Adult patients with alopecia areata and those with more severe hair loss have an increased risk for anxiety and depression, according to researchers from Massachusetts General Hospital in Boston.
A literature search was conducted for studies that included a diagnosis of alopecia areata, a qualitative or quantitative assessment of anxiety or depression, and a control group.
Seventeen studies were included, and eight studies were included in the anxiety meta-analysis and a separate depression meta-analysis.
In the meta-analysis, 6,010 patients with alopecia areata and 20,961 control patients were included from four cross-sectional and four case-control studies.
The researchers found a positive relationship with anxiety (OR = 2.5; 95% CI, 1.54-4.06) and depression (OR = 2.71; 95% CI, 1.52-4.82).
However, the researchers noted that a possible potential for publication bias may exist in the studies assessing anxiety and depression.
Three studies showed no significant difference in anxiety between patients with alopecia areata and controls. In the qualitative analysis, three studies demonstrated no significant difference in depression between patients with alopecia areata and controls.
However, within depression scores, the researchers found that all four studies in the qualitative analysis showed that patients with alopecia areata had significantly higher scores compared with controls.
There was no significant difference in Children’s Depression Inventory scores in patients with alopecia areata compared with healthy siblings of patients with alopecia areata.
Stress can lead to hair loss through a variety of processes, according to the researchers.
“For instance, psychological stress triggers the hair follicle equivalent of the hypothalamic-pituitary-adrenal axis, resulting in increased corticotropic-releasing hormone secretion, which stimulates mast cell production and degranulation,” Jean-Phillip Okhovat, MD, MPH, of the department of dermatology at Massachusetts General Hospital, and colleagues wrote.
The two studies that did not support a significant association between alopecia areata, anxiety and depression were from a pediatric population, and children may be less likely to develop depression and anxiety until they reach an age when stronger friendships are formed, the researchers wrote.
Those with less severe alopecia areata may have a lower risk for developing depression and anxiety due to hair loss.
Future studies should address suicidal ideation in this patient population, the researchers concluded. – by Abigail Sutton
Disclosures: The authors report no relevant financial disclosures.