Biobank (project number 74311). UK Biobank is approved under Research Ethics Committee reference 16/NW/0274 and is compliant with the General Data Protection Regulation (https://www.ukbiobank.ac.uk/explore-your-participation/basis-of-your-participation). This study is funded by the NIHR Research for Patient Benefit programme (grant reference number PB-PG-0418-20025). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This work was supported and funded by the BIOMAP (Biomarkers in Atopic Dermatitis and Psoriasis) consortium. This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement number 821511 (BIOMAP). The JU receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. This publication reflects only the author’s view and the JU is not responsible for any use that may be made of the information it contains. This work was supported by Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and the Wellcome Trust. This research was funded in whole or in part by the Wellcome Trust [G205039/Z/16/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript (AAM) version arising from this submission. This work uses data provided by patients and collected by the NHS as part of their care and support. We are enormously grateful to all members of our Patient and Public Advisory Panel who have attended regular meetings and made invaluable contributions to the analysis and interpretation of this study based on their lived experience.
Disclosure
Sinéad M. Langan is a co-investigator in a consortium with industry and multiple academic partners (BIOMAP-IMI.eu), an investigator on a Horizon 2020 IMI grant with industry partners but is not in receipt of industry funding. Joseph F. Hayes has received consultancy fees from the Wellcome, grants from UKRI, personal fees from Juli Health, during the conduct of the study; grants from UKRI, personal fees from Juli Health, outside the submitted work; In addition, Dr Joseph F Hayes has a patent juli health pending to United States Patent and Trademark Office; and juli Health. Kathryn E. Mansfield reports personal consultancy fees from AMGEN. Catherine H Smith is an investigator in consortia with industry and academic partners (see BIOMAP-IMI.eu and HIPPOCRATES-IMI.eu); MRC CASE PhD studentships (Boehringer Ingelheim, Astra Zeneca). The authors report no other conflicts of interest in this work.