Atopic Dermatitis Linked to Stress, Depression, Anxiety, Suicidal Ideation

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A new study showed atopic dermatitis significantly impacts the psychological well-being of patients in terms of stress, depression, anxiety, and suicidal ideation.¹

“Our study concluded that [atopic dermatitis] contributes to the development of depression across all age groups, consistent with previous findings showing a higher frequency of depression among individuals with [atopic dermatitis] compared to healthy participants,” wrote investigators, led by Yaser Mansoor Almutawa, MD, from King Hamad University in Bahrain.

Atopic dermatitis typically manifests during childhood or adolescence—a critical part of life in terms of metabolic, mental, and physical development. Hence, developing atopic dermatitis during these years of life can impact one’s mental health. Approximately 15 – 30% of the global pediatric population have atopic dermatitis globally, which is more than adults who have a 10% global prevalence of this skin disease.

According to the National Eczema Association, children with atopic dermatitis have greater rates of depression and anxiety.² Children may get bullied or feel socially isolated because of their skin’s appearance.

Although studies found the lesions can lead to psychological issues, the exact pathogenesis of psychological distress in patients with atopic dermatitis is unclear.¹ Thus, investigators conducted a meta-analysis aiming to assess the impact of atopic dermatitis on stress, depression, anxiety, and suicidal ideation.

After searching PubMed/Medline, the Cochrane Library, Scopus, Embase, Google Scholar, Web of Science, PsychINFO, and CINAHL, 31 cohort or cross-sectional studies met inclusion requirements. Investigators included studies from 12 countries, published between 2011 – 2023, and they were a mix between cross-sectional studies (n = 26) and observational studies (n = 5).

The case groups ranged from 20 – 600,125 participants, and the control group ranged from 26 – 2,341,285,705 participants. In total, 25 studies assessed for depression, 19 assessed for anxiety, 11 assessed for suicidal ideation, and 4 assessed for stress.

Investigators also evaluated the risk of bias using the Newcastle-Ottawa Scale. This tool affected 3 groups: selection bias (up to 4 stars – 5 stars for cohort and cross-sectional studies, respectively), comparability of exposed and controlled individuals (up to 2 stars), and outcome evaluation (up to 3 stars).

Receiving ≥ 7 stars is considered high quality, 4 – 6 stars is considered fair quality, and ≤ 3 stars is considered low quality. Among the studies, 25 were deemed of good quality and 6 of fair quality; the studies all received ratings between 5 – 8 stars.

Investigators found positive association between atopic dermatitis and stress (odds ratio [OR], 1.546; 95% confidence interval [CI], 1.445 – 1.653; P = .000), depression (OR, 1.140; 95% CI, 1.127 – 1.153; P = .000), anxiety (OR, 1.080; 95% CI, 1.063 – 1.097; P = .000), and suicidal ideation (OR, 1.158; 95% CI, 1.44 – 1.172; P = .000.

Investigators noted inconsistent relationships between atopic dermatitis and other depression scores. However, the Hamilton Depression Rating Scale (HAM-D) and Beck Depression Inventory scores were significantly greater in patients with atopic dermatitis. The inconsistent relationships may be due to only a small percentage of patients with atopic dermatitis having depression.

The team also observed a significant publication bias for the outcomes of depression (P = .029) and anxiety (P = .003), as found by Egger’s test and funnel plots.

“The dermatologist must take significant steps to promote the mental health and [quality of life] of [atopic dermatitis] patients in all age groups and genders while also being attentive to the disease’s impact on their mental health,” investigators concluded. “More longitudinal research is required to understand the intricate connections between [atopic dermatitis] and stress, depression, anxiety, and suicidal ideation, as well as the best ways to prevent and treat them.

References

1. ^{Almutawa YM, AlGhareeb M, Bhattarai E, Aljalahma J. Investigation of the Impact of Atopic Dermatitis (AD) on Stress, Depression, Anxiety, and Suicidal Ideation: A Systematic Review and Meta-Analysis. Cureus. 2024;16(6):e63376. Published 2024 Jun 28. doi:10.7759/cureus.63376}
2. ^{Eczema and Mental Health in Children. National Eczema Association. https://nationaleczema.org/eczema/children/eczema-child-behavior/. Accessed August 8, 2024.}