Top Risk Factors for Anxiety, Depression Identified in Atopic Dermatitis

Anxiety and depression are common yet underrecognized complications in people living with atopic dermatitis (AD), in whom factors such as poor sleep, frequent medical visits, low education levels, and comorbid allergic conditions significantly increase the risk of psychological distress—compounding disease burden and lowering quality of life.¹

This new study identifies key contributors to mental health decline in individuals with atopic dermatitis, highlighting the need for integrated care. | Image Credit: Pormezz - stock.adobe.com

This cross-sectional study is published in World Journal of Psychiatry.

“Patients with AD exhibit a significantly higher probability of experiencing anxiety and depression compared to the general population,” wrote the researchers of the study. “In this study, 24.5% of the patients displayed symptoms of anxiety, and 19.8% exhibited symptoms of depression, indicating a substantial impact of AD on mental health.”

AD has been consistently linked to increased rates of mental health challenges, particularly anxiety, depression, and suicidal ideation.² Meta-analyses have shown that adults with AD are more than twice as likely to experience depression (pooled OR, 2.19) and anxiety (pooled OR, 2.19) compared with those without the condition. Among children, AD is also associated with a higher risk of depression (pooled OR, 1.27), although fewer studies have examined links with anxiety in this age group.

In this cross-sectional study, researchers evaluated 273 patients diagnosed with AD who received care at a hospital in Shanghai between July 2021 and June 2023.¹ Participants completed a series of standardized assessments, including a general information questionnaire to capture demographic and clinical characteristics, the Hospital Anxiety and Depression Scale (HADS) to screen for psychological symptoms, the Scoring Atopic Dermatitis index to measure disease severity, and the Dermatology Life Quality Index (DLQI) to assess the impact of AD on patients’ daily lives.

The study aimed to identify independent risk factors for anxiety and depression in individuals with AD and analyze how these psychological comorbidities relate to disease prognosis and quality of life.

The study found a high prevalence of psychological symptoms among patients with AD, with 24.5% experiencing anxiety and 19.8% showing signs of depression.

Key independent risk factors for anxiety included lower educational attainment (OR, 0.338; 95% CI, 0.183-0.625), frequent medical visits (OR, 2.300; 95% CI, 1.234-4.255), sleep disorders (OR, 2.013; 95% CI, 1.032-3.923), and coexisting allergic rhinitis (OR, 2.052; 95% CI, 1.097-3.839). Depression was significantly associated with more severe pruritus (OR, 6.837; 95% CI, 1.330-35.132), increased number of medical visits (OR, 2.979; 95% CI, 1.430-6.205), sleep disturbances (OR, 2.245; 95% CI, 1.033-5.024), and comorbid asthma (OR, 2.208, 95% CI, 1.003-4.859).

Additionally, higher scores on the DLQI were positively correlated with both anxiety and depression, as well as with pruritus intensity, sleep problems, and disease severity.

However, the researchers acknowledged several limitations of their research. First, the sample size was relatively small, which could have limited the statistical power and representativeness of the results. Additionally, psychological symptoms were assessed solely using the HADS, rather than structured clinical interviews, potentially introducing measurement bias.

Despite these limitations, the researchers believe the study highlights the cumulative impact of physical and psychological factors on overall quality of life in those with AD.

“Therefore, in the clinical diagnosis and treatment of AD, it is crucial to adhere to a holistic approach that treats both the body and mind,” wrote the researchers. “This includes assessing the psychological state of patients and implementing psychological interventions to alleviate symptoms of anxiety and depression. Additionally, it is necessary to strengthen the comprehensive management of the disease and collaborate on multiple fronts to improve the quality of life for patients with AD.”

References

1. Liu K, Gao W, Lu H-G, et al. Risk factors for anxiety and depression in patients with atopic dermatitis and their impact on prognosis. World Journal of Psychiatry. 2025;15(6). doi:10.5498/wjp.v15.i6.104738

2. Rønnstad ATM, Halling-Overgaard AS, Hamann CR, et al. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: A systematic review and meta-analysis. J Am Acad Dermatol. 2018 Sep;79(3):448-456.e30. doi: 10.1016/j.jaad.2018.03.017