OBJECTIVES: To estimate the prevalence of depression and food insecurity, and to evaluate social determinants of health (SDH) associated with depression in adults with psoriasis.

METHODS: Adults (age ≥18) who indicated being diagnosed with psoriasis using the 2013–2014 National Health and Nutrition Examination Survey (NHANES) were included. Depression was assessed with the Patient Health Questionnaire-9 and was defined as a score of ≥5 (mild depression: 5-9; moderate-to-severe depression: 10-27). Food insecurity was assessed with the 18-item US Household Food Security Survey Module. Adults with household marginal-to very low food security were classified as experiencing food insecurity. The prevalence of depression and food insecurity among patients with psoriasis were estimated using survey methods to account for different sampling probabilities. Weighted logistic regression was used to evaluate the association between depression and patient characteristics including SDH. Penalized regression was performed to select variables included in the multivariable regression.

RESULTS: The overall prevalence of depression and food insecurity was 28.4% and 23.3%, respectively, among adults with psoriasis. Compared to adults with no/minimal depression (PHQ-9 <5), those with depression were more likely to report fair/poor health condition, physical disability, sleep disorder, or ≥4 physical limitations. Food insecurity was associated with higher odds of depression (OR=3.24, 95% CI [1.34-7.87]), particularly for those reporting low-to-very low food security. Lower income (<$20K) was also associated with higher odds of depression (OR=2.66, 95% CI [1.09-6.49]). After adjusting for other factors, having ≥4 physical limitations were significantly associated with depression (adjusted OR=6.65, 95% CI [2.19-20.19]).

CONCLUSIONS: Prevalence of depression and food insecurity were high in adults with psoriasis. This analysis shows that SDH play an important role in depression, with self-reported physical limitation exerting the strongest influence. Providing supportive resources to address those SDH amenable to change may help manage the burden of depression among adults with psoriasis.