Severe Atopic Dermatitis Associated with Depression in Pediatric Patients

Joy Wan, MD, MSCE

An investigation into the associations between atopic dermatitis and mental health conditions revealed that the disease was linked to symptoms of depression and internalizing behaviors that carried on through childhood and adolescence.

Investigators led by Joy Wan, MD, MSCE, Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, believed the findings highlighted the importance of behavioral and mental health awareness in young populations.

Atopic dermatitis has been considered one of the most common inflammatory skin diseases, affecting up to 15%-20% of pediatric populations worldwide.

Associations between the disease and anxiety, suicidal ideation, and depression had been confirmed in earlier studies, though most studies had focused on adult populations.

According to investigators, pediatric depression often goes untreated and under-diagnosed, likely due to the subtle symptoms recorded. As a result, limited research exists on the subject.

In the newest study, Wan and colleagues examined the association between the disease and symptoms of depression and internalizing behaviors at key points across childhood and adolescence.

The Study

The investigators performed a longitudinal cohort study with data from the Avon Longitudinal Study of Parents and Children (ALSPAC) between September 6, 1990, to December 31, 2009.

In addition to questionnaires and clinics, biological samples were collected in accordance with the Human Tissue Act (2004).

A total of 11,181 children were enrolled in the study. Each participating family had a child with at least 1 completed assessment of atopic dermatitis and 1 completed mood questionnaire.

A repeated measure of atopic dermatitis annual period prevalence was assessed at 11 points from 6 months to 18 years of age and was reported by mothers through 14 years of age and by adolescents and young adults at 16 and 18 years of age.

Depression was measured using child-reported responses to the Short Moods and Feelings Questionnaire (SMFQ) at 5 points from 10 to 18 years of age.

The Findings

Wan and colleagues found that Children with symptoms of depression were more likely to be female (2673 of 4710 [56.8%] vs 2767 of 6471 [42.8%]), from a higher social class (243 of 4710 [5.2%] vs 317 of 6471 [4.9%]).

They were also likely to have a parent with a higher level of education (1127 of 4710 [23.9%] vs 1299 of 6471 [20.1%]), and to be from families with a higher quartile of financial difficulties (923 of 4710 [19.6%] vs 989 of 6471 [15.3%]).

Additionally, the period prevalence of symptoms of depression as measured by the SMFQ increased from 6.0% at 10 years of age to 21.6% at 18 years of age.

Though associations were not found in mild or moderate cases of atopic dermatitis, they were recorded in severe disease. Severe AD was associated with an increased risk in anxiety and depression (aOR, 5.18; 95% CI, 2.06- 13.04).

The nearly 2 decades of follow-up provided Wan and colleagues with sufficient data to confirm the associations that begin in early childhood. They added that future research could focus on developing strategies for managing pediatric illnesses including atopic dermatitis, as well as mental illness.

“Because many new AD therapies are being brought to market is important to study the effect of new therapies on sleep and mental health outcomes among pediatric patients,” the team wrote. “The large and increasing burden of pediatric mental illness highlights the importance of clinician awareness of the psychosocial needs of children and adolescents with atopic dermatitis.”

The study, “Association of Atopic Dermatitis and Mental Health Outcomes Across Childhood, A Longitudinal Cohort Study,” was published online in JAMA Dermatology.