Four years stability of type D personality in patients with moderate to severe psoriasis and its implications for psychological impairment

Aguayo-Carreras, Paula; Ruiz-Carrascosa, José Carlos; Ruiz-Villaverde, Ricardo; Molina-Leyva, Alejandro

doi:10.1016/j.abd.2021.02.005

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ORIGINAL ARTICLE • An. Bras. Dermatol. 96 (05) • 2021 • https://doi.org/10.1016/j.abd.2021.02.005 copy

Four years stability of type D personality in patients with moderate to severe psoriasis and its implications for psychological impairment^☆ ☆ How to cite this article: Aguayo-Carreras P, Ruiz-Carrascosa JC, Ruiz-Villaverde R, Molina-Leyva A. Four years stability of type D personality in patients with moderate to severe psoriasis and its implications for psychological impairment. An Bras Dermatol. 2021;96:558-564. ,^☆☆ ☆☆ Study conducted at the Psoriasis Unit, Hospital Universitario San Cecilio, Granada, Spain.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Psoriasis is a systemic auto-inflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D is a stable personality trait in healthy subjects but there is no data regarding its stability in patients with moderate-severe psoriasis. Objectives: To assess the stability of type D personality in patients with moderate to severe psoriasis as well as assessing the influence of type D personality on anxiety and depression.

Methods:

Prospective cohort study. Forty psoriasis patients with type D personality and sixtysix patients with psoriasis without type D personality were included in the study. Participants completed the DS14 test and HADS at baseline and four years later.

Results:

At baseline, the prevalence of type D personality was 37.7% and at week 208 it was 27.3%. The stability of type D personality was higher in patients with an incomplete education level and in those who were separated/divorced or windowed. During follow-up, 15% of patients developed type D personality. Male sex, having topical treatment, the presence of previous depression, anxiety, and high levels of negative affectivity at baseline increase the risk of developing type D personality.

Study limitations:

Sample size, psoriasis severity restricted to moderate and severe and all patients being under treatment for psoriasis.

Conclusion

The presence of type D personality varies over time in psoriasis patients. Therefore, type D personality is possibly more a state than a trait phenomenon, modified by environmental factors. Type D personality is associated with a higher risk of anxiety.

KEYWORDS
Anxiety; Depression; Psoriasis; Type D personality

	TDp (n = 40)	No tDp (n = 66)	p-values
Age (years)	52.30 ± 1.97	51.46 ± 1.53	0.74
Male:Female ratio	21:19	10:13	0.41
BMI	28.50 ± 0.95	28.6 ± 0.74	0.92
Educational level (%)			0.15
Primary incomplete	7 (17.50)	4 (6.06)
Secondary	21 (52.50)	36 (54.55)
Academic	12 (30)	26 (39.39)
Marital status (%)			0.66
Single	5 (12.50)	12 (18.18)
Married	30 (75)	48 (71.21)
Others	5 (12.50)	6 (10.61)
Arthropathy (%)			0.69
Yes	13 (32.50)	19 (28.79)
Years of evolution	22.20 ± 1.93	24.14 ± 1.44	0.41
Psoriasis treatment (%)			0.68
Topical	7 (17.50)	9 (13.64)
Classical systemic drugs	14 (35.00)	20 (30.30)
Biological drugs	19 (47.50)	37 (56.06)
Baseline PASI	4.48 ± 0.79	4.14 ± 0.62	0.74
Baseline HADS-A >8	25 (62.5)	20 (30.30)	0.001
Baseline HADS-D >8	19 (47.50)	13 (19.70)	0.002

	tDp Stable (n = 19)	tDp Loss (n = 21)	p-value
Age (years)	52.78 ± 2.5	51.8 ± 2.38	0.78
Male: female ratio	9:10	12:9	0.53
BMI	28.22 ± 1.62	28.75 ± 1.54	0.81
Educational level primary incomplete vs. secondary-academic	6 (31.58) vs. 13 (68.42)	1 (4.76) vs. 20 (95.24)	0.03
Marital status single-married vs. divorced-windowed	14 (73.68) vs. 5 (26.32)	21 (100.00) vs. 0 (0.00)	0.02
PASI (baseline)	5.14 ± 1.08	3.88 ± 1.02	0.40
PASI (week 208)	3.67 ± 0.79	1.47 ± 0.76	0.05
HADS-A >8 (%)	13 (68.42)	12 (57.14)	0.46
HADS-D >8 (%)	11 (57.89)	8 (38.10)	0.20
Baseline psoriasis treatment (%)			0.29
Topical	3 (15.79)	4 (19.05)
Classical systemic drugs	9 (47.37)	5 (23.81)
Biological drugs	7 (36.84)	12 (57.14)
Final psoriasis treatment (%)			0.39
Topical	1 (5.26)	4 (19.05)
Classical systemic drugs	2 (10.53)	2 (9.52)
Biological drugs	16 (84.21)	15 (71.43)

	Generate tDp (n = 10)	No tDp (n = 56)	p-values
Age (years)	51.20 ± 4.2	51.51 ± 1.8	0.95
Male:Female ratio	1:4	19:9	0.004
BMI	27.63 ± 1.69	28.79 ± 0.71	0.51
Educational level (%)			0.37
Primary incomplete	1 (10.0)	3 (5.36)
Secondary	7 (70.0)	29 (51.79)
Academic	2 (20.0)	24 (42.86)
Marital status (%)			0.97
Single	2 (20.0)	10 (17.86)
Married	7 (70.0)	41 (73.21)
Divorced	1 (10.0)	5 (8.93)
PASI (baseline)	4.04 ± 1.68	4.16 ± 0.71	0.94
PASI (week 208)	1.00 ± 0.72	1.63 ± 0.30	0.42
Baseline HADS-A >8	6 (60.0)	14 (25.0)	0.03
Baseline HADS-D >8	5 (50)	8 (14.29)	0.01
Baseline psoriasis treatment (%)			0.92
Topical	1 (10.0)	8 (14.29)
Classical systemic drugs	3 (30.0)	17 (30.36)
Biological drugs	6 (60.0)	31 (55.36)
Final psoriasis treatment (%)			0.14
Topical	3 (30.0)	5 (9.09)
Classical systemic drugs	0 (0.0)	4 (7.27)
Biological drugs	7 (70.0)	46 (83.64)

	Week 0		p-values	Week 208		p-values
	tDp (n = 40)	No tDp (n = 66)	p-values	TDp (n = 29)	No tDp (n = 77)	p-values
HADS-A >8	25 (62.50)	20 (30.30)	0.001	16 (55.17)	19 (24.68)	0.035
HADS-D >8	19 (47.50)	13 (19.70)	0.002	9 (31.03)	7 (9.10)	0.076

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[1] ☆
How to cite this article: Aguayo-Carreras P, Ruiz-Carrascosa JC, Ruiz-Villaverde R, Molina-Leyva A. Four years stability of type D personality in patients with moderate to severe psoriasis and its implications for psychological impairment. An Bras Dermatol. 2021;96:558-564.