Boosting Mental Health Access for Patients with Psoriatic Disease

By M. Elaine Husni, MD, MPH, Leonard Calabrese, DO, and Anthony Fernandez, MD, PhD

The association of psoriatic disease with depression and anxiety has long been established, but providing mental health support for patients with psoriatic disease remains a significant challenge. Despite treatment advances, up to 20.7% of psoriatic disease patients report poor mental health compared to 7.1% of the general population. Increasing evidence suggests that along with medication and talk therapy, optimizing sleep, physical activity, stress and nutrition may improve mental well- being.

While numerous online health programs have emerged to help patients strengthen these behaviors, very little exists for those with psoriatic disease. Now a new Cleveland Clinic trial is studying a 12-week, web-based e-coaching program called Immune Strength, which is tailored for those with psoriatic disease. Immune Strength uses self-directed patient empowerment to enhance mental wellness.

One hundred participants with psoriatic diseases are randomly assigned to the 12-week Immune Strength program (intervention group) or to a waiting list (control group). Control group subjects receive access to Immune Strength 12 for weeks. Program participants have 24/7 access with weekly contact to a certified health coach. Support teams include mental health counselors, dietitians, sleep psychologists and exercise physiologists.

Stress, sleep, nutrition and exercise

The program’s patient content focuses on four areas:

• Stress management. Patients receive education on mindfulness and meditation practices to reduce stress; activation practices to reduce and manage pain and fatigue; positivity; guided imagery.

• Sleep. Patients receive directed education on insomnia, tracking sleep quality, managing sleep hygiene and the link between sleep and health.

• Nutrition. Patients receive education on topics such as diet and inflammation, eating habits, stress and food, and mindful eating.

• Exercise. Patients receive guidance on exercises tailored to their fitness level, focusing on strength, range of motion and chair yoga, plus education on the disease-related benefits of exercise.

Changes in mental health burden will be measured using well-validated measures of mental health as the primary outcome at baseline and at the end of the study. Secondary outcomes will include validated self-efficacy and patient-reported outcomes. The goals of the study are to determine the improvement of behavioral health, feasibility and practicality of an e-coaching program in patients with psoriatic diseases.