Age, Gender, Disease Severity Influence Dermatology-Related Depression

Psychological status and measures of quality of life (QoL) differs for patients of various chronic skin conditions, dependent on factors including their demographic and disease severity, according to new research.

In a cross-sectional study from a team of Thailand investigators, the mental health of patients with common dermatologic diseases including psoriasis, atopic dermatitis, and vitiligo were found to be frequently affected by increased depression and anxiety.

The data, presented at the American Academy of Dermatology (AAD) Virtual Meeting Experience this weekend, provides more context into which patients suffering from which dermatological conditions may need monitoring for worsened quality of life or psychological burden.

Investigators from Ramathibodi Hospital at Mahidol University, led by Pasita Palakornkitti, MD, sought to evaluate psychological aspects and QoL in Thai patients with diagnosed vitiligo, psoriasis, and adult atopic dermatitis—with consideration to patient age, gender, disease duration, and extent of affected areas.

As they noted, previous research has indicated a significant impact of such diseases on metrics of anxiety and depression.

Palakornkitti and colleagues conducted the questionnaire-based assessment at their institute from June – December 2020. Qualified participants were ≥18 years old, diagnosed with any 1 of the 3 diseases. To evaluate anxiety, depression, and QoL, they used a trio of metrics:

• Hospital Anxiety and Depression Scale (HADS) for anxiety and mild depression
• The 9-Question Patients Health Questionnaire (PHQ-9) for major depression
• Dermatology Life Quality Index (DLQI) for moderately impaired QoL.

Among their 300 participants, 121 (40.3%) had diagnosed vitiligo; 100 (33.3%) had diagnosed psoriasis; and 79 (26.3%) had adult atopic dermatitis. Mean patient age was 43.1 years old, with 65.7% females. Nearly two-thirds of patients (63.7%) had their disease for >5 years, and more than half (54.3%) reported ≤3% extent of affected area.

Patients with adult atopic dermatitis were the most likely to report mild depression per HADS (21.5%) or moderately impaired QoL per DLQI (64.6%) among all disease groups. Patients with psoriasis, meanwhile, had the highest prevalence of anxiety per HADS (26.0%). Just 5.8% of patients with vitiligo reported major depression per PHQ-9, versus 16.0% and 17.7% of psoriasis and atopic dermatitis patients, respectively.

Among patients with atopic dermatitis, patients <50 years old were more than four-fold likely to suffer from impaired QoL (OR, 4.36; 95% CI, 1.29 – 14.72) versus old patients. But patients with longer disease duration and affected areas were even more likely to report impaired QoL than those with recent diagnoses and lesser affected area.

Similar outcomes were observed among patients with psoriasis, including for depression and anxiety outcomes. Among vitiligo patients, female patients were nearly three-fold more likely to report impaired QoL than male counterparts (OR, 2.74; 95% CI, 1.16 – 6.49).

The investigators concluded that, aside from unique gender differences and varied rates of depression and anxiety across the dermatologic conditions, the most consistent outcome pertained to age: those <50 years old were more likely to report poorer QoL regardless of disease, severity, duration, or gender.

The study, “Anxiety, Depression and Quality of life in patients with chronic skin diseases,” was presented at AAD VMX.