Patients with atopic dermatitis (AD) have a higher likelihood of clinical depression, depressive symptoms, parental depression, use of antidepressants, and suicidality compared with individuals without AD, according to the results of a study published in the Journal of the American Academy of Dermatology.
The investigators sought to explore the complex relationship between AD and depression, with prior studies having demonstrated conflicting results. They conducted a systematic review and meta-analysis of all published observational studies in which the presence of depression was analyzed among patients with AD. There were 2 reviewers involved in the analysis of the study title/abstract review and data abstraction, and random effects weighting was used to perform a pooled meta-analysis.
A total of 106 studies met inclusion criteria, with 36 of them having sufficient data to conduct a meta-analysis on the prevalence of depression among individuals with and without AD. The pooled random effects prevalence of any depression was higher among adults and children with AD than among those without AD (19.2% vs 14.1%, respectively), which included clinical depression (14.9% vs 12.6%, respectively) and depressive symptoms (22.2% vs 14.5%, respectively). Moreover, patients with AD had a significantly increased likelihood of experiencing depression (22 of 36 studies: pooled odds ratio [OR] 1.71; 95% CI, 1.48-1.98; P <.001). In fact, the prevalence of any form of depression was higher among individuals with AD than those without the disorder (20.1% vs 14.8%, respectively).
The results were similar in sensitivity analyses of studies that evaluated clinical depression (12 of 24 studies: OR 1.61; 95% CI, 1.34-1.93) or depressive symptoms (9 of 11 studies: OR 1.70; 95% CI, 1.38-2.10). In addition, the odds of depression were slightly higher among the 26 studies that included healthy control patients (22 of 26 studies: OR 1.95; 95% CI, 1.67-2.28).
Parents of children with AD were more likely to have depression (3 of 6 studies: OR 1.60; 95% CI, 1.01-2.53). Antidepressant use was numerically greater among adults and children with AD vs those without AD (pooled random effects prevalence: 29.3% vs 20.3%, respectively). The pooled random effects prevalence of suicidality was higher among adults with AD vs those without AD (12.2% vs 6.4%, respectively). Further, individuals with AD were significantly more likely to experience suicidal ideation (12 of 14 studies: OR 1.97; 95% CI, 1.19-3.35; P <.001).
The investigators concluded that the presence of depression and suicidality should be incorporated into clinical decision-making in patients with AD. The results of this study should help to foster awareness on the part of healthcare providers and payers of the comorbidity among AD, depression, and suicidal ideation.
Patel KR, Immaneni S, Singam V, Rastogi S, Silverberg JI. Association between atopic dermatitis, depression and suicidal ideation: a systematic review and meta-analysis [published online October 23, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.08.063.