Atopic dermatitis (AD) does not have a substantial effect on the overall risk for neuropsychiatric disorders in children, although disease severity and age may be modifying factors, researchers reported in study findings published in the Journal of the European Academy of Dermatology and Venereology.
The retrospective cohort study evaluated the risk for major neuropsychiatric disorders in children aged younger than 18 years with AD with use of data from the Health Improvement Network database from 1994 to February 2015.
Patients with AD were matched with as many as 5 patients without AD, and AD severity was estimated with use of treatment proxies. Study outcomes included attention-deficit/hyperactivity disorder (ADHD), autism, anxiety, depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder (OCD), suicidality, and completed suicide.
A total of 409,431 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) were matched with 1,809,029 patients without AD. The median age was 4 (interquartile range [IQR] 2-9) years in the non-AD group (52% male) and 4 (IQR 1-8) years in the mild AD group (52% male), 9 (IQR 4-14) years in the moderate AD group (51% male), and 5 (IQR 1-10) years in the severe AD group (56% male), respectively. The mean follow-up was 5.0 (IQR 2.0-9.4) years for the non-AD group and an average of 5 to 7 years for those with AD, respectively.
No significant difference was observed regarding the adjusted risk of new-onset ADHD between the AD and non-AD groups (hazard ratio [HR] 1.02; 95% CI, 0.97-1.06). No overall association was found between AD and autism, but moderate AD was associated with an increased risk for incident autism (1.25, 1.11-1.41), and AD was associated with autism in children aged 5 years and younger and 6 to 11 years.
The adjusted risk for anxiety was slightly but statistically significantly increased in children who had mild AD (HR 1.08, 1.06-1.10) and lower in those with moderate or severe AD (0.81, 0.77-0.84 and 0.77, 0.70-0.84, respectively). The findings were comparable for depression, with mild AD associated with an increased risk (1.05, 1.03-1.09) and moderate and severe AD associated with a decreased risk (0.68, 0.65-0.71 and 0.64, 0.58-0.70, respectively). A positive association was found between AD and depression in adolescents, with an inverse association occurring in younger children.
The rate of suicidal ideation or attempt was slightly increased in children with mild AD (1.04, 1.01-1.08) and lower in those with moderate or severe AD (0.76, 0.70-0.81 and 0.74, 0.63-0.86, respectively). Children aged 5 years and younger with AD were less likely to have suicidal ideation or attempt compared with those without AD, and those with AD aged 12 to 17 years were more likely to have suicidal ideation attempt. Completed suicide was rare among all groups.
No overall association was found between AD and bipolar disorder, with an increased risk (1.38, 1.01-1.87) occurring in those aged 12 to 17 years with AD compared with those without AD. The adjusted risk for OCD was significantly increased in children with AD compared with those without AD (1.26, 1.16-1.37), especially for those with mild (1.30, 1.20-1.42) or moderate (1.20, 1.01-1.43) AD. The risk for schizophrenia was significantly reduced in children with moderate AD (0.50, 0.28-0.89).
“Most strikingly, our primary analyses suggest a potentially inverse relationship between moderate/severe AD and anxiety and depression,” researchers wrote. “One possible explanation for the differences in our findings may be due to differences in assessment, as we relied on medical records to capture diagnoses and estimate
AD severity.” They also suggested that “treatments for severe AD could mitigate neuropsychiatric symptoms.”
The investigators noted that misclassification of AD severity may have occurred because treatments and dermatology referrals were used as proxies. In addition, outcome misclassification, ascertainment bias, and reverse causation are possible.
“[Our findings] call for additional prospective research — studies which measure AD severity and treatment independently and assess neuropsychiatric outcomes via both symptom report and physician diagnosis—to further dissect the nature of relationships, and modifying factors thereof, between pediatric AD and neuropsychiatric comorbidities,” stated the researchers.
Disclosure: This study was supported by a contract from Pfizer, Inc. Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Wan J, Shin DB, Syed MN, Abuabara K, Lemeshow AR, Gelfand JM. Atopic dermatitis and risk of major neuropsychiatric disorders in children: a population-based cohort study. J Eur Acad Dermatol Venereol. Published online August 26, 2022. doi:10.1111/jdv.18564