March 11, 2019
2 min read

Eczema tied to anxiety, depression

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Image of Johnathan Silverberg
Jonathan Silverberg

Adults with atopic dermatitis, or eczema, have significantly higher rates of anxiety and depression than those without dermatitis, according to study findings.

However, the researchers found that these mental health conditions are often not diagnosed in these patients.

“The burden of atopic dermatitis is often underappreciated, especially in adults,” Jonathan I. Silverberg, MD, PhD, MPH, of Northwestern University’s Feinberg School of Medicine, told Healio Psychiatry.

The characteristics of atopic dermatitis (AD) — itch, skin pain, sleep disturbances and multiple comorbidities — can cause significant psychosocial distress and mental health burden, according to Silverberg and colleagues.

Using a cross-sectional, population-based design, the investigators examined the connection between atopic dermatitis and anxiety and depression symptoms/diagnosis in 2,893 U.S. adults. They evaluated participants’ mental health using the Hospital Anxiety and Depression Scale anxiety (HADS-A) and depression (HADS-D) scores as well as self-reported 1-year history of anxiety and depression.

After adjusting for socio-demographics, the researchers found that atopic dermatitis was associated with significantly higher mean HADS-A and HADS-D scores than those without AD (7.7 vs. 5.6 for anxiety; 6 vs. 4.3 for depression).

Adults with atopic dermatitis also had higher prevalence of abnormal HADS-A (28.6% vs. 15.5%) and HADS-D (13.5% vs. 9%) scores and were at higher risk for abnormal HADS-A (OR = 2.19; 95% CI, 1.65-2.91) and HADS-D (OR = 1.5; 95% CI 1.04-2.17) scores, according to the results.

Participants with moderate and severe atopic dermatitis had significantly worse mental health than those with mild AD, the researchers found.

Analysis indicated stepwise and significantly increased anxiety and depression scores in patients with moderate and severe self-reported AD, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD itch and sleep (P < .0001 for all). In addition, all participants with severe PO-SCORAD, POEM and PO-SCORAD itch had borderline or abnormal anxiety and depression scores.

“All patients with severe atopic dermatitis had elevated anxiety and depression scores,” Silverberg told Healio Psychiatry. “Such symptoms should be incorporated into clinical assessments and treatment decisions.”

Silverberg and colleagues also found that adults with atopic dermatitis had higher prevalence of anxiety or depression diagnosed in the past year than those without AD (40% vs. 17.5%); however, many adults with AD who had borderline and/or abnormal scores reported no diagnosis of these mental health conditions.

“These data support the heavy mental health burden that AD places on patients. It is important for clinicians to recognize that virtually all patients with moderate-to-severe AD have symptoms of anxiety and depression,” the researchers wrote. “We recommend that clinicians incorporate assessment of mental health symptoms in clinical practice to determine disease burden and screen for patients with symptoms of anxiety and depression.” – by Savannah Demko

Disclosure: The authors report numerous relevant financial disclosures; please see the full study.