Anxiety, Depression Higher in Patients With Atopic Eczema Compared With Other Chronic Diseases

Coping with severe depression.
Coping with severe depression.
Depression, anxiety, and reduced quality of life are seen more frequently in patients with atopic eczema—and these associations imply that it may be more than just a skin disease.

Patients with atopic eczema have a higher prevalence of depression and anxiety compared with patients with other chronic diseases, highlighting the importance of assessing mental health comorbidities in patients with eczema to improve quality of life (QoL) outcomes, according to study research published in the Journal of the European Academy of Dermatology and Venereology.

In this cross-sectional study, an analysis was performed on participant data in the population-based LIFE-Health Adult Study from Germany. Participants completed standardized questionnaires for depression (Centre of Epidemiologic Studies-Depression scale [CES-D]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Additionally, social isolation was assessed using the Lubben Social Network Scale (LSNS), and QoL was assessed using the Short Form Health Survey-8. Psychosocial outcomes were compared in patients with atopic eczema (n=372) vs patients with other chronic diseases, including diabetes, cancer, and cardiovascular disease (n=9109).

A significantly greater percentage of patients with atopic eczema had CES-D scores that indicated the presence of depression compared with the control group (9.3% vs 6.3%, respectively; P <.001). Patients with atopic eczema were also more likely to have higher GAD-7 scores, suggesting a higher prevalence of anxiety in this population (8.4% vs 5.6%; P <.001).

The odds ratio (OR) for anxiety in participants with atopic eczema was 1.5 (95% CI, 1.0-2.2; P <.049), compared with ORs of 1.2 in diabetes mellitus and 1.4 in stroke. Factors associated with the risk for anxiety included older age (OR, 0.981; 95% CI, 0.974-0.989; P <.001), female sex (OR, 1.9; 95% CI, 1.6-2.3; P <.001), low/middle socioeconomic status (OR, 2.4; 95% CI, 1.8-2.3; P <.001), and history of cancer (OR, 1.9; 95% CI, 1.4-2.4; P =.001).

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A binary logistic regression analysis demonstrated an OR of 1.5 (95% CI, 1.0-2.3; P =.031) for the association between depression and atopic eczema. This OR was similar to the OR in patients with a cancer history (OR, 1.6; 95% CI, 1.0-2.3; P =.001). Factors associated with depression included a self-reported history of stroke (OR, 2.2; 95% CI, 1.3-3.6; P =.003) and diabetes mellites (OR, 1.3; 95% CI, 1.0-1.8; P =.048), in addition to the other factors reported in the anxiety analysis.

There was no significant association between atopic eczema and social isolation in an analysis adjusted for LSNS-6 scores with age, socioeconomic status, and other parameters. Compared with controls, participants with atopic eczema had lower mean QoL scores for the physical (48.0 vs 46.9, respectively; P <.010) and mental (52.5 vs 50.6, respectively; P <.001) components.

A potential limitation of this study was the reliance on a cross-sectional cohort of patients from Germany that did not report the severity of diseases.

The investigators suggest that clinicians who treat patients with atopic eczema “should be aware of potentially associated mental health abnormalities.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Treudler R, Zeynalova S, Riedel-Heller SG, et al. Depression, anxiety and quality of life in subjects with atopic eczema in a population-based cross-sectional study in Germany [published online December 14, 2019]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.16148