Title: Mental illness in atopic eczema and psoriasis: how big is the problem, why does it happen and how can we prevent it?
Funder: Department of Health and Social Care

Abstract: Research question Do we need to consider screening for mental illness in people with atopic eczema and psoriasis, and if so who would benefit the most? Background Mental illness is more common in people with skin diseases like atopic eczema and psoriasis, but we do not know the size of the problem, how well it is recognised, or why it happens. Evidence suggests screening for mental illness in those with physical illness is effective, however we do not know if screening is feasible in a real-world setting. Aim To explore why adults with atopic eczema/psoriasis are more likely to develop mental illness, and what could be done to identify psychological distress in these people. Objectives To quantify the burden of mental illness (common mental disorders: depression and anxiety; severe mental illness: schizophrenia, bipolar disorder, and other psychoses) in those with atopic eczema and psoriasis. To establish the risk factors for mental illness in those with atopic eczema and psoriasis and identify population groups most at risk. To quantify and understand the potential burden of unmet mental health need in those with skin disease who may not consult a doctor for their mental health symptoms. To explore the use of new technologies to identify mental health needs in those with skin disease. Methods 1) Cohort studies using UK primary care health data (Clinical Practice Research Datalink) (Objectives 1-3); 2) Cross-sectional and cohort studies using survey and linked electronic health record data from a large prospective cohort of the UK population (UK Biobank) (Objectives 1-3); 3) An exploratory study using self-reported psychological status data captured using handheld touchscreen devices in clinic waiting rooms (Integrating Mental and Physical Healthcare: Research, Training and Services [IMPARTS]) assessing the feasibility of identifying mental health needs using these devices (Objective 4). Timelines for delivery July 2019 to September 2020. Anticipated Impact By quantifying the burden of mental illness in those with atopic eczema/psoriasis, and identifying risk factors for mental illness and unmet need, we will highlight the importance of mental illness, and be able to inform targeted efforts to prevent and treat mental illness in individuals with visible and potentially stigmatising skin disease. Through exploring the feasibility of the use of touchscreen devices in clinic waiting rooms to screen for mental illness in those with skin disease, we will investigate a possible approach to the delivery of mental health screening. Earlier recognition (or, potentially, recognition of mental illness in those who may otherwise have been missed) and management of mental illness would limit their negative impact. Dissemination We will publish our results in academic journals at key meetings, and collaborate with patients already involved in the study to share our results with patients and the public. If our findings identify a substantial need, we will apply for further funding to support more extensive public engagement to highlight the problem and provide qualitative information, and involve GPs in discussing the utility of implementing routine mental health screening.

Lay abstract: Aim To explore why adults with eczema and psoriasis are more likely to develop mental illness, and what could be done to identify mental health issues in these people. Background Mental illness is more common in people with skin diseases like eczema and psoriasis, but we do not know why. Possible causes include socioeconomic deprivation, poor sleep quality, poor lifestyle choices or inflammation. Identifying the types of people most at risk of mental illness would help target screening to identify psychological distress at those who need it most. Screening might be easily delivered using touchscreen devices (e.g. iPads) in clinic waiting rooms. Earlier recognition (or, potentially, recognition of mental illness in those who may otherwise have been missed) and management of mental illness would help improve people s lives. Design/Methods We will use three sources of information about people: 1) Every time people interact with either their GP or a hospital information is added to their electronic health record. We will use routinely-collected data from these encounters to follow very large numbers of people, with and without skin disease, over time to see if those with skin disease are more likely to develop mental illness, and to identify the risk factors and people most affected. 2) We will do similar studies using information from a large study of adults across the UK. It includes over half a million adults who are being followed over time from an initial comprehensive set of questionnaires and health assessments. The study has collected information on important measures (including sleep quality) that might not be available or accurate in health record data alone, and also includes individuals who may not consult their doctor for their mental health symptoms. We will therefore be able to explore the burden of potentially unmet mental health need in those with skin disease. 3) Touchscreen devices are being used in the waiting rooms of some hospital skin clinics to identify mental illness using screening questions that GPs regularly use to assess patients. We will use information collected using these touchscreen devices to explore if using them is practical. Patient/Public Involvement People with eczema/psoriasis have help develop this application, and will be involved throughout; playing an important role in interpreting and communicating our findings through innovative methods including video storyboards and a theatre production (funded by Wellcome). Dissemination We will collaborate with patient representatives to share our results with others (e.g. Twitter and workshops), and present our results in academic journals and at key meetings. If we identify a substantial need, we will apply for more funding to support work to highlight and explore the problem with the public, and involve GPs in discussing their thoughts about routine mental health screening.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH;SKIN