TY - JOUR
T1 - Psychological stress and psoriasis
T2 - a systematic review and meta-analysis
AU - Snast, I.
AU - Reiter, O.
AU - Atzmony, L.
AU - Leshem, Y. A.
AU - Hodak, E.
AU - Mimouni, D.
AU - Pavlovsky, L.
N1 - Publisher Copyright:
© 2017 British Association of Dermatologists
PY - 2018/5
Y1 - 2018/5
N2 - Background: Psychological stress has long been linked with the exacerbation/onset of psoriasis. Objectives: To determine if antecedent psychological stress is associated with the exacerbation/onset of psoriasis. Methods: A search of the PubMed, PsycINFO, Cochrane library and ClinicalTrials.gov databases was performed. Surveys evaluating beliefs about stress reactivity were analysed separately. Suitable studies were meta-analysed. Results: Thirty-nine studies (32 537 patients) were included: 19 surveys, seven cross-sectional studies, 12 case–control studies and one cohort study. Forty-six per cent of patients believed their disease was stress reactive and 54% recalled preceding stressful events. Case–control studies evaluating stressful events rates prior to the exacerbation (n = 6) or onset (n = 6) of psoriasis varied in time lag to recollection (≤ 9 months to ≥ 5 years). Pooling five studies evaluating stressful events preceding onset of psoriasis gave an odds ratio (OR) of 3·4 [95% confidence interval (CI) 1·8–6·4; I 2 = 87%]; the only study evaluating a documented stress disorder diagnosis reported similar rates between patients and controls (OR 1·2, 95% CI 0·8–1·8). Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, whereas two found more frequent/severe preceding events among patients with psoriasis. A small prospective cohort study reported a modest association between stress levels and exacerbation of psoriasis (r = 0·28, P < 0·05). Conclusions: The association between preceding stress and exacerbation/onset of psoriasis is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with exacerbation/onset of psoriasis.
AB - Background: Psychological stress has long been linked with the exacerbation/onset of psoriasis. Objectives: To determine if antecedent psychological stress is associated with the exacerbation/onset of psoriasis. Methods: A search of the PubMed, PsycINFO, Cochrane library and ClinicalTrials.gov databases was performed. Surveys evaluating beliefs about stress reactivity were analysed separately. Suitable studies were meta-analysed. Results: Thirty-nine studies (32 537 patients) were included: 19 surveys, seven cross-sectional studies, 12 case–control studies and one cohort study. Forty-six per cent of patients believed their disease was stress reactive and 54% recalled preceding stressful events. Case–control studies evaluating stressful events rates prior to the exacerbation (n = 6) or onset (n = 6) of psoriasis varied in time lag to recollection (≤ 9 months to ≥ 5 years). Pooling five studies evaluating stressful events preceding onset of psoriasis gave an odds ratio (OR) of 3·4 [95% confidence interval (CI) 1·8–6·4; I 2 = 87%]; the only study evaluating a documented stress disorder diagnosis reported similar rates between patients and controls (OR 1·2, 95% CI 0·8–1·8). Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, whereas two found more frequent/severe preceding events among patients with psoriasis. A small prospective cohort study reported a modest association between stress levels and exacerbation of psoriasis (r = 0·28, P < 0·05). Conclusions: The association between preceding stress and exacerbation/onset of psoriasis is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with exacerbation/onset of psoriasis.
UR - http://www.scopus.com/inward/record.url?scp=85042609859&partnerID=8YFLogxK
U2 - 10.1111/bjd.16116
DO - 10.1111/bjd.16116
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C2 - 29124739
AN - SCOPUS:85042609859
SN - 0007-0963
VL - 178
SP - 1044
EP - 1055
JO - British Journal of Dermatology
JF - British Journal of Dermatology
IS - 5
ER -