OBJECTIVES: Estimate direct and indirect costs of depression and anxiety in patients with psoriasis (PsO). METHODS: Retrospective cohort analysis was conducted using Truven MarketScan data®. Adult patients with at least 2 diagnosis of PsO (ICD-9-CM: 696.1) between year 2010 and 2011 (at least one PsO diagnosis in year 2010) having continuous enrollment of medical and pharmacy benefits were included. Patients with Health and Productivity Management data for 2011 were included for the indirect cost analysis, including costs associated with absence of leave (ABS), short term disability (STD), and long term disability (LTD). Indirect costs were calculated using average 2011 hourly wage data for all US private industries (number of ABS/STD/LTD days * 8 hours * an average hourly wage). Multiple regressions were conducted to compare year 2011 direct costs and indirect costs (gamma regression or two part models) between patients with and without depression or anxiety respectively, controlling for age, gender, and region and PsO severity in year 2010.   RESULTS: Among a total of 56,406 PsO patients (mean age 52 years), 7.9% patients with depression and 5.7% with anxiety in year 2010 were included in the direct cost analyses. A total of 1,434 patients for ABS, 5,878 for STD and 5,692 for LTD were included in the indirect cost analyses. The adjusted healthcare costs were significantly higher for patients with depression ($20,794 vs. $14,028) or anxiety ($18,501 vs. $14,320) than those without (p<0.001 for all). The major differences between indirect costs were STD costs whereby the adjusted mean difference between patients with depression vs. without depression were $997 (95% confidence interval (CI) $432-1561), between patients with anxiety vs. without was $268 (95% CI $-158-790). CONCLUSIONS: Significant proportion of PsO patients had depression and anxiety, and patients with depression and anxiety have substantial higher direct and indirect costs than those without.