Symptoms and Diagnosis of Anxiety and Depression in Atopic Dermatitis in U.S. Adults

J.I. Silverberg; J.M. Gelfand; D.J. Margolis; M. Boguniewicz; L. Fonacier; M.H. Grayson; P.Y. Ong; Z.C. Chiesa Fuxench; E.L. Simpson

Disclosures

The British Journal of Dermatology. 2019;181(3):554-565. 

In This Article

Abstract and Introduction

Abstract

Background: The relationship between atopic dermatitis (AD), anxiety and depression in the U.S. adult population is not well established.

Objectives: To determine the relationship of AD and its severity with symptoms and diagnosis of anxiety and depression in U.S. adults.

Methods: A cross-sectional, population-based study of 2893 adults was performed. AD was determined using modified U.K. Diagnostic Criteria.

Results: Adults with AD vs. those without AD had higher mean Hospital Anxiety and Depression Scale anxiety (HADS-A) (7·7 vs. 5·6) and depression (HADS-D) (6·0 vs. 4·3) scores and higher prevalences of abnormal (≥ 11) HADS-A (28·6% vs. 15·5%) and HADS-D (13·5% vs. 9·0%) scores. In multivariable linear and logistic regression models controlling for sociodemographics, AD was associated with significantly higher mean HADS-A and HADS-D scores (7·7 and 6·0) and higher odds of abnormal HADS-A [odds ratio (OR) 2·19, 95% confidence interval (CI) 1·65–2·91] and HADS-D scores (OR 1·50, 95% CI 1·04–2·17) (P ≤ 0·03 for all). Mean and abnormal HADS-A and HADS-D scores were increased in moderate and severe/very severe self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD itch and sleep (P < 0·0001 for all). All respondents with severe PO-SCORAD, POEM and PO-SCORAD itch had borderline or abnormal HADS-A and HADS-D scores. Adults with AD vs. those without AD had higher prevalence of self-reported healthcare-diagnosed anxiety or depression in the past year (40·0% vs. 17·5%). Many adults with AD who had borderline and/or abnormal HADS-A or HADS-D scores reported no diagnosis of anxiety or depression.

Conclusions: AD is associated with significantly increased anxiety and depression, which may go undiagnosed.

Introduction

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by itch, skin pain, sleep disturbances and multiple comorbidities, all of which can lead to significant psychosocial distress and mental health burden.[1–6] However, previous studies found conflicting results regarding whether AD is associated with increased mental health disorders, e.g. depression or anxiety.[7–9] We hypothesized that AD is associated with higher likelihood of anxiety and/or depression.

In addition, there are a number of outstanding questions about the relationship between AD, anxiety and depression. Firstly, the prevalence and severity of anxiety and depression in the U.S. adult population with AD are not well established. Secondly, the relationship of different aspects of AD severity with anxiety and depression requires elucidation. We hypothesized that symptoms of anxiety and depression are very common in AD, especially in moderate-to-severe AD. Finally, anxiety and depression may go undiagnosed in all age groups.[10,11] We hypothesized that a large proportion of adults with AD have undiagnosed anxiety and/or depression. In the present study, we sought to determine the relationship of AD and its severity with symptoms and diagnosis of anxiety and depression in U.S. adults.

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