Patients With Atopic Dermatitis More Prone to Depression, Anxiety

Patients with atopic dermatitis, particularly those with more severe skin manifestations, were shown to be at greater risk of depression and anxiety compared with the general population.

Incidence of depression and anxiety may be greater in patients with atopic dermatitis (AD) compared with the general population, according to a recent study, and severe disease could also increase risk of suicidal ideation. Findings were published in the International Archives of Allergy and Immunology.

As a chronic inflammatory skin disease, AD has been indicated in prior research to increase risk of depression and/or anxiety in patients. Notably, this risk has been suggested to begin as early as childhood, with internalizing behaviors linked with mild and severe pediatric cases of AD.

Seeking to further investigate the association of psychological comorbidities in those with AD, researchers from the Atopic Dermatitis Centre of Reference and Excellence in Leipzig, Germany, conducted a prospective monocentric noninterventional study of patients under treatment enrolled in their University Dermatology Department.

In the study, 84 adult patients with AD (median age, 35.0 years; age range, 19.4-92.8 years; 44 women) were compared with age- and sex-matched controls from the healthy LIFE-Adult cohort for incidence of adverse mental health conditions, using several measurement scales to determine severity of disease, behavioral health, and other variables:

  • Patient-Oriented Severity Scoring of AD (PO-SCORAD)
  • Eczema Area and Severity Index (EASI)
  • Patient-Oriented Eczema Measure (POEM)
  • Dermatologic Life Quality Index (DLQI)
  • Lubben Social Network Scale 6 (LSNS-6)
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Hospital Anxiety and Depression Scale (HADS-D and -A)
  • Generalized Anxiety Disorder Scale-7 (GAD-7)

Among patients with AD, median (interquartile range) scores on PO-SCORAD were 40.4 (23.4-55.4); EASI, 9.3 (3.4-18.9); POEM, 16 (8-24); and DLQI, 10 (4-18).

Compared with controls, patients with AD exhibited significantly higher scores on the HADS, GAD-7, and CES-D (all P < .001). No significant difference in the LSNS-6 score was observed between the AD and control groups (18 vs 19; P = .067).

Moreover, a significant correlation was found between skin severity (POEM) and depression/anxiety values (GAD-7, CES-D, and HADS-A and -D; all P < .001), as well as for PO-SCORAD with GAD-7 and CES-D (all P < .05). EASI was not found to be correlated with HADS-A or -D, or CES-D.

Suicidal ideation in the last 12 months was identified in 18 patients with AD and 2 individuals in the control group, and those with AD were significantly more likely to have severe signs and symptoms of disease vs nonsevere.

In concluding, researchers said that patient-oriented scores may help identify patients with AD at high risk for psychological comorbidities.

Reference

Kage P, Poblotzki L, Zeynalova S, Zarnowskia J, Simon JC, Treudlera R. Depression, anxiety, and suicidal ideation in patients with atopic eczema in a prospective study in Leipzig, Germany. Int Arch Allergy Immunol. Published online December 3, 2021. doi:10.1159/000520159