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.

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