Links Between Alopecia and Mental Health Vary by Country

Alopecia areata (AA) can have significant impacts on patients’ mental health, but a new study suggests the impacts vary based on sex, age, and country, among other factors.¹

The links between AA and mental health have already been well established. A study from 2021, for instance, found that depression and anxiety were both positively associated with AA, independently of other risk factors such as age, marital status, and body mass index.² That study found that female patients and people between the ages of 30 and 49 were at a particularly high risk of anxiety and depression.

The new report evaluated how alopecia areata affects mental health across cultural and national borders. | Image credit: melita - stock.adobe.com

However, many of the studies linking AA with mental health disorders are based on single populations or geographical areas. For example, that 2021 study was based on a database of Israeli patients. Another study from 2023 found that AA may have a significant negative effect on patients’ quality of life due to the impact on work life and stigmatization, among other factors.³ However, that study was based on a sample of patients living in Europe.

In the new report, corresponding author Mesbah Talukder, PhD, of Bangladesh’s BRAC University, and colleagues, wanted to gain a more comprehensive understanding of how AA affects mental health across cultural and national borders. Their findings were published in the Journal of Cosmetic Dermatology.¹ 

They turned to the 2021 Global Burden of Disease Study, focusing on 5 countries—China, Japan, India, Brazil, and the US. The investigators looked at the prevalence of AA and years lived with disability data (a proxy for disease severity), as well as anxiety and depression rates. The data included both male and female patients and was broken into 3 age-based cohorts: patients under the age of 20, patients 20 to 54 years of age, and patients over 55 years of age.

The analysis confirmed that AA increases the risk of anxiety and depression in female patients, but the impact varied by country. In China, Japan, Brazil, and India, the investigators found links between AA and anxiety, but China was the only country in which the association persisted across age groups. In Japan and India, the link was only present in the youngest cohort.

The investigators found a positive association between depression and AA in female patients in China, India, and Brazil. Those correlations were true both for patients under the age of 20 and for patients between ages 20 and 54.

“We have demonstrated that there is a significant but complex relationship between alopecia areata and anxiety and depressive disorders,” Talukder and colleagues wrote.

Notably, the authors said their data suggest that links between anxiety and depression are most common among people under the age of 20. The data also showed, however, that females are at a greater risk than male patients across cultures. There were no statistically significant links between AA and anxiety or depression in any of the male cohorts analyzed, the authors said.

Talukder and colleagues cited a couple of potential reasons for the lack of association between mental health disorders and AA in men. They noted that previous research has suggested that men and women process trauma differently, with females experiencing higher rates of post-traumatic stress disorder after potentially traumatic events.⁴ Additionally, though, the authors said differences in self-image between male and female patients may play a role in patients’ ability to cope with the effects of hair loss.⁵

The investigators said it was also notable that the data did not elucidate any links between anxiety and depression and AA in the US. They said more research is needed to better understand why, but they it could have to do with issues such as access to health care.

Talukder and colleagues concluded that while their research highlighted nuances in the relationship between AA and mental health, the link itself cannot be ignored.

“The impact of hair loss disorders such as alopecia areata on the mental health of patients should not be discounted, but rather addressed as part of a patient’s ongoing care,” they wrote.

References

1. Gupta AK, Economopoulos V, Talukder M. Examining the relationship between alopecia areata and mental health: an investigation of the Global Burden of Disease Study 2021. J Cosmet Dermatol. 2025;24(7):e70325. doi:10.1111/jocd.70325
2. Tzur Bitan D, Berzin D, Kridin K, Cohen A. The association between alopecia areata and anxiety, depression, schizophrenia, and bipolar disorder: a population-based study. Arch Dermatol Res. 2022;314(5):463-468. doi:10.1007/s00403-021-02247-6
3. Gisondi P, Puig L, Richard MA, et al. Quality of life and stigmatization in people with skin diseases in Europe: A large survey from the 'burden of skin diseases' EADV project. J EurAcad Dermatol Venereol. 2023;37 Suppl 7:6-14. doi:10.1111/jdv.18917
4. Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132(6):959-992. doi:10.1037/0033-2909.132.6.959
5. Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol. 1999;141(3):398-405. doi:10.1046/j.1365-2133.1999.03030.x