Pediatric Atopic Dermatitis Linked to Clinically Significant Mental Health Symptoms

Atopic dermatitis is associated with clinically significant mental health symptoms, but nearly half of children with atopic dermatitis and severe mental health impairments may not receive mental healthcare, suggesting a critical practice gap.

Pediatric atopic dermatitis (AD) is associated with significant mental health symptoms that may go untreated, according to study results published in the Journal of the American Academy of Dermatology.

In a cross-sectional study using data from the US National Health Interview Survey (2013-2017), children with and without AD were assessed for mental disorder with impairment, using the Strengths and Difficulties Questionnaire. The definition of mental disorder with impairment derived from the Child/Adolescent or Preschool Age Psychiatric Assessments. Mental health services use was also reported.

Of 57,726,856 children, 6,807,687 (11.8%) reported AD in the last 12 months. The prevalence of any mental disorder with impairment was 26.7% (95% CI, 25.1%-28.3%); 10.9% of cases (95% CI, 9.9%-12.1%) were evaluated as severe. Comparatively, mental disorder with impairment was present in 17.7% (95% CI, 17.2%-18.2%) of those without AD and 6.2% of patients with severe presentation (95% CI, 5.9%-6.5%). When adjusted for socioeconomic factors, AD was associated with higher odds of mental disorder with impairment (odds ratio [OR], 1.52; 95% CI, 1.39-1.67). On the basis of the Strengths and Difficulties Questionnaire subdomains, children with recent AD were more likely to worry often (adjusted OR [aOR], 1.64; 95% CI, 1.51-1.79), be unhappy (aOR, 1.41; 95% CI 1.26-1.57), have poor attention (aOR, 1.34; 95% CI, 1.24-1.43), misbehave (aOR, 1.20; 95% CI, 1.10-1.31), and have better relationships with adults than peers (aOR, 1.20; 95% CI, 1.10-1.30). In multivariable models adjusted for such common comorbidities as asthma, hayfever/respiratory allergy, attention-deficit/hyperactivity disorder, and autism, AD remained associated with mental disorder with impairment (aOR, 1.28; 95% CI, 1.14-1.44). Finally, the percentage of children with AD and mental disorder with impairment who had seen a mental health provider in the past year was 19.9% (mild) and 53.5% (severe).

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The study was limited by the potential bias of self-reported data. Also, the prevalence of MDI estimated from the Strengths and Difficulties Questionnaire is likely higher than its true prevalence, yet the tool does not capture all mental health symptoms affected by AD.

“Our study…suggests that utilization of health and social services by children with AD and impaired mental health is low relative to the degree of impairment identified,” the investigators wrote. “It is essential for clinicians and caregivers to recognize the mental health impact of AD so that children are appropriately screened and referred for care.”

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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Wan J, Takeshita J, Shin DB, Gelfand JM. Mental health impairment among children with atopic dermatitis: a U.S. population-based cross-sectional study of the 2013-2017 National Health Interview Survey [published online October 15, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.10.019