Dermatologists should take ownership of screening patients for mental health concerns associated with their skin condition, according to the authors of a Viewpoint article in JAMA Dermatology.
Skin conditions can lead to psychiatric disorders in 30% of patients, particularly adolescents; patients being treated for facial lesions and scars; patients suffering from insomnia; and patients with severe or recalcitrant skin disease, said Mohammad Jafferany, MD, of Central Michigan University in Mount Pleasant, and colleagues.
“When the psychiatric concern is related to skin disease, dermatologists are in a unique position to identify the problem and help patients seek treatment.”
In dermatology, associated psychiatric conditions can fall into one of two categories, the authors said: 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.”
Symptoms should be tracked and documented, the authors suggested. “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.”
Dermatologists do not always follow-up appropriately when they do identify mental health problems in a patient consultation, the Viewpoint authors said. “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.”
Some dermatologists may have difficulty perceiving a patient’s psychological distress, and may feel uncertain regarding psychiatric diagnoses, particularly in patients who 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, the authors noted. Questions include:
- Over the past 2 weeks, how often have you been bothered by (a) little interest or pleasure in doing things; or (b) feeling down, depressed, or hopeless?
- 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?”