Association Between Hospital-diagnosed Atopic Dermatitis and Psychiatric Disorders and Medication Use in Childhood

I. Vittrup; Y. M. F. Andersen; C. Droitcourt; L. Skov; A. Egeberg; M. C. Fenton; P. Mina-Osorio; S. Boklage; J. P. Thyssen

Disclosures

The British Journal of Dermatology. 2021;185(1):91-100. 

In This Article

Abstract and Introduction

Abstract

Background: While adult atopic dermatitis (AD) is associated with anxiety and depression, and paediatric AD is linked to attention deficit hyperactivity disorder (ADHD), the relationship between AD in childhood and other psychiatric disorders is largely unknown.

Objectives: To determine the relationship between AD and diagnosis and treatment of psychiatric disorders in children.

Methods: All Danish children born between 1 January 1995 and 31 December 2012 with a hospital diagnosis of AD (n = 14 283) were matched 1 : 10 with children without a hospital diagnosis of AD. Endpoints were psychotropic medication use, hospital diagnoses of depression, anxiety, ADHD, or self-harming behaviour, accidental/suicidal death, and consultation with a psychiatrist or psychologist.

Results: Significant associations were observed between hospital-diagnosed AD and antidepressant [adjusted hazard ratio (aHR) 1·19, 95% confidence interval (CI) 1·04–1·36], anxiolytic (aHR 1·72, 95% CI 1·57–1·90), and centrally acting sympathomimetic (aHR 1·29, 95% CI 1·18–1·42) medication use. Consultation with a psychiatrist (aHR 1·33, 95% CI 1·16–1·52) or psychologist (aHR 1·25, 95% CI 1·11–1·41) was also associated with AD. No association with a hospital diagnosis of depression (aHR 0·58, 95% CI 0·21–1·56), anxiety (aHR 1·47, 95% CI 0·98–2·22) or self-harming behaviour (aHR 0·88, 95% CI 0·27–2·88) was observed, but a diagnosis of ADHD (aHR 1·91, 95% CI 1·56–2·32) was significantly associated with AD. The absolute risks were generally low.

Conclusions: The increased risk of treatment, but not of a hospital diagnosis of psychiatric disorders in children with hospital-diagnosed AD, suggests that psychiatric issues in children with AD could be of a transient, reversible or mild–moderate nature.

Introduction

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin condition that most often begins in early childhood and affects up to 15% of children in Denmark.[1] Children with AD are affected by pruritus and interrupted sleep, have a higher risk of social isolation, stigmatization and altered self-esteem,[2–4] and have significantly reduced quality of life,[5,6] with quality-of-life scores being positively correlated with AD severity.[7] While paediatric AD has been shown to be associated with attention deficit hyperactivity disorder (ADHD),[8–11] the relationship between paediatric AD and other psychiatric disorders is largely unknown.[12,13]

This study investigated whether Danish children with AD seen within the hospital system had increased occurrence of psychiatric diagnoses, psychotropic medication use, consultations with psychologists or psychiatrists, or death from accident or suicide.

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