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Can Two Simple Questions Measure Depression in People With Psoriasis?

Posted on January 28, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Brooke Dulka, Ph.D.

  • People with psoriasis are at an increased risk for depression compared to the general population.
  • The Two Questions Test can effectively measure depression in people with psoriasis, even during treatment, according to a recent study.
  • The test results do not represent a formal diagnosis of depression, which should be conducted by a trained clinical psychologist, according to the researchers.

Depression is a common symptom for people living with psoriasis. Research has shown that as many as 28 percent of people with the skin condition also experience depressive symptoms. However, doctors often overlook these symptoms, due to the time constraints of doctor appointments.

A new study has found that, by posing two simple questions, doctors can quickly determine whether someone may have depressive symptoms and whether they’re getting better as a person undergoes psoriasis treatment.

The study, published in the The Journal of Dermatology, evaluated the effectiveness of the Two Questions Test, also known as the Whooley Questions. The yes-or-no questions are:

  1. “Have you frequently felt dejected, sad, glum, or hopeless during the past month?”
  2. “Have you taken significantly less pleasure and joy in things, which you otherwise enjoy doing, over the past month?”

A person could answer the questions in writing while waiting for their doctor appointment to begin. Their physician could then review and discuss their answers during the visit. Based on a conversation with individuals who answer “Yes” to one or both questions, a dermatologist may determine that a referral for further mental health care is needed.

The study looked at a total of 139 individuals who were just starting biologic treatment for moderate to severe psoriasis. Researchers assessed participants’ psoriatic and psychiatric symptoms using several different tests. They first collected scores at a baseline time point, then periodically over the course of 28 weeks.

Overall, researchers found that the Two Questions Test was effective in measuring depression in people with psoriasis. The Dermatology Life Quality Index (which measures skin-related quality of life) was strongly associated with the individuals' responses on the Two Questions Test. This means that depression and skin-related quality of life are linked together in a measurable way. However, there was no relationship between the test scores and skin symptoms.

This study supports the use of the Two Questions Test as an initial screening tool for depression and as a tool for the repeated assessment of depressive symptoms in people with psoriasis. This is important because measuring depression in people with psoriasis is crucial for treating it and improving quality of life.

Researchers noted, however, that the Two Questions Test is not the ideal tool for diagnosing depression. “The gold standard for diagnosing ... depression remains the assessment by a trained clinical psychologist or psychiatrist,” according to the study. “However, in the face of long waiting lists, referral to the primary care physician may serve as an interim solution.”

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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