Depression among people with chronic skin disease at Boru Meda Hospital in Northeast Ethiopia

PLOS ONE RESEARCH ARTICLE Depression among people with chronic skin disease at Boru Meda Hospital in Northeast Ethiopia Yasin Nurye1, Minale Tareke2, Meseret Tadesse2, Maregu Shegaw ID3*, Tesfa Mekonen ID2,4,5 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Psychiatry, Boru Meda General Hospital, Dessie, Ethiopia, 2 Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia, 3 Department of Psychiatry, School of Nursing and Midwifery, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia, 4 School of Psychology, The University of Queensland, Brisbane, Australia, 5 National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia * Abstract OPEN ACCESS Citation: Nurye Y, Tareke M, Tadesse M, Shegaw M, Mekonen T (2023) Depression among people with chronic skin disease at Boru Meda Hospital in Northeast Ethiopia. PLoS ONE 18(2): e0282022. https://doi.org/10.1371/journal.pone.0282022 Editor: Ari Samaranayaka, University of Otago, NEW ZEALAND Received: August 2, 2022 Accepted: February 6, 2023 Background The comorbidity of depression with chronic skin disease negatively affects the quality of life and disease prognosis, creating an immense burden on patients, families, and the wider community. However, there are limited studies conducted on the prevalence of depression and associated factors among people with chronic skin disease in Ethiopia. Objective This study aimed to assess the prevalence and associated factors of depression among people with chronic skin disease at Boru Meda Hospital, Northeast Ethiopia. Published: February 24, 2023 Copyright: © 2023 Nurye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting information file. Funding: This study was funded by Bahir Dar University. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Abbreviations: AD, Atopic Dermatitis; AOR, Adjusted odds ratio; BDI, Beck Depression Inventory; BIDQ, Body-Image Disturbance Methods An institutional-based cross-sectional study was carried out from March 10- April 18, 2021, among a total of 381 people with chronic skin disease. The Patient Health Questioner-9 was used to assess depression. A logistic regression analysis model with an adjusted odds ratio was used to assess the strength of associations between the outcome and predictor variables. P-value < 0.05 was considered statistically significant. Result The magnitude of depression among people with chronic skin disease was 23.6% (95%Cl: 19.8%, 28.6%). We identified significantly increased odds of depression among participants with rural residence (AOR = 3.45, 95% CI: 1.64, 7.28), duration of illness above 5 years (AOR = 3.59, 95% CI: 1.31, 9.85), comorbid medical illness AOR = 2.51, 95% CI: 1.06, 5.98), family history of mental illness (AOR = 3.39, 95% CI: 1.11, 10.41), non-adherence to chronic skin disease medications (AOR = 3.53, 95% CI: 1.20, 10.41), low self-image (AOR = 4.69, 95% CI: 2.25, 9.77), and perceived stigma (AOR = 4.61, 95% CI: 2.14, 9.92). PLOS ONE | https://doi.org/10.1371/journal.pone.0282022 February 24, 2023 1 / 12 PLOS ONE Questionnaire; CI, Confidence Interval; DLQI, Dermatological Life Quality Index. Depression among people with chronic skin disease at Boru Meda Hospital in Northeast Ethiopia Conclusion Depression was common among patients with chronic skin diseases. This study has indicated a need for proper screening of depression in the current medical treatment of patients with chronic skin disease in Boru Meda Hospital, Northeast Ethiopia. Introduction The skin carries immense psychological significance in human life. As such, any disfiguring skin disorders have negative impact on mental health of individuals [1]. Chronic skin diseases including psoriasis, atopic dermatitis, vitiligo, leprosy, and cutaneous leishmaniasis [2, 3] have a devastating effect on a person’s physical, social, and psychological well-being. These psychosocial impacts consequently affect the quality of life [4–6]. The cosmetic disfiguration due to these chronic skin diseases can be a cause of stigma in social situations and patients can develop a low self-image that is directly associated with depression [5, 7–10]. On the other hand, depression is also one of the most common illnesses being the second leading cause of disability worldwide and a major contributor to suicide [11]. Depression is associated with chronic morbidity and mortality, which imposes a substantial burden in developed and developing countries [12] and is highly associated with chronic skin diseases [13]. Patients with chronic skin disease have a higher level of depression and lower level of selfesteem [5] most of the time, chronic skin disease patients who have comorbid depression have suicidal ideation [14]. The magnitude of depression among patients with chronic skin conditions ranges from 9–70% [10, 15, 16]. For instance, depression in psoriasis patients accounts for 42.33%, in vitiligo it is 46.3%, and in atopic dermatitis it is 35.45% [13]. For most patients with chronic skin diseases, their psychiatric diagnosis remains unrecognized and untreated [17]. This is because of the stigma of psychiatric illnesses, and patients prefer the treatment of their dermatological diseases rather than their psychiatric disorders which results in immense psychic and somatic suffering, social and occupational dysfunction, poor academic performance, drug abuse, suicide, and an increase in mortality [17]. Depression acts as a psychosocial stressor in initiating, exacerbating, and causing a relapse of skin problems. Conversely, it could be a consequence of dermatological disorders due to their long course and effects on self-esteem [18]. For example, depression significantly increased the risk of developing psoriasis and vitiligo [19]. On the other hand, vitiligo can lead to depression due to its cosmetically disfiguring visibility [20]. Depression also harms treatment adherence, quality of life, prognosis, and functional capacity, in people with chronic skin disease, resulting in poor vocational, and social functioning [21]. On the other hand, due to their chronic nature, effects on the individuals’ self-image, loss of hope of total recovery, and frequent recurrences, chronic skin diseases are considered one of the most important predisposing factors causing suicidal ideation [22]. The visibility of dermatological disease combined with its psychological impact often leads to feelings of embarrassment, decreas (...truncated)