AA Unlikely to Cause Anxiety, Depression but May Be Affected by Mental Illness

Mature woman with alopecia. | Image Credit: highwaystarz - stock.adobe.com

Patients with alopecia areata (AA) displayed a casual, unidirectional relationship with anxiety and major depression disorder (MDD).

Alopecia is a hair loss condition typically caused by genetic predispositions, autoimmune factors, or deficiencies in micronutrients. In a large scale, 2-sample Mendelian randomization (MR) analyses, the relationship between patients with AA and anxiety or depression was examined.¹

In a previous study conducted on adult patients with AA, there were associations between health-related quality of life (HRQOL) and psychological burdens.² Researchers found hair regrowth to be a key feature in HRQOL after the success of certain treatments.

Data for the present analysis were collected from genome-wide association studies (GWAS).¹ The selection of instrumental values included single nucleotide polymorphisms (SNPs). Four distinct approaches were utilized for the analysis methods: MR-Egger, weighted median, random effect inverse variance (IVW) weighted, and weighted mode.

Results indicated the absence of a weak IV in MR analysis because the minimum F-statistic for all SNPs was 19.53. Associations between genetic liability to AA had increased risks of MDD and anxiety, with ORs of 1.01 (P = .046) and 1.16 (P = .004), respectively. In a reverse analysis, there was no significance between anxiety and risk of AA; however, MDD may be linked to an increased risk of AA.

There was still no notable association between AA and anxiety even after adjusting for asthma status, a potential confounding variable. No relevant evidence of horizontal pleiotrophy was found by the MR-Egger intercept. The GWAS analysis found a unidirectional causal relationship where AA has a risk effect against MDD and anxiety. These findings and prior analyses suggest AA risk is not only influenced by environmental factors, but genetic factors as well.

In the former study on HRQOL, patients with minimal to no hair regrowth were compared with patients who had meaningful regrowth.² Results shouw patients with regrowth had better Hospital Anxiety and Depression Scale scores by week 36.

Another study reported 79.9% of patients with AA have negative long-term effects such as decreased self-esteem, mental health problems, and issues with daily activities.³ Even though women were more likely to be affected than men, both groups had a large majority with severely impaired QOL.

Researchers suggested holistic approaches to reducing effects on QOL while managing the disease.³ Physicians stress the importance of addressing emotional and social burdens with patients in conjunction with treatment therapies.

However, the emotional and social burdens of patients with AA are not all the same because they vary based on a multitude of factors. For instance, patients younger than 40 years were more likely to exercise, engage in sports, or get involved in religious or patient organizations compared with patients 40 years or older. The more a patient with AA chose holistic coping approaches, the less likely they were to face mental illness issues.³

Study limitations of the MR study include the large-scale data extraction among European populations and the potential for selection bias overlap, which restricts the universal generalizability toward other populations.¹ Associations between anxiety and MDD in relation to AA also should be approached with caution.

Recognizing psychological burdens that patients with AA face can help to initiate timely treatments and appropriate psychological counseling such as support and interventions to address emotional well-being.

References

1. Yu N, Guo Y. Association between alopecia areata, anxiety, and depression: Insights from a bidirectional two-sample Mendelian randomization study. J Affect Disord. 2024;350:328-331. doi:10.1016/j.jad.2024.01.152

2. Santoro C. Hair regrowth in severe alopecia areata improves quality of life while reducing anxiety, depression^{. The American Journal of Managed Care®}. January 12, 2024. Accessed May 6, 2024. https://www.ajmc.com/view/hair-regrowth-in-severe-alopecia-areata-improves-quality-of-life-while-reducing-anxiety-depression

3. Santoro C. Severe AA impairs quality of life, study calls for holistic management strategies. The American Journal of Managed Care. April 17, 2024. Accessed May 6, 2024. https://www.ajmc.com/view/severe-aa-impairs-quality-of-life-study-calls-for-holistic-management-strategies