Effects of psychosocial interventions on patient-reported outcomes in patients with psoriasis: a systematic review and meta-analysis

Background: Psoriasis can lead to high psychosocial burden, and the occurrence of psoriasis is related to psychological distress.

Objectives: This study provides an overview of psychosocial interventions for patients with psoriasis and examines their effects on patient-reported outcomes.

Methods: A systematic search of four electronic databases (CENTRAL, MEDLINE, Embase and PsycINFO) was conducted in January 2017. All trials on psychosocial interventions for patients with psoriasis that used patient-reported outcomes and a comparison group were included. Data were extracted on intervention, study population and outcomes. Risk of bias was assessed according to the Cochrane Handbook. A meta-analysis on quality of life, depression and anxiety was performed. This review was registered on PROSPERO (CRD42016037934).

Results: Nineteen studies were included. Interventions primarily used cognitive behavioural or mindfulness-based techniques. Risk of bias was mostly rated 'unclear' due to nontransparent reporting (e.g. no study protocols were published, only one study reported blinding of patients). Meta-analysis using standardized mean differences between the intervention and control groups showed significant, small-to-medium effects (given with 95% confidence intervals) on quality of life (0·28, 0·04-0·51; six studies, n = 664) and anxiety (0·36, 0·15-0·57; six studies, n = 363). The effect on depression was not significant (0·37, -0·05 to 0·80; five studies, n = 326).

Conclusions: Psychosocial interventions offer an effective means to improve quality of life and anxiety in patients with psoriasis. Although the importance of such psychosocial aspects for psoriasis is unquestioned, there is a lack of high-quality evaluation studies. Nontransparent reporting of risk of bias, low power and a lack of replication studies make it difficult to reach confident conclusions from the evidence. What's already known about this topic? Psoriasis symptoms and psychosocial burden reinforce one another. Different psychosocial interventions for patients with psoriasis exist to address this problem. Most studies report positive effects on psoriasis severity, and some also on certain patient-reported outcomes such as quality of life. Only a very few interventions have been subject to rigorous testing. Further research is needed on the evaluation of the effects and the methodological quality of these interventions. What does this study add? This review provides a comprehensive overview of psychosocial interventions for patients with psoriasis. It evaluates the effects of the interventions on patient-reported outcomes and rates the methodological quality of their evaluation studies. It underlines the importance and effectiveness of addressing psychosocial burden in patients with psoriasis by identifying adequate interventions. The results of this study show that further research, especially with adequately tested interventions, is strongly needed.