The Psychiatric Burden of Pediatric Psoriasis

Psoriasis in children and adolescents, as in affected adults, is thought to be associated with an increased risk of having depression and anxiety. However, the limited supporting evidence is based on insurance databases with established diagnoses. Several studies have shown a reduced quality of life in children with psoriasis, but none has specifically explored factors that may influence this poor quality of life, such as itch, pain, sleep disturbance, perceived stigma, altered peer relationships, and associated psychiatric burden, including on the family. In this proposal, we aim to understand these psychiatric issues and their underlying factors as directly reported by children with psoriasis (Aim 1), as well as to determine the impact of pediatric psoriasis on family relationships and psychiatric burden (Aim 2). Towards these goals we will enroll 300 dyads of child with psoriasis and a parent, encompassing mild, moderate and severe strata of psoriasis. We will leverage the availability of validated pediatric tools (PROMIS, Neuro-QoL) that provide T-scores compared with healthy children to assess these burdens. Using computer adaptive testing and short-forms to minimize burden and maximize information, we will capture data about psychological stress, anxiety, and depressive symptoms, as well as the factors that contribute to psychiatric burden (itch, pain and pain interference, sleep disturbance, poor peer relationships, and stigma). The burden on family relationships and on parental mental health will also be assessed. We will correlate disease severity and each underlying factor (eg stigma, sleep) with mental health burden, as well as the child’s assessment and impact with that on the parent. Our results will increase our knowledge about the symptoms and psychiatric burden of psoriasis in children and their families, and promote the use of simple, rapidly-administered tools for use in clinical practice, enabling more holistic care.