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The Dermatology Life Quality Index (DLQI) is one of the most frequently used questionnaires to evaluate the impact of dermatological diseases on patients' lives. This study aimed to assess the reliability and validity of the instrument and to test its unidimensionality in a large sample of patients with psoriasis (n=976) hospitalized at IDI-IRCCS, Rome, Italy. Nine hundred patients completed the DLQI, the Psoriasis Disability Index (PDI) and the Skindex-29 (response rate 92%). The internal consistency of the DLQI was high (Cronbach's alpha=0.83). Evidence of convergent validity was provided by high (r=0.64-0.81) correlations between the DLQI, the PDI, and the functioning and emotions scales of Skindex-29. Exploratory factor analysis indicated the presence of four different principal common factors. Confirmatory factor analysis showed a clear second-order factor structure, with a homogeneous second-order factor underlying the four primary-surface factors. This study confirms that the DLQI is a reliable and valid instrument to assess patient-perceived impact of skin disease. Also, it supports the unidimensionality of the DLQI and hence corroborates the common practice of using the total score.

Although mental disorders are frequent among dermatological patients, little is known about their recognition by dermatologists. This study aimed to assess dermatologists' ability to recognize depressive and anxiety disorders. All adult outpatients who visited four dermatologists on predetermined days (n=317) completed the 12-item General Health Questionnaire (GHQ-12) and the section on depressive and anxiety disorders of the Patient Health Questionnaire (PHQ). Dermatologists, masked to GHQ-12 and PHQ scores, rated patients' mental health status. The analysis was performed on 277 patients (87%) with complete data. With the PHQ as criterion standard, the dermatologists' assessment sensitivity was 33%, while specificity was 76%. In most cases of disagreement between the dermatologists and the PHQ, the GHQ-12 corroborated the PHQ classification. Anxiety disorders tended to be recognized better than depressive disorders. Among patients with a PHQ diagnosis, male gender tended to be associated with misclassification by dermatologists. Although limitations inherent in self-report psychiatric assessment should be considered, this study suggests that mental disorders often go unrecognized in dermatological patients. This issue might be addressed by implementing specific training programmes, using validated screening questionnaires for depression and anxiety, and developing rational consultation-liaison services.