LAUSR

and selection bias from in-clinic recruits; however, there were no major differences in the demographic characteristics of the responders and nonresponders in our study population and the mean PHQ-9 scores for clinic and nonclinic samples were similar. Furthermore, the response rate in the clinic sample was high (90%). Another possible limitation is that disease severity was self-reported. The HSSA tool was validated using a small sample size and had moderate agreement between physician and self-assessed disease severity. In addition, the Hurley staging used for the HSSA tool has only moderate agreement between providers and is most reliable for patients with severe disease. The PHQ-9 is not a diagnostic instrument, but assesses the severity of depressive symptoms used in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition depression criteria. The most appropriate intervention for patients with HS may be multidisciplinary. Individuals with HS of any Hurley stage may be prone to depression. In order to improve the poor psychosocial functioning of patients with HS, screening and treatment for depression could be considered.