Atopic dermatitis (AD) is associated with depression, anxiety, and suicidal behavior in both children and adults, according to a study recently published in the Journal of the American Academy of Dermatology

Individuals with AD often develop visible skin lesions and chronic or intermittent pruritus, which may interrupt sleep. They are also at increased risk for occupational hand eczema and disability. These factors affect quality of life and can have a profound effect on a patient’s psychological health. Previous studies have found correlations between AD and depression, anxiety, and suicidal behavior without quantifying the magnitude of these associations. 

Investigators performed a systematic review and meta-analysis using 3 medical databases (PubMed, Embase, and PsychINFO) to further investigate the psychological health of individuals with AD qualitatively and quantitatively. The review included 42 studies that related AD and depression, 44 studies that related AD and anxiety, and 11 studies that related AD and suicidal ideation and/or attempts. All included studies had a control reference group without AD. Investigators also included primary epidemiologic data about AD and the three specific psychiatric diagnoses in the meta-analysis. 

Investigators found a significant correlation between adult AD and depression (pooled odds ratio [OR] 2.19; 95% CI, 1.87-2.57).  Similarly, they found a significant correlation between adult AD and anxiety (pooled OR 2.19; 95% CI, 1.75-2.73).  Additionally, AD was associated with depression in children (pooled OR 1.27; 95% CI, 1.12-1.45), and was positively associated with suicidal ideation in adults and adolescents (pooled OR 4.32; 95% CI, 1.93-9.66). Few available studies investigated the risk of completed suicide; however, most of these found a positive correlation between AD and completed suicide. 

This study was limited by its inclusion of research that used different definitions of depression and anxiety and that often did not assess the severity of AD in participants. 

Investigators concluded that there is a significant relationship between AD and depression, anxiety, and suicidal ideation. Providers treating patients with AD should thus watch for symptoms of these psychiatric diagnoses across all ages. Additionally, providers should prioritize AD treatment, as disease improvement reduces the risks of depression, anxiety, and suicidal ideation and attempts. 

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Reference

Rønnstad ATM, Halling-Overgaard AS, Hamann CR, et al. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in adults: A systematic review and meta-analysis [published online September 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.03.017