Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations

F. J. Dalgard; Svensson; U. Gieler; L. Tomas-Aragones; L. Lien; F. Poot; G. B.E. Jemec; L. Misery; C. Szabo; D. Linder; F. Sampogna; A. W.M. Evers; J. Anders Halvorsen; F. Balieva; J. Szepietowski; A. Lvov; S. E. Marron; I. K. Alturnay; A. Y. Finlay; S. S. Salek; J. Kupfer

doi:10.1111/bjd.16250

Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations

F. J. Dalgard^*
, Svensson
, U. Gieler
, L. Tomas-Aragones
, L. Lien
, F. Poot
, G. B.E. Jemec
, L. Misery
, C. Szabo
, D. Linder
, F. Sampogna
, A. W.M. Evers
, J. Anders Halvorsen
, F. Balieva
, J. Szepietowski
, A. Lvov
, S. E. Marron
, I. K. Alturnay
, A. Y. Finlay
, S. S. Salek

J. Kupfer

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

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.

Original language	English
Pages (from-to)	464-470
Number of pages	7
Journal	British Journal of Dermatology
Volume	179
Issue number	2
DOIs	https://doi.org/10.1111/bjd.16250
Publication status	Published - Aug 2018
Externally published	Yes

Funding

1Department of Dermatology and Venereology, Sk©ane University Hospital, Lund University, Malm€o, Sweden 2Department of Dermatology and 20Institute of Medical Psychology, Justus Liebig University, Giessen, Germany 3Department of Psychology, University of Zaragoza, Spain 4National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway 5Department of Dermatology, Universite libre de Bruxelles, Brussels, Belgium 6Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark 7Department of Dermatology, University Hospital of Brest, Brest, France 8Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary 9Section of Biostatistics and 12Department of Dermatology, University of Oslo, Oslo, Norway 10Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata, Rome, Italy 11Department of Health, Medical and Neuropsychology, Faculty of Social and Behavioral Science, the Netherlands 13Department of Dermatology, Stavanger University Hospital, Stavanger, Norway 14Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland 15Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia 16Department of Dermatology, Royo Villanova Hospital, Zaragoza, Spain 17University of Health Science, Istanbul Sisli Hamidiye Efdal Health Training and Research Centre, Istanbul, Turkey 18Department of Dermatology, Cardiff University School of Medicine, Cardiff, U.K. 19School of Life and Medical Sciences, University of Hertfordshire, Hatfield, U.K.

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10.1111/bjd.16250

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Dalgard, F. J., Svensson, Gieler, U., Tomas-Aragones, L., Lien, L., Poot, F., Jemec, G. B. E., Misery, L., Szabo, C., Linder, D., Sampogna, F., Evers, A. W. M., Halvorsen, J. A., Balieva, F., Szepietowski, J., Lvov, A., Marron, S. E., Alturnay, I. K., Finlay, A. Y., ... Kupfer, J. (2018). Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations. British Journal of Dermatology, 179(2), 464-470. https://doi.org/10.1111/bjd.16250

@article{155dc00100934f8bbf5675b2ad21724e,

title = "Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations",

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.",

author = "Dalgard, \{F. J.\} and Svensson and U. Gieler and L. Tomas-Aragones and L. Lien and F. Poot and Jemec, \{G. B.E.\} and L. Misery and C. Szabo and D. Linder and F. Sampogna and Evers, \{A. W.M.\} and Halvorsen, \{J. Anders\} and F. Balieva and J. Szepietowski and A. Lvov and Marron, \{S. E.\} and Alturnay, \{I. K.\} and Finlay, \{A. Y.\} and Salek, \{S. S.\} and J. Kupfer",

year = "2018",

month = aug,

doi = "10.1111/bjd.16250",

language = "English",

volume = "179",

pages = "464--470",

journal = "British Journal of Dermatology",

issn = "0007-0963",

publisher = "Oxford University Press",

number = "2",

}

Dalgard, FJ, Svensson, Gieler, U, Tomas-Aragones, L, Lien, L, Poot, F, Jemec, GBE, Misery, L, Szabo, C, Linder, D, Sampogna, F, Evers, AWM, Halvorsen, JA, Balieva, F, Szepietowski, J, Lvov, A, Marron, SE, Alturnay, IK, Finlay, AY, Salek, SS & Kupfer, J 2018, 'Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations', British Journal of Dermatology, vol. 179, no. 2, pp. 464-470. https://doi.org/10.1111/bjd.16250

TY - JOUR

T1 - Dermatologists across Europe underestimate depression and anxiety

T2 - results from 3635 dermatological consultations

AU - Dalgard, F. J.

AU - Svensson, null

AU - Gieler, U.

AU - Tomas-Aragones, L.

AU - Lien, L.

AU - Poot, F.

AU - Jemec, G. B.E.

AU - Misery, L.

AU - Szabo, C.

AU - Linder, D.

AU - Sampogna, F.

AU - Evers, A. W.M.

AU - Halvorsen, J. Anders

AU - Balieva, F.

AU - Szepietowski, J.

AU - Lvov, A.

AU - Marron, S. E.

AU - Alturnay, I. K.

AU - Finlay, A. Y.

AU - Salek, S. S.

AU - Kupfer, J.

PY - 2018/8

Y1 - 2018/8

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85047552929

U2 - 10.1111/bjd.16250

DO - 10.1111/bjd.16250

M3 - Article

C2 - 29247454

AN - SCOPUS:85047552929

SN - 0007-0963

VL - 179

SP - 464

EP - 470

JO - British Journal of Dermatology

JF - British Journal of Dermatology

IS - 2

ER -

Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations

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