Psychiatric comorbidity in patients with Psoriasis: a cross sectional study from North India

Psychiatric comorbidity in patients with Psoriasis: a cross sectional study from North India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychiatric comorbidity in patients with Psoriasis: a cross sectional study from North India Kriti Sahore, Dinesh Dutt Sharma, Suman Lata, Ghanshyam Verma, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4999262/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Apr, 2025 Read the published version in SN Comprehensive Clinical Medicine → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Psoriasis is a psychocutaneous disorder whose prognosis is affected by psychological factors. Despite the psychological impact of the disease only 33% of the sufferers receive mental healthcare. The current study was planned to estimate the prevalence and factors affecting psychiatric co-morbidities among psoriasis patients in a tertiary care hospital. Materials and methods: 288 consecutive patients diagnosed with psoriasis of the age 18 and above were inducted in the study. Patient were included after signing informed consent. Patient particulars were noted in the sociodemographic profile sheet and clinical profile sheet designed for the study. Diagnosis of psychiatric disorders was made according to ICD-10. If the patients are found to have anxiety or depressive disorders, the severity of the same was assessed by using appropriate scales. Result: Anxiety was reported in 66 (22.9%) patients. Mild depression found in 23 (8.0%) patients, moderate depression occurred in 25 (8.7%) patients, and severe depression recorded in 23 (8.0%) patients. Psychiatric comorbidity was present in 74.3%, with maximum patients being diagnosed with anxiety disorder unspecified. The association between psychiatric comorbidity and higher educational level, living in joint families, in urban areas and lower middle socioeconomic status was statistically significant. Conclusion: Our study showed the psychiatric burden to be significant in patients with psoriasis. It represents an unmet need with treatment of psychiatric comorbidity leading to improved quality of life. Psoriasis Psychiatric comorbidity anxiety depression Figures Figure 1 Figure 2 Figure 3 Introduction Psoriasis is a psychocutaneous disorder with multiple factors involved in its induction and exacerbation. 1 Indian studies have shown the incidence of psoriasis in between 0.8 to 5.6%. 2 While the disease’s progress is affected by psychological factors, the illness in itself affects the psyche of the person especially due to its chronic nature and visible deformity which negatively affecting the quality of life. 3,4,5 The relationship between psoriasis and mental illness, as well as any possible underlying pathophysiologic causes for this relationship have a biological basis also with inflammatory pathways being implicated. 6 Studies have shown a strong association between depressive symptoms, suicidal ideation, and psoriasis. 7 Kumar et al. reported psychiatric morbidity in psoriasis patients to the tune of 52% having light anxiety, 36% having mild to moderate anxiety, and 12% having moderate to severe anxiety. 8 In a cross-sectional study, by Lakshmy et al. reported prevalence of 78.9% for depression and 76.7% for anxiety. 9 Another study confirmed the increased number of psychiatric diagnoses in patients with psoriasis, with 38.5% having had a lifetime psychiatric disorder diagnosis compared with 16.7% of patients with other conditions. 10 Despite the psychological impact of the disease only 33% of the sufferers receive mental healthcare. 11 With a dearth of studies from India, the current study was planned to estimate the prevalence and factors affecting psychiatric co-morbidities among psoriasis patients in a tertiary care hospital. Material and methods The cross sectional analytical study was carried out in the Department of Psychiatry. Patients was recruited from Dermatology outpatient department (OPD) and inpatient department (IPD). 288 consecutive patients diagnosed with psoriasis of the age 18 and above were inducted in the study. Patient with history of traumatic brain injury (significant head injury) / any organic disease-causing Psychiatric co-morbidity in past/ present, patients already diagnosed with psychiatric illness before being diagnosed with psoriasis and those unwilling or unable to give consent were excluded from the study. All eligible patients signed informed consent before participating in the study. Before starting the study was approved from the institute ethics committee (IEC). Patient particulars were noted in the sociodemographic profile sheet and clinical profile sheet designed for the study. Diagnosis of psychiatric disorders was made according to ICD-10. If the patients are found to have anxiety or depressive disorders, the severity of the same was assessed by using appropriate scales such as: Hamilton Depression Rating Scale (HAM- D), or Hamilton Anxiety Rating Scale (HAM-A). Medical comorbidities of the patients were assessed from history, examination and medical records and was confirmed by a medicine specialist as well. Statistical analysis Descriptive data on socio demographic and clinical variables were analyzed by using percentage, mean and standard deviation. The differences in the distribution of categorical and continuous variables was compared by using chi2test and by unpaired t test respectively.2-tailed value of < 0.05 was taken as statistically significant. Data was analyzed using statistical software SPSS info version 27.0. Results A total of 288 patients were evaluated. Majority of patients belong to the age group of 36-60 years (58%) while the rest of patients belong to the age group of 18-35 years (42%). Majority of the patients was male (53.1%) followed by females (46.9%). Sociodemographic profile of patients were as given in table 1. Table 1: Sociodemographic profile Sociodemographic Profile of patients recruited Category Number Percent Marital status Unmarried 71 24.7 Married 190 66.0 Divorced 27 9.4 Education status No formal Education 50 17.4 Up to 12th Standard 132 45.8 Graduation 89 30.9 Postgraduation 17 5.9 Occupation Unemployed 106 36.8 Employed 182 63.2 Residence Rural 183 63.5 Urban 105 36.5 Family structure Nuclear 109 37.8 Extended/Joint 179 62.2 Socioeconomic status according to Modified Kuppuswamy scale Upper 10 3.5 Upper middle 61 21.2 Lower middle 84 29.2 Upper lower 61 21.2 Lower 72 25.0 Clinical profile Disease duration 10 Years 52 18.1 Psychiatric comorbidity: Anxiety was reported in 66 (22.9%) patients. Mild anxiety found in 27 (9.4%) patients (HAM-A score <17), mild to moderate anxiety found in 24 (8.3%) patients, and moderate to severe anxiety found in 15 (5.2%) patients as shown in figure number 1. Mild to severe depression was reported in 71 (24.7%) patients. Mild depression found in 23 (8.0%) patients, moderate depression occurred in 25 (8.7%) patients, and severe depression recorded in 23 (8.0%) patients. Mild to moderate (9.6%) and moderate to severe (9.6%) anxiety tends to occurred in advanced age at a higher rate as compared to the age group of 18-35 years, however, the difference was not statistically significant (p value= 0.428) which is shown in figure number 2. Severe depression tends to occurred in age group of 30-60 years (11.1%) at a higher rate as compared to the age group of 18-35 years (5.2%), however, the difference was not statistically significant (p value= 0.129) as shown in figure number 3. Mild to moderate (9.6%) and moderate to severe (5.4%) anxiety tends to occurred in female at a higher rate as compared to the males, however, the difference was not statistically significant. Severe depression tends to occurred in females (7.4%) at a higher rate as compared to the males (3.3%), however, the difference was not statistically significant. Diagnosis according to ICD 10 Table 2: Prevalence of Psychiatric comorbidity Neuropsychiatry symptoms Number Percent Nil psychiatry 74 25.7 Adjustment disorder 35 12.2 Anxiety disorder unspecified 56 19.4 Mixed anxiety and depression 40 13.9 Mild to Moderate Depressive episode 44 15.3 Severe Depressive episode 25 8.7 Nonorganic insomnia 14 4.9 Total 288 100.0 Psychiatric comorbidity was present in 74.3%, with maximum patients being diagnosed with anxiety disorder unspecified. The association between education level and psychiatric diagnosis was statistically significant. (p value: 0.001). Patients having psoriasis who were diagnosed with psychiatric illnesses resided significantly more in rural areas (p value:0.001). Those living in joint families had significantly more psychiatric illnesses than nuclear family. (p value: 0.001). Psychiatric diagnosis were significantly more in patients belonging to lower middle socioeconomic status. (p value: 0.001) Table 3: Association between sociodemographic factors and psychiatric comorbidity Sociodemographic factor Nil Psychiatry Psychiatric comorbidity P value Education No formal Education Up to 12th Standard Graduation Post graduation 5 45 20 4 45 87 69 13 0.001* Occupation Unemployed Employed 23 51 83 131 0.707 Residence Rural Urban 37 37 146 68 0.001* Marital status Unmarried Married Divorced 19 47 8 52 143 19 0.434 Family structure Nuclear Joint 26 48 83 131 0.001* Socioeconomic status Upper Upper middle Lower middle Upper lower Lower 4 27 16 9 18 6 34 68 52 54 0.001* Discussion Psoriasis is a chronic inflammatory disease of the skin and joints which imposes a unique burden notably in terms of poor body image and social perception, due to the condition’s increased frequency and visible skin discoloration. 12 Psoriasis patients experience stress associated to their illness, cosmetic deformities, and social stigma, which impairs their physical, psychological, vocational, and social functioning. This leads to psychological disorders including depression and anxiety as well as other associated comorbidities. 13 This study exemplifies the need of consultation liaison between dermatologists, psychiatrists, and psychologists for comprehensive care and treatment of patients with psoriasis. Age Majority of the patients was male (53.1%) followed by females (46.9%) in our study which is comparable to other studies like Sarkar et al., Mohapatra et al. and Kumar et al. 2 , 3 , 8 This may be due to females being less treatment seeker than men. In the study by Kumar et al. majority of the population in the study group were married (n = 70, 77.8%) which is corroborated with the findings of present study. 8 A majority of study population was from rural areas (63.5%) which is in contrast to the study by Kumar et al. which showed most of patients were from an urban background (62.2%) as well as the observations reported by the Lakshmy et al. 8 , 9 Patients with lower educational attainment and a rural background may have fewer coping mechanisms and, as a result, greater mental health problems. Socioeconomic status indicates that most of patients belong to lower middle class (29.2%) which was in contrast to that of study by Kumar et al. where majority of patients belonged to the upper lower socioeconomic class (n = 47, 52.2%). 8 This can be attributed to our hospital being a state level hospital and majority of the population in the state being rural. In present study, anxiety was reported in 22.9% patients and mild to severe depression was reported in 24.7% patients. Mattoo et al., assessed psychiatric morbidity among psoriasis out-patients using GHQ and psychiatric morbidity was reported in 24.3% of cases which is corroborated with the present study. 13 In the study by Sarkar et al., the psychiatric morbidity was assessed by SRQ and found to be 62.5%. 3 According to a systemic review by Gosh et al., patients with psoriasis showed prevalence of depression varying from 8.5–89.1% and reported that both depressive and anxiety condition tends to occur together in individuals with psoriasis which support finings of present study. 14 The combined prevalence of mild, moderate, and severe depression in the Mohapatra et al. research was 44.4%. 2 Present study was limited by the small sample size, due to which results of present study could not be generalized for a larger cohort. It was a single centric study and results may not be applicable for larger demographics. A further multicentric study with ample sample is required to validate the results of present study. Current study elucidates the need of management of psychiatric manifestations in patients with psoriasis for comprehensive care and better quality of life for the patients. Declarations 1. Funding: none 2. Conflicts of interest/Competing interests :The authors declare no competing interests. 3. Ethics approval: study approved by Institutional ethics committee of Indira Gandhi Medical College, Shimla, Himachal Pradesh. 4. Consent to participate: Written consents taken from all participants. 5. Written Consent for publication: Consent has been taken from the institute and all authors for publication 6. Availability of data and material: Data can be made available on request. 7. Code availability: NA 8. Authors Contributions: K.S. , D.D.S, S.L, G.S were contributed to the conception and design of work K.S. was involved in acquisition, analysis, or interpretation of data, drafting the work, S.J. , S.L. revised the work, S.J, K.S. wrote the main manuscript text, prepared the figures and text All authors reviewed the manuscript. References Christophers E. Psoriasis− epidemiology and clinical spectrum. Clin Exp Dermatol. 2001;26(4):314-20. Mohapatra B, Chakraborty K, Sinha N, Mondal A, Mukherjee P, Chatterjee M. Prevalence of Psychiatric Comorbidities in Patients with Psoriasis: A Cross-sectional Study from a Tertiary Care Hospital in Eastern India. Indian Journal of Private Psychiatry. 2020;14(2):68-74. Sarkar S, Sarkar A, Saha R, Sarkar T. Psoriasis and psychiatric morbidity: a profile from a tertiary care centre of Eastern India. Journal of family medicine and primary care. 2014;3(1):29-32. Hayes J, Koo J. Psoriasis: depression, anxiety, smoking, and drinking habits. Dermatol Ther. 2010;23(2):174-80. Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T, editors. Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. Journal of Investigative Dermatology Symposium Proceedings; 2004: Elsevier. Hedemann TL, Liu X, Kang CN, Husain MI. Associations between psoriasis and mental illness: an update for clinicians. Gen Hosp Psychiatry. 2022;75:30-7. Gupta MA, Schork NJ, Gupta AK, Kirkby S, Ellis CN. Suicidal ideation in psoriasis. Int J Dermatol. 1993;32(3):188-90. Kumar A, Bhuyan D, Barua S, Dihingia S, Borgohain L. Psychiatric Morbidities and Their Impact on Quality of Life in Patients With Psoriasis. Cureus. 2023;15(8). Lakshmy S, Balasundaram S, Sarkar S, Audhya M, Subramaniam E. A cross-sectional study of prevalence and implications of depression and anxiety in psoriasis. Indian J Psychol Med. 2015;37(4):434-40. Pompili M, Innamorati M, Trovarelli S, Narcisi A, Bellini S, Orsini D, et al. Suicide risk and psychiatric comorbidity in patients with psoriasis. J Int Med Res. 2016;44(1_suppl):61-6. Goyal S, Pisharody RR, Nath S. Psychiatric morbidity in psoriasis: A case-control study. Journal of Marine Medical Society. 2017;19(1):18-23. Kowalewska B, Krajewska-Kułak E, Sobolewski M. The impact of stress-coping strategies and the severity of psoriasis on self-esteem, illness acceptance and life satisfaction. Dermatology and Therapy. 2022;12(2):529-43. Mattoo S, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in psoriasis: Prevalence and correlates in India. Ger J Psychiatry. 2005;8:17-22. Ghosh A, Ghosh A, SK MI, Oza R. Psychological impact on the quality-of-life in patients of psoriasis vulgaris: A systemic review. Asian Journal of Medical Sciences. 2024;15(5):260-8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Apr, 2025 Read the published version in SN Comprehensive Clinical Medicine → Version 1 posted Editorial decision: Revision requested 18 Sep, 2024 Editor assigned by journal 17 Sep, 2024 Submission checks completed at journal 17 Sep, 2024 First submitted to journal 29 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4999262","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":355710936,"identity":"09f3a7fb-3303-4bd9-bd89-8b139ad79137","order_by":0,"name":"Kriti Sahore","email":"","orcid":"","institution":"Indira Gandhi Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kriti","middleName":"","lastName":"Sahore","suffix":""},{"id":355710937,"identity":"bdc6b7ac-ec86-43c6-bc18-6a480797f3ca","order_by":1,"name":"Dinesh Dutt Sharma","email":"","orcid":"","institution":"Indira Gandhi Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dinesh","middleName":"Dutt","lastName":"Sharma","suffix":""},{"id":355710938,"identity":"de61dcf3-f49a-4275-9304-1c5a301e4541","order_by":2,"name":"Suman Lata","email":"","orcid":"","institution":"Indira Gandhi Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Suman","middleName":"","lastName":"Lata","suffix":""},{"id":355710939,"identity":"90b468df-a3de-4db7-96fd-09eec47ef669","order_by":3,"name":"Ghanshyam Verma","email":"","orcid":"","institution":"Indira Gandhi Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ghanshyam","middleName":"","lastName":"Verma","suffix":""},{"id":355710940,"identity":"b46d6738-f104-4590-80da-85563bdcad3a","order_by":4,"name":"Sumeesha Jaswal","email":"data:image/png;base64,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","orcid":"","institution":"Indira Gandhi Medical College and Hospital","correspondingAuthor":true,"prefix":"","firstName":"Sumeesha","middleName":"","lastName":"Jaswal","suffix":""}],"badges":[],"createdAt":"2024-08-29 17:00:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4999262/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4999262/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s42399-025-01835-1","type":"published","date":"2025-04-07T16:05:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66329481,"identity":"aa52ac4e-c6fb-4a02-a8fb-a16b8aa07502","added_by":"auto","created_at":"2024-10-10 13:15:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22083,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Anxiety symptoms\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4999262/v1/69252a7aeb38d6f4208fc9ce.png"},{"id":66325435,"identity":"6b760827-e288-4f0c-a12f-9d53ff37cd4f","added_by":"auto","created_at":"2024-10-10 12:51:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":12780,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Anxiety according to the age group.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4999262/v1/26e6d94bdc718563d3e7c438.png"},{"id":66327434,"identity":"e38bc164-fd05-4ad3-8ae9-41ea87971ac5","added_by":"auto","created_at":"2024-10-10 13:07:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":11564,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of\u003cstrong\u003e \u003c/strong\u003eDepression according to the age group.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4999262/v1/19d004d67353347c2d3e98d3.png"},{"id":80558683,"identity":"82e79cbd-bd35-4b62-aba5-692de354ce35","added_by":"auto","created_at":"2025-04-14 16:16:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":532515,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4999262/v1/6fbafb97-5f3c-4adb-bec2-5c735525e634.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychiatric comorbidity in patients with Psoriasis: a cross sectional study from North India","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePsoriasis is a psychocutaneous disorder with multiple factors involved in its induction and exacerbation.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIndian studies have shown the incidence of psoriasis in between 0.8 to 5.6%.\u003csup\u003e2\u003c/sup\u003e While the disease’s progress is affected by psychological factors, the illness in itself affects the psyche of the person especially due to its chronic nature and visible deformity which negatively affecting the quality of life.\u003csup\u003e3,4,5\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe relationship between psoriasis and mental illness, as well as any possible underlying pathophysiologic causes for this relationship have a biological basis also with inflammatory pathways being implicated.\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eStudies have shown \u0026nbsp;a strong association between depressive symptoms, suicidal ideation, and psoriasis.\u003csup\u003e7\u003c/sup\u003e\u0026nbsp; Kumar et al. reported \u0026nbsp;psychiatric morbidity in psoriasis patients to the tune of 52% having light anxiety, 36% \u0026nbsp; having mild to moderate anxiety, and 12% having moderate to severe anxiety.\u003csup\u003e8\u003c/sup\u003e In a cross-sectional study, by Lakshmy et al. reported prevalence of 78.9% for depression and 76.7% for anxiety.\u003csup\u003e9\u003c/sup\u003e Another study confirmed the increased number of psychiatric diagnoses in patients with psoriasis, with 38.5% having had a lifetime psychiatric disorder diagnosis compared with 16.7% of patients with other conditions.\u003csup\u003e10\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the psychological impact of the disease only 33% of the sufferers receive mental healthcare.\u003csup\u003e11\u003c/sup\u003e With a dearth of studies from India, the current study was planned to estimate the prevalence and factors affecting psychiatric co-morbidities among psoriasis patients in a tertiary care hospital.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThe cross sectional analytical study was carried out in the Department of Psychiatry. Patients was recruited from Dermatology outpatient department (OPD) and inpatient department (IPD). 288 consecutive patients diagnosed with psoriasis of the age 18 and above were inducted in the study. Patient with history of traumatic brain injury (significant head injury) / any organic disease-causing Psychiatric co-morbidity in past/ present, patients already diagnosed with psychiatric illness before being diagnosed with psoriasis and those unwilling or unable to give consent were excluded from the study. All eligible patients signed informed consent before participating in the study. Before starting the study was approved from the institute ethics committee (IEC).\u003c/p\u003e \u003cp\u003ePatient particulars were noted in the sociodemographic profile sheet and clinical profile sheet designed for the study. Diagnosis of psychiatric disorders was made according to ICD-10. If the patients are found to have anxiety or depressive disorders, the severity of the same was assessed by using appropriate scales such as: Hamilton Depression Rating Scale (HAM- D), or Hamilton Anxiety Rating Scale (HAM-A). Medical comorbidities of the patients were assessed from history, examination and medical records and was confirmed by a medicine specialist as well.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive data on socio demographic and clinical variables were analyzed by using percentage, mean and standard deviation. The differences in the distribution of categorical and continuous variables was compared by using chi2test and by unpaired t test respectively.2-tailed value of \u0026lt;\u0026thinsp;0.05 was taken as statistically significant. Data was analyzed using statistical software SPSS info version 27.0.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 288 patients were evaluated. Majority of patients belong to the age group of 36-60 years (58%) while the rest of patients belong to the age group of 18-35 years (42%). Majority of the patients was male (53.1%) followed by females (46.9%).\u003c/p\u003e\n\u003cp\u003eSociodemographic profile of patients were as given in table 1.\u003c/p\u003e\n\u003cp\u003eTable 1: Sociodemographic profile\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003eSociodemographic Profile of patients recruited\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e66.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNo formal Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUp to 12th Standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e30.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePostgraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily structure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNuclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eExtended/Joint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e62.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocioeconomic status according to Modified Kuppuswamy scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUpper middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eLower middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUpper lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical profile\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDisease duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026lt;2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e2-5 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e6-10 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026gt;10 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePsychiatric comorbidity:\u003c/p\u003e\n\u003cp\u003eAnxiety was reported in 66 (22.9%) patients. Mild anxiety found in 27 (9.4%) patients (HAM-A score \u0026lt;17), mild to moderate anxiety found in 24 (8.3%) patients, and moderate to severe anxiety found in 15 (5.2%) patients as shown in figure number 1.\u003c/p\u003e\n\u003cp\u003eMild to severe depression was reported in 71 (24.7%) patients. Mild depression found in 23 (8.0%) patients, moderate depression occurred in 25 (8.7%) patients, and severe depression recorded in 23 (8.0%) patients.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Mild to moderate (9.6%) and moderate to severe (9.6%) anxiety tends to occurred in advanced age at a higher rate as compared to the age group of 18-35 years, however, the difference was not statistically significant (p value= 0.428) which is shown in figure number 2.\u003c/p\u003e\n\u003cp\u003eSevere depression tends to occurred in age group of 30-60 years (11.1%) at a higher rate as compared to the age group of 18-35 years (5.2%), however, the difference was not statistically significant (p value= 0.129) as shown in figure number 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMild to moderate (9.6%) and moderate to severe (5.4%) anxiety tends to occurred in female at a higher rate as compared to the males, however, the difference was not statistically significant.\u003c/p\u003e\n\u003cp\u003eSevere depression tends to occurred in females (7.4%) at a higher rate as compared to the males (3.3%), however, the difference was not statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e\u0026nbsp;Diagnosis according to ICD 10\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 2: Prevalence of Psychiatric comorbidity\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eNeuropsychiatry symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eNil psychiatry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eAdjustment disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eAnxiety disorder unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eMixed anxiety and depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eMild to Moderate Depressive episode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eSevere Depressive episode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eNonorganic insomnia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47.7396%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9548%;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePsychiatric comorbidity was present in 74.3%, with maximum patients being diagnosed with anxiety disorder unspecified.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The association between education level and psychiatric diagnosis was statistically significant. (p value: 0.001). Patients having psoriasis who were diagnosed with psychiatric illnesses resided \u0026nbsp; significantly more in rural areas (p value:0.001).\u003c/p\u003e\n\u003cp\u003eThose living in joint families had significantly more psychiatric illnesses than nuclear family. (p value: 0.001). Psychiatric diagnosis were significantly more in patients belonging to lower middle socioeconomic status. (p value: 0.001)\u003c/p\u003e\n\u003cp\u003eTable 3: Association between sociodemographic factors and psychiatric comorbidity\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2372%;\"\u003e\n \u003cp\u003eSociodemographic factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8269%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3526%;\"\u003e\n \u003cp\u003eNil Psychiatry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9936%;\"\u003e\n \u003cp\u003ePsychiatric comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5897%;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2372%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.8269%;\"\u003e\n \u003cp\u003eNo formal Education\u003c/p\u003e\n \u003cp\u003eUp to 12th Standard\u003c/p\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003cp\u003ePost graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3526%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.9936%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5897%;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2372%;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8269%;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3526%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9936%;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5897%;\"\u003e\n \u003cp\u003e0.707\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2372%;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8269%;\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3526%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9936%;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5897%;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2372%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8269%;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3526%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9936%;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5897%;\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2372%;\"\u003e\n \u003cp\u003eFamily structure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8269%;\"\u003e\n \u003cp\u003eNuclear\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eJoint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3526%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9936%;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5897%;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2372%;\"\u003e\n \u003cp\u003eSocioeconomic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8269%;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003cp\u003eUpper middle\u003c/p\u003e\n \u003cp\u003eLower middle\u003c/p\u003e\n \u003cp\u003eUpper lower\u003c/p\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3526%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9936%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003ePsoriasis is a chronic inflammatory disease of the skin and joints which imposes a unique burden notably in terms of poor body image and social perception, due to the condition\u0026rsquo;s increased frequency and visible skin discoloration.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePsoriasis patients experience stress associated to their illness, cosmetic deformities, and social stigma, which impairs their physical, psychological, vocational, and social functioning. This leads to psychological disorders including depression and anxiety as well as other associated comorbidities.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study exemplifies the need of consultation liaison between dermatologists, psychiatrists, and psychologists for comprehensive care and treatment of patients with psoriasis.\u003c/p\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003eMajority of the patients was male (53.1%) followed by females (46.9%) in our study which is comparable to other studies like Sarkar et al., Mohapatra et al. and Kumar et al.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e This may be due to females being less treatment seeker than men.\u003c/p\u003e \u003cp\u003eIn the study by Kumar et al. majority of the population in the study group were married (n\u0026thinsp;=\u0026thinsp;70, 77.8%) which is corroborated with the findings of present study.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA majority of study population was from rural areas (63.5%) which is in contrast to the study by Kumar et al. which showed most of patients were from an urban background (62.2%) as well as the observations reported by the Lakshmy et al.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Patients with lower educational attainment and a rural background may have fewer coping mechanisms and, as a result, greater mental health problems.\u003c/p\u003e \u003cp\u003eSocioeconomic status indicates that most of patients belong to lower middle class (29.2%) which was in contrast to that of study by Kumar et al. where majority of patients belonged to the upper lower socioeconomic class (n\u0026thinsp;=\u0026thinsp;47, 52.2%).\u003csup\u003e8\u003c/sup\u003e This can be attributed to our hospital being a state level hospital and majority of the population in the state being rural.\u003c/p\u003e \u003cp\u003eIn present study, anxiety was reported in 22.9% patients and mild to severe depression was reported in 24.7% patients. Mattoo et al., assessed psychiatric morbidity among psoriasis out-patients using GHQ and psychiatric morbidity was reported in 24.3% of cases which is corroborated with the present study.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e In the study by Sarkar et al., the psychiatric morbidity was assessed by SRQ and found to be 62.5%.\u003csup\u003e3\u003c/sup\u003e According to a systemic review by Gosh et al., patients with psoriasis showed prevalence of depression varying from 8.5\u0026ndash;89.1% and reported that both depressive and anxiety condition tends to occur together in individuals with psoriasis which support finings of present study.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e The combined prevalence of mild, moderate, and severe depression in the Mohapatra et al. research was 44.4%.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePresent study was limited by the small sample size, due to which results of present study could not be generalized for a larger cohort. It was a single centric study and results may not be applicable for larger demographics. A further multicentric study with ample sample is required to validate the results of present study.\u003c/p\u003e \u003cp\u003eCurrent study elucidates the need of management of psychiatric manifestations in patients with psoriasis for comprehensive care and better quality of life for the patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e1. Funding: none\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Conflicts of interest/Competing interests :The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e3. Ethics approval: study approved by Institutional ethics committee of Indira Gandhi Medical College, Shimla, Himachal Pradesh.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Consent to participate: Written consents taken from all participants.\u003c/p\u003e\n\u003cp\u003e5. Written Consent for publication: Consent has been taken from the institute and all authors for publication\u003c/p\u003e\n\u003cp\u003e6. Availability of data and material: Data can be made available on request.\u003c/p\u003e\n\u003cp\u003e7. Code availability: NA\u003c/p\u003e\n\u003cp\u003e8. Authors Contributions:\u003c/p\u003e\n\u003cp\u003eK.S. , D.D.S, S.L, G.S were contributed to the conception and design of work\u003c/p\u003e\n\u003cp\u003eK.S. was involved in acquisition, analysis, or interpretation of data, drafting the work,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eS.J. , S.L. revised the work,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eS.J, K.S. wrote the main manuscript text, prepared the figures and text\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eChristophers E. Psoriasis\u0026minus; epidemiology and clinical spectrum. Clin Exp Dermatol. 2001;26(4):314-20.\u003c/li\u003e\n \u003cli\u003eMohapatra B, Chakraborty K, Sinha N, Mondal A, Mukherjee P, Chatterjee M. Prevalence of Psychiatric Comorbidities in Patients with Psoriasis: A Cross-sectional Study from a Tertiary Care Hospital in Eastern India. Indian Journal of Private Psychiatry. 2020;14(2):68-74.\u003c/li\u003e\n \u003cli\u003eSarkar S, Sarkar A, Saha R, Sarkar T. Psoriasis and psychiatric morbidity: a profile from a tertiary care centre of Eastern India. Journal of family medicine and primary care. 2014;3(1):29-32.\u003c/li\u003e\n \u003cli\u003eHayes J, Koo J. Psoriasis: depression, anxiety, smoking, and drinking habits. Dermatol Ther. 2010;23(2):174-80.\u003c/li\u003e\n \u003cli\u003eStern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T, editors. Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. Journal of Investigative Dermatology Symposium Proceedings; 2004: Elsevier.\u003c/li\u003e\n \u003cli\u003eHedemann TL, Liu X, Kang CN, Husain MI. Associations between psoriasis and mental illness: an update for clinicians. Gen Hosp Psychiatry. 2022;75:30-7.\u003c/li\u003e\n \u003cli\u003eGupta MA, Schork NJ, Gupta AK, Kirkby S, Ellis CN. Suicidal ideation in psoriasis. Int J Dermatol. 1993;32(3):188-90.\u003c/li\u003e\n \u003cli\u003eKumar A, Bhuyan D, Barua S, Dihingia S, Borgohain L. Psychiatric Morbidities and Their Impact on Quality of Life in Patients With Psoriasis. Cureus. 2023;15(8).\u003c/li\u003e\n \u003cli\u003eLakshmy S, Balasundaram S, Sarkar S, Audhya M, Subramaniam E. A cross-sectional study of prevalence and implications of depression and anxiety in psoriasis. Indian J Psychol Med. 2015;37(4):434-40.\u003c/li\u003e\n \u003cli\u003ePompili M, Innamorati M, Trovarelli S, Narcisi A, Bellini S, Orsini D, et al. Suicide risk and psychiatric comorbidity in patients with psoriasis. J Int Med Res. 2016;44(1_suppl):61-6.\u003c/li\u003e\n \u003cli\u003eGoyal S, Pisharody RR, Nath S. Psychiatric morbidity in psoriasis: A case-control study. Journal of Marine Medical Society. 2017;19(1):18-23.\u003c/li\u003e\n \u003cli\u003eKowalewska B, Krajewska-Kułak E, Sobolewski M. The impact of stress-coping strategies and the severity of psoriasis on self-esteem, illness acceptance and life satisfaction. Dermatology and Therapy. 2022;12(2):529-43.\u003c/li\u003e\n \u003cli\u003eMattoo S, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in psoriasis: Prevalence and correlates in India. Ger J Psychiatry. 2005;8:17-22.\u003c/li\u003e\n \u003cli\u003eGhosh A, Ghosh A, SK MI, Oza R. Psychological impact on the quality-of-life in patients of psoriasis vulgaris: A systemic review. Asian Journal of Medical Sciences. 2024;15(5):260-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Psoriasis, Psychiatric comorbidity, anxiety, depression ","lastPublishedDoi":"10.21203/rs.3.rs-4999262/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4999262/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Psoriasis is a psychocutaneous disorder whose prognosis is affected by psychological factors. Despite the psychological impact of the disease only 33% of the sufferers receive mental healthcare. The current study was planned to estimate the prevalence and factors affecting psychiatric co-morbidities among psoriasis patients in a tertiary care hospital.\u003c/p\u003e\n\u003cp\u003eMaterials and methods: 288 consecutive patients diagnosed with psoriasis of the age 18 and above were inducted in the study. Patient were included after signing informed consent. Patient particulars were noted in the sociodemographic profile sheet and clinical profile sheet designed for the study. Diagnosis of psychiatric disorders was made according to ICD-10. If the patients are found to have anxiety or depressive disorders, the severity of the same was assessed by using appropriate scales.\u003c/p\u003e\n\u003cp\u003eResult: Anxiety was reported in 66 (22.9%) patients. Mild depression found in 23 (8.0%) patients, moderate depression occurred in 25 (8.7%) patients, and severe depression recorded in 23 (8.0%) patients. Psychiatric comorbidity was present in 74.3%, with maximum patients being diagnosed with anxiety disorder unspecified. The association between psychiatric comorbidity and higher educational level, living in joint families, in urban areas and lower middle socioeconomic status was statistically significant.\u003c/p\u003e\n\u003cp\u003eConclusion: Our study showed the psychiatric burden to be significant in patients with psoriasis. It represents an unmet need with treatment of psychiatric comorbidity leading to improved quality of life.\u003c/p\u003e","manuscriptTitle":"Psychiatric comorbidity in patients with Psoriasis: a cross sectional study from North India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-10 12:51:34","doi":"10.21203/rs.3.rs-4999262/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-18T11:09:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-17T11:01:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-17T10:22:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"SN Comprehensive Clinical Medicine","date":"2024-08-29T16:59:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9d7ba3ee-22c2-4932-8fa5-06a777c1c20b","owner":[],"postedDate":"October 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-14T16:10:58+00:00","versionOfRecord":{"articleIdentity":"rs-4999262","link":"https://doi.org/10.1007/s42399-025-01835-1","journal":{"identity":"sn-comprehensive-clinical-medicine","isVorOnly":false,"title":"SN Comprehensive Clinical Medicine"},"publishedOn":"2025-04-07 16:05:52","publishedOnDateReadable":"April 7th, 2025"},"versionCreatedAt":"2024-10-10 12:51:34","video":"","vorDoi":"10.1007/s42399-025-01835-1","vorDoiUrl":"https://doi.org/10.1007/s42399-025-01835-1","workflowStages":[]},"version":"v1","identity":"rs-4999262","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4999262","identity":"rs-4999262","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}