Prevalence of depression among adult psoriatic patients in Palestine: a cross-sectional study in primary healthcare settings.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease associated with substantial psychosocial burden and an elevated risk of depression. OBJECTIVES: This study aimed to estimate the prevalence of depression among adult psoriasis patients and to identify associated demographic, clinical and psychosocial factors. METHODS: A cross-sectional study was conducted between March and September 2025 across governmental dermatology clinics in the West Bank. A total of 320 adult patients with psoriasis completed interviewer-assisted Arabic questionnaires with a response rate of 92.5%. Depression was assessed using the validated Patient Health Questionnaire-9 (score ≥10 indicating depression). Psoriasis severity and psychosocial impact were evaluated using the self-administered Simplified Psoriasis Index. Multivariate logistic regression was used to identify independent predictors of depression. RESULTS: The prevalence of depression was 33.1% based on a screening tool (95% CI 28.0% to 38.6%). In multivariate analysis, lower educational attainment (elementary/middle school vs university: adjusted OR (aOR)=2.6; 95% CI 1.3 to 5.4; p=0.013) and higher psychosocial impact score (aOR=1.3; 95% CI 1.1 to 1.4; p<0.001) were independently associated with depression. Female sex demonstrated a borderline, non-significant association with depression (aOR=1.7; p=0.064). Notably, clinical severity of psoriasis was not a significant predictor after adjustment, although 50% of patients with severe disease screened positive for depression. Pruritus was prevalent (79.7%) and significantly associated with depression in univariate analysis. CONCLUSIONS: Depression affects approximately one in three patients with psoriasis in this primary care setting, associated more closely with psychosocial burden and socioeconomic factors than with clinical disease severity. These findings underscore the critical need for routine depressive symptom screening and integrated mental health support within dermatological care, particularly in conflict-affected and resource-limited regions.