Questionnaire Helped Detect Depression in Patients With HS

Implementing the Patient Health Questionnaire-2 (PHQ-2) in a hidradenitis suppurativa (HS) clinic improved the ability of dermatologists to detect patients at risk for depression, results from a single-center study showed.

“Depression screening is recommended for all patients with HS,” the study’s first author, Raveena Ghanshani, a third-year medical student and clinical research fellow in dermatology at the University of Southern California (USC), Los Angeles, said in an interview prior to the annual Symposium on Hidradenitis Suppurativa Advances, where the study was presented during an oral abstract session. “However, there is a paucity of data regarding outcomes and feasibility of screening for depression in patients with HS in busy dermatology clinics,” he added.

To evaluate the feasibility of implementing the PHQ-2 questionnaire in a dermatology practice to aid in the early diagnosis and management of depression in HS, Ghanshani and colleagues retrospectively evaluated the charts of 151 patients who completed a PHQ-2 screening questionnaire during visits to the USC HS clinic between January 1, 2024, and June 30, 2024. Of the 151 patients, 80.8% were women, their mean age was 37.5 years, more than half (54.7%) had Hurley stage II HS, 32.4% had Hurley stage III disease, and 12.8% had Hurley stage I HS. Nearly one third of patients (31.9%) were White, nearly 30% were Hispanic, 18.8% were Black, 4.9% were Asian, 2.1% were multiracial, and about 42% identified as “other.”

The researchers found that 26.5% of patients overall screened positive on the PHQ-2, and that the rate of those who screened positive was similar by disease stage (26.3% of those with Hurley stage I HS, 25.9% of those with Hurley stage II HS, and 27.1% of those with Hurley stage III HS).

In other findings, 55% of patients with a positive PHQ-2 result did not have a preexisting diagnosis of depression, and among all patients with a positive PHQ-2 score, 60% were new clinic visits and 40% were follow-up patients. Actions that clinicians took for patients who screened positive for depression included providing mental health resources, referrals for therapy, and advising patients to seek further workup with primary care or psychiatry.

“We have found the PHQ-2 tool to be helpful in identifying patients with HS who may have undiagnosed depression and who might benefit from further evaluation by a mental health professional or primary care provider,” the study’s senior author, Katrina Lee, MD, a dermatologist at USC, told this news organization.

In addition, “it is feasible to implement the PHQ-2 questionnaire during HS visits in our dermatology clinics,” she said. “The questionnaire can be completed in 1 minute and serve as a springboard to start a discussion regarding mental health with patients.” 

In the opinion of Adam Friedman, MD, professor and chair of dermatology at the George Washington University, Washington, DC, who was asked to comment on the study, the findings “highlight more than I believe was initially intended.” The demographics of patients seen in the study, he said, “continue to push us away from the historical and single-center study-driven perception that this is a disease that predominantly impacts those who identify as Black.” In addition, Friedman continued, while one would expect a direct correlation between Hurley stage and increasing severity of depression, “that was not the case, underscoring the importance of not underestimating the burden of mild or early disease.”

He added that he would like to see “follow-up data pertaining to the intervention described to help guide best practices for managing depression and other psychiatric disorders in the HS population.”

The researchers acknowledged certain limitations of the study, including its single-center design and small sample size.

Two of the study authors, Vivian Shi, MD, and Jennifer L. Hsiao, MD, reported having served as an advisory board member, investigator, speaker, and/or received research funding from multiple pharmaceutical companies and serving on the board of directors for the Hidradenitis Suppurativa Foundation. The other authors and Friedman reported having no relevant conflicts to disclose.