Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations

F J Dalgard, Å Svensson, U Gieler, L Tomas-Aragones, L Lien, F Poot, G B E Jemec, L Misery, C Szabo, D Linder, F Sampogna, A W M Evers, J Anders Halvorsen, F Balieva, J Szepietowski, A Lvov, S E Marron, I K Alturnay, A Y Finlay, S S SalekJ Kupfer

Research output: Contribution to journalArticle

Abstract

BACKGROUND: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrist underdiagnose depression. This has not been explored among dermatologists.

OBJECTIVES: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale.

METHODS: The study was an observational cross-sectional multi-centre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in out-patient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders.

RESULTS: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0.4) for all diagnose categories. The true positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in depressed or anxious patients defined by HADS-value >=11) was 44.0% for depression and 35.6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined byHADS-value < 11) was 56.0% for depression and 64.4% for anxiety.

CONCLUSIONS: Dermatologists in Europe tend to underestimate mood disorders. The results point out that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. The psychological suffering of dermatological patients needs to be addressed when present. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalBritish Journal of Dermatology
DOIs
Publication statusE-pub ahead of print - Dec 16 2017

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Referral and Consultation
Anxiety
Depression
Skin Diseases
Mood Disorders
Dermatologists
Psychological Stress
Observational Studies
Psychiatry
Outpatients
Psychology
Physicians

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Dermatologists across Europe underestimate depression and anxiety : results from 3635 dermatological consultations. / Dalgard, F J; Svensson, Å; Gieler, U; Tomas-Aragones, L; Lien, L; Poot, F; Jemec, G B E; Misery, L; Szabo, C; Linder, D; Sampogna, F; Evers, A W M; Anders Halvorsen, J; Balieva, F; Szepietowski, J; Lvov, A; Marron, S E; Alturnay, I K; Finlay, A Y; Salek, S S; Kupfer, J.

In: British Journal of Dermatology, 16.12.2017.

Research output: Contribution to journalArticle

Dalgard, FJ, Svensson, Å, Gieler, U, Tomas-Aragones, L, Lien, L, Poot, F, Jemec, GBE, Misery, L, Szabo, C, Linder, D, Sampogna, F, Evers, AWM, Anders Halvorsen, J, Balieva, F, Szepietowski, J, Lvov, A, Marron, SE, Alturnay, IK, Finlay, AY, Salek, SS & Kupfer, J 2017, 'Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations', British Journal of Dermatology. https://doi.org/10.1111/bjd.16250
Dalgard, F J ; Svensson, Å ; Gieler, U ; Tomas-Aragones, L ; Lien, L ; Poot, F ; Jemec, G B E ; Misery, L ; Szabo, C ; Linder, D ; Sampogna, F ; Evers, A W M ; Anders Halvorsen, J ; Balieva, F ; Szepietowski, J ; Lvov, A ; Marron, S E ; Alturnay, I K ; Finlay, A Y ; Salek, S S ; Kupfer, J. / Dermatologists across Europe underestimate depression and anxiety : results from 3635 dermatological consultations. In: British Journal of Dermatology. 2017.
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title = "Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations",
abstract = "BACKGROUND: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrist underdiagnose depression. This has not been explored among dermatologists.OBJECTIVES: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale.METHODS: The study was an observational cross-sectional multi-centre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in out-patient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders.RESULTS: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0.4) for all diagnose categories. The true positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in depressed or anxious patients defined by HADS-value >=11) was 44.0{\%} for depression and 35.6{\%} for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined byHADS-value < 11) was 56.0{\%} for depression and 64.4{\%} for anxiety.CONCLUSIONS: Dermatologists in Europe tend to underestimate mood disorders. The results point out that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. The psychological suffering of dermatological patients needs to be addressed when present. This article is protected by copyright. All rights reserved.",
author = "Dalgard, {F J} and {\AA} Svensson and U Gieler and L Tomas-Aragones and L Lien and F Poot and Jemec, {G B E} and L Misery and C Szabo and D Linder and F Sampogna and Evers, {A W M} and {Anders Halvorsen}, J and F Balieva and J Szepietowski and A Lvov and Marron, {S E} and Alturnay, {I K} and Finlay, {A Y} and Salek, {S S} and J Kupfer",
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year = "2017",
month = "12",
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journal = "British Journal of Dermatology",
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TY - JOUR

T1 - Dermatologists across Europe underestimate depression and anxiety

T2 - results from 3635 dermatological consultations

AU - Dalgard, F J

AU - Svensson, Å

AU - Gieler, U

AU - Tomas-Aragones, L

AU - Lien, L

AU - Poot, F

AU - Jemec, G B E

AU - Misery, L

AU - Szabo, C

AU - Linder, D

AU - Sampogna, F

AU - Evers, A W M

AU - Anders Halvorsen, J

AU - Balieva, F

AU - Szepietowski, J

AU - Lvov, A

AU - Marron, S E

AU - Alturnay, I K

AU - Finlay, A Y

AU - Salek, S S

AU - Kupfer, J

N1 - This article is protected by copyright. All rights reserved.

PY - 2017/12/16

Y1 - 2017/12/16

N2 - BACKGROUND: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrist underdiagnose depression. This has not been explored among dermatologists.OBJECTIVES: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale.METHODS: The study was an observational cross-sectional multi-centre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in out-patient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders.RESULTS: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0.4) for all diagnose categories. The true positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in depressed or anxious patients defined by HADS-value >=11) was 44.0% for depression and 35.6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined byHADS-value < 11) was 56.0% for depression and 64.4% for anxiety.CONCLUSIONS: Dermatologists in Europe tend to underestimate mood disorders. The results point out that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. The psychological suffering of dermatological patients needs to be addressed when present. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrist underdiagnose depression. This has not been explored among dermatologists.OBJECTIVES: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale.METHODS: The study was an observational cross-sectional multi-centre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in out-patient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders.RESULTS: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0.4) for all diagnose categories. The true positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in depressed or anxious patients defined by HADS-value >=11) was 44.0% for depression and 35.6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined byHADS-value < 11) was 56.0% for depression and 64.4% for anxiety.CONCLUSIONS: Dermatologists in Europe tend to underestimate mood disorders. The results point out that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. The psychological suffering of dermatological patients needs to be addressed when present. This article is protected by copyright. All rights reserved.

U2 - 10.1111/bjd.16250

DO - 10.1111/bjd.16250

M3 - Article

JO - British Journal of Dermatology

JF - British Journal of Dermatology

SN - 0007-0963

ER -