Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis
Abstract
:1. Introduction
2. Methods
2.1. Stress Evaluation
2.2. Anxiety and Depression
2.3. Salivary Cortisol Measure
2.4. Statistical Analysis
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Michalek, I.M.; Loring, B.; John, S. A systematic review of worldwide epidemiology of psoriasis. J. Eur. Acad. Dermatol. Venereol. 2017, 31, 205–212. [Google Scholar] [CrossRef] [PubMed]
- Stewart, T.J.; Tong, W.; Whitfeld, M.J. The associations between psychological stress and psoriasis: A systematic review. Int. J. Dermatol. 2018, 57, 1275–1282. [Google Scholar] [CrossRef] [PubMed]
- Richards, H.; Ray, D.; Kirby, B.; Mason, D.; Plant, D.; Main, C.; Fortune, D.; Griffiths, C. Response of the hypothalamic-pituitary-adrenal axis to psychological stress in patients with psoriasis. Br. J. Dermatol. 2005, 153, 1114–1120. [Google Scholar] [CrossRef]
- Evers, A.; Verhoeven, E.; Kraaimaat, F.; De Jong, E.; De Brouwer, S.; Schalkwijk, J.; Sweep, F.; Van De Kerkhof, P. How stress gets under the skin: Cortisol and stress reactivity in psoriasis. Br. J. Dermatol. 2010, 163, 986–991. [Google Scholar] [CrossRef]
- Robati, R.M.; Toossi, P.; Rahmati-Roodsari, M.; Khalilazar, S.; Abolhasani, E.; Namazi, N.; Younespour, S. Association of Psoriasis Severity with Serum Prolactin, Thyroid Hormones, and Cortisol before and after Treatment. Sci. World J. 2013, 2013, 1–5. [Google Scholar] [CrossRef] [PubMed]
- Brunoni, A.; Santos, I.; Sabbag, C.; Lotufo, P.; Benseñor, I. Psoriasis severity and hypothalamic-pituitary-adrenal axis function: Results from the CALIPSO study. Braz. J. Med Biol. Res. 2014, 47, 1102–1106. [Google Scholar] [CrossRef] [Green Version]
- Bilgiç, Ö.; Bilgiç, A.; Sivrikaya, A.; Selvi, Y.; Ünlü, A.; Altinyazar, H.C. Association between endocrinological, immunological and psychosocial variables in psoriasis patients. G. Ital. Dermatol. Venereol. 2016, 151, 603–609. [Google Scholar]
- Pietrzak, R.; Rykowski, P.; Pasierb, A.; Bartoszewicz, Z.; Stakun, M.; Rykowska, M.; Karoń, K.; Rudnicka, L.; Czuwara, J. Adrenocorticotropin/cortisol ratio—a marker of psoriasis severity. Adv. Dermatol. Allergol. 2020, 37, 746–750. [Google Scholar] [CrossRef]
- Kwon, C.W.; Fried, R.G.; Nousari, Y.; Ritchlin, C.; Tausk, F. Psoriasis: Psychosomatic, somatopsychic, or both? Clin. Dermatol. 2018, 36, 698–703. [Google Scholar] [CrossRef]
- Taylor, W.; Gladman, D.; Helliwell, P.; Marchesoni, A.; Mease, P.; Mielants, H. CASPAR Study Group Classification criteria for psoriatic arthritis: Development of new criteria from a large international study. Arthritis Rheum. 2006, 54, 2665–2673. [Google Scholar] [CrossRef]
- Bert, F.; Ferrara, M.; Boietti, E.; Langiano, E.; Savatteri, A.; Scattaglia, M.; Moro, G.L.; Leombruni, P.; De Vito, E.; Siliquini, R. Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study. Psychol. Rep. 2020, 29. [Google Scholar] [CrossRef]
- Cohen, S.; Kamarck, T.; Mermelstein, R. A global measure of perceived stress. J. Health Soc. Behav. 1983, 24, 385–396. [Google Scholar] [CrossRef]
- Mondo, M.; Sechi, C.; Cabras, C. Psychometric evaluation of three versions of the Italian Perceived Stress Scale. Curr. Psychol. 2021, 40, 1884–1892. [Google Scholar] [CrossRef]
- Cohen, S.; Williamson, G.M. Perceived stress in a probability sample of the United States. In The Social Psychology of Health; Spacapan, S., Oskamp, S., Eds.; Sage: Newbury Park, CA, USA, 1988; pp. 31–67. [Google Scholar]
- Snaith, R.P.; Zigmond, A.S. HADS: Hospital Anxiety and Depression Scale; NFER Nelson: Windsor, UK, 1994. [Google Scholar]
- Bjelland, I.; Dahl, A.A.; Haug, T.T.; Neckelmann, D. The validity of the Hospital Anxiety and Depression Scale. J. Psychosom. Res. 2002, 52, 69–77. [Google Scholar] [CrossRef]
- Rousset, L.; Halioua, B. Stress and psoriasis. Int. J. Dermatol. 2018, 57, 1165–1172. [Google Scholar] [CrossRef] [PubMed]
- Dalgard, F.J.; Gieler, U.; Tomas-Aragones, L.; Lien, L.; Poot, F.; Jemec, G.; Misery, L.; Szabo, C.; Linder, D.; Sampogna, F.; et al. The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries. J. Investig. Dermatol. 2015, 135, 984–991. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tribó, M.; Turroja, M.; Castaño-Vinyals, G.; Bulbena, A.; Ros, E.; García-Martínez, P.; Tausk, F.; Sagristà, M.; Pujol, R.; Ferran, M.; et al. Patients with Moderate to Severe Psoriasis Associate with Higher Risk of Depression and Anxiety Symptoms: Results of a Multivariate Study of 300 Spanish Individuals with Psoriasis. Acta Derm. Venereol. 2019, 99, 417–422. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Martínez-Ortega, J.M.; Nogueras, P.; Muñoz-Negro, J.E.; Gutiérrez-Rojas, L.; González-Domenech, P.; Gurpegui, M. Quality of life, anxiety and depressive symptoms in patients with psoriasis: A case-control study. J. Psychosom. Res. 2019, 124, 109780. [Google Scholar] [CrossRef] [PubMed]
- Van Beugen, S.; Van Middendorp, H.; Ferwerda, M.; Smit, J.V.; Zeeuwen-Franssen, M.E.J.; Kroft, E.B.M.; De Jong, E.M.G.J.; Donders, A.R.T.; Van de Kerkhof, P.C.M.; Evers, A.W.M. Predictors of perceived stigmatization in patients with psoriasis. Br. J. Dermatol. 2017, 176, 687–694. [Google Scholar] [CrossRef] [PubMed]
- Khoury, L.R.; Danielsen, P.L.; Skiveren, J. Body image altered by psoriasis. A study based on individual interviews and a model for body image. J. Dermatol. Treat. 2013, 25, 2–7. [Google Scholar] [CrossRef]
- Krueger, G.; Koo, J.; Lebwohl, M.; Menter, A.; Stern, R.S.; Rolstad, T. The impact of psoriasis on quality of life: Results of a 1998 National Psoriasis Foundation patient-membership survey. Arch. Dermatol. 2001, 137, 280–284. [Google Scholar]
- Koo, J.; Marangell, L.; Nakamura, M.; Armstrong, A.; Jeon, C.; Bhutani, T.; Wu, J. Depression and suicidality in psoriasis: Review of the literature including the cytokine theory of depression. J. Eur. Acad. Dermatol. Venereol. 2017, 31, 1999–2009. [Google Scholar] [CrossRef]
- Connor, C.J.; Liu, V.; Fiedorowicz, J. Exploring the Physiological Link between Psoriasis and Mood Disorders. Dermatol. Res. Pr. 2015, 2015, 1–11. [Google Scholar] [CrossRef] [Green Version]
- Yang, H.; Zheng, J. Influence of stress on the development of psoriasis. Clin. Exp. Dermatol. 2020, 45, 284–288. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sternberg, E. Neuroendocrine Factors in Susceptibility to Inflammatory Disease: Focus on the Hypothalamic-Pituitary-Adrenal Axis. Horm. Res. 1995, 43, 159–161. [Google Scholar] [CrossRef]
- Epstein, F.H.; Reichlin, S. Neuroendocrine-Immune Interactions. N. Engl. J. Med. 1993, 329, 1246–1253. [Google Scholar] [CrossRef] [PubMed]
- Chrousos, G.P. The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N. Engl. J. Med. 1995, 332, 1351–1362. [Google Scholar] [CrossRef] [PubMed]
- Elenkov, I.J.; Chrousos, G.P. Stress Hormones, Th1/Th2 patterns, Pro/Anti-inflammatory Cytokines and Susceptibility to Disease. Trends Endocrinol. Metab. 1999, 10, 359–368. [Google Scholar] [CrossRef]
- Slominski, A.T.; Brozyna, A.; Tuckey, R. Cutaneous Glucocorticoidogenesis and Cortisol Signaling Are Defective in Psoriasis. J. Investig. Dermatol. 2017, 137, 1609–1611. [Google Scholar] [CrossRef] [PubMed]
- Hannen, R.; Udeh-Momoh, C.; Upton, J.; Wright, M.; Michael, A.; Gulati, A.; Rajpopat, S.; Clayton, N.; Halsall, D.; Burrin, J.; et al. Dysfunctional Skin-Derived Glucocorticoid Synthesis Is a Pathogenic Mechanism of Psoriasis. J. Investig. Dermatol. 2017, 137, 1630–1637. [Google Scholar] [CrossRef]
- Champaneri, S.; Xu, X.; Carnethon, M.; Bertoni, A.; Seeman, T.; DeSantis, A.S.; Roux, A.D.; Shrager, S.; Golden, S.H. Diurnal salivary cortisol is associated with body mass index and waist circumference: The multiethnic study of atherosclerosis. Obes. 2012, 21, E56–E63. [Google Scholar] [CrossRef] [PubMed]
Psoriasis (n = 126) | Controls (n = 116) | p-Value | |
---|---|---|---|
Sex (male/female) | 82/44 | 50/66 | 0.001 |
Age (years) | 53.8 ± 14.1 | 52.1 ± 6.6 | 0.227 |
PASI | 15.8 ± 4.2 | ||
Psoriasis duration (years) | 21.6 ± 14.4 | ||
Body mass index (kg/m2) | 26.6 ± 4.4 | 24.3 ± 3.8 | <0.001 |
Obesity, n (%) | 25 (19.8) | 8 (6.9) | 0.003 |
Arterial hypertension | 37 (29.4) | 12 (10.3) | <0.001 |
Diabetes mellitus | 12 (9.5) | 3 (2.6) | 0.025 |
Dyslipidemia | 16 (12.7) | 6 (5.2) | 0.042 |
Personal history of psychiatric diseases | 1 (0.8) | 1 (0.9) | 0.953 |
Use of benzodiazepines | 2 (1.6) | 2 (1.7) | 0.934 |
Occupational status | <0.001 | ||
Employed | 90 (71.4) | 108 (93.1) | |
Unemployed | 6 (4.8) | 6 (5.2) | |
Retired | 30 (23.8) | 2 (1.7) | |
Educational level | <0.001 | ||
Primary | 22 (19.0) | 3 (2.4) | |
Lower secondary | 47 (40.5) | 5 (4.0) | |
Upper secondary | 46 (39.7) | 56 (44.4) | |
Degree | 11 (9.5) | 52 (41.3) | |
HADS | |||
Depression subscale | 9.5 ± 0.3 | 6.2 ± 0.3 | <0.001 |
Anxiety subscale | 8.2 ± 0.4 | 4.2 ± 0.3 | <0.001 |
PSS | 17.2 ± 0.6 | 15.1 ± 0.8 | 0.0289 |
Variable | β (95% CI) | p-Value |
---|---|---|
PSS * | 2.29 (0.09–4.48) | 0.04 |
HADS-A * | 3.07 (2.17–3.96) | <0.001 |
HADS-D * | 3.78 (2.96–4.60) | <0.001 |
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Gisondi, P.; Geat, D.; Bellinato, F.; Spiazzi, L.; Danese, E.; Montagnana, M.; Lippi, G.; Girolomoni, G. Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis. J. Pers. Med. 2021, 11, 1069. https://doi.org/10.3390/jpm11111069
Gisondi P, Geat D, Bellinato F, Spiazzi L, Danese E, Montagnana M, Lippi G, Girolomoni G. Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis. Journal of Personalized Medicine. 2021; 11(11):1069. https://doi.org/10.3390/jpm11111069
Chicago/Turabian StyleGisondi, Paolo, Davide Geat, Francesco Bellinato, Laura Spiazzi, Elisa Danese, Martina Montagnana, Giuseppe Lippi, and Giampiero Girolomoni. 2021. "Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis" Journal of Personalized Medicine 11, no. 11: 1069. https://doi.org/10.3390/jpm11111069
APA StyleGisondi, P., Geat, D., Bellinato, F., Spiazzi, L., Danese, E., Montagnana, M., Lippi, G., & Girolomoni, G. (2021). Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis. Journal of Personalized Medicine, 11(11), 1069. https://doi.org/10.3390/jpm11111069