The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis.

BACKGROUND: Sparse information is available concerning mental health issues in psoriasis, psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients. OBJECTIVE: To estimate risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, PsA and AS, respectively, compared with the general population. METHODS: This population-based cohort study analysed 36 214 psoriasis patients, 5138 PsA patients and 1878 AS patients who were frequency-matched with a general population cohort. Annual incidence rate of depression, suicidal ideation and suicide attempt was calculated separately for psoriasis, PsA and AS. RESULTS: There was an increased risk of depression in the three cohorts; adjusted IRR: psoriasis, 1.14 (95% CI, 1.11, 1.17); PsA, 1.22 (95% CI, 1.16, 1.29); AS, 1.34 (95% CI, 1.23, 1.47). There was no significantly increased risk for suicidal ideations or suicide attempt among psoriasis, PsA or AS patients. LIMITATIONS: Patients were not excluded if previously diagnosed with depression, suicidal ideation or suicide attempt. Suicide attempt and completed suicide analyses were not adjusted for presence of depression. Use of systemic psoriasis treatment to measure severe psoriasis could lead to psoriasis severity misclassification. CONCLUSION: The risk of depression, but not suicidal ideation or suicide attempt, was significantly increased in patients with psoriasis, PsA and AS.

How schools perceive the school health service.

An awareness by health professionals of changing priorities facing the School Health Service (SHS) has led to increased attempts to evaluate current practice. In the present study we set out to examine how schools perceive the SHS, to identify their concerns and obtain their suggestions for improvements. Despite direct and repeated personal communication, only 26 questionnaires were returned out of 64 sent to primary and post primary schools. The majority of responses indicated a lack of knowledge about the various aspects of the SHS and a request for more information. Half the questionnaires indicated dissatisfaction with the current SHS--particular problems identified were poor communication, lack of information and inability to deal with social problems. Suggestions made by schools to improve the SHS include improved communication between schools, SHS and parents, better and increased health education. Schools identified the current health needs of pupils as health education; social, family and behavioural problems; and developmental problems. Overall those schools who responded welcomed the approach from the SHS.