P101 Are we ready to use the WHO-5 questionnaire in Psoriasis?

Abstract Since its first publication in 1998, the 5-item World Health Organization Wellbeing index ‘WHO-5’ has become one of the most widely used questionnaires to assess psychological wellbeing. In this systematic review, we provide an overview of its use in psoriasis compared with other disease areas. Studies reporting the use of WHO-5 were searched on the MEDLINE database and classified using the 11th version of the International Classification of Diseases (ICD). The WHO-5 items recall the previous 2-week period and include the following domains: (i) ‘cheerful and in good spirits’; (ii) ‘calm and relaxed’; (iii) ‘active and vigorous’; (iv) ‘I woke up fresh and rested’; and (v) ‘daily life filled with things that interest me’. The answers range from 5 (all the time) to 0 (never), and the resulting score (multiplied by 4) ranges from 0 (wellbeing absence) to 100 (maximal wellbeing). A total of 493 studies belonging to 11 ICD groups were included (Table 1). Only six studies reported the use of WHO-5 in diseases of the skin: three in psoriasis, two in lichen sclerosus, and one in general skin conditions. The first psoriasis study to use WHO-5 in moderate-to-severe patients reported an overall WHO-5 score of 53.8 ± 27.0. A second study found significant differences in wellbeing depending upon the severity of the disease: 58.2 ± 10.7 in patients with mild (PASI<7) vs. 47.8 ± 12.0 in severe disease (PASI > 12). In a third study including patients with controlled psoriasis (PASI 2.4 ± 4.2), WHO-5 at baseline and 12 weeks later were 62.4 ± 11.2 and 65.6 ± 10.8, respectively. The impact of moderate-to-severe psoriasis on psychological wellbeing is of a similar level to other diseases with distress, such as breast cancer (52.0), uncontrolled diabetes (51.4) and idiopathic pulmonary fibrosis (52.4). In conclusion, WHO-5 is a short questionnaire widely used in several disease areas to detect when a disease impairs psychological wellbeing. Despite very few number of studies, data suggest that moderate-to-severe psoriasis has a profound impact on the psychological wellbeing of patients and warrants further research. Table 1WHO-5 use across disease areasDisease-related areaNo. of studiesCOVID-19 pandemic147Endocrinology109Mental, behavioural or neurodevelopmental disorders (excluding clinical depression)89Clinical depression33Diseases of the circulatory system25Diseases of the genitourinary system15Neoplasms17Diseases of the musculoskeletal system or connective tissue15Diseases of the nervous system12Diseases of the respiratory system (excluding COVID-19)7Diseases of the skin6Diseases of the visual system4Others14Total493