Severe atopic dermatitis (AD) is associated with symptoms of depression and internalizing behaviors throughout childhood and adolescence, researchers reported in a study published in JAMA Dermatology.

The longitudinal cohort study analyzed data from September 6, 1990, to December 31, 2009, from the Avon Longitudinal Study of Parents and Children (ALSPAC), which recruited pregnant women in Avon, UK. Eligible participants were the children who were alive at age 1 year with at least 1 completed assessment of AD and a mood questionnaire. Data were analyzed from August 30, 2019, to July 30, 2020.

A repeated measure of the annual period prevalence of AD assessed at 11 points from ages 6 months to 18 years according to a standardized question about flexural dermatitis and severity was the primary exposure.


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The Short Moods and Feelings Questionnaire (SMFQ) was used to measure depression with child-reported responses at 5 points from ages 10 to 18 years. Maternal report of the emotional symptoms subscale of the Strength and Difficulties Questionnaire (SDQ) at 7 points from ages 4 to 16 years was used to measure internalizing behaviors.

The cohort included 11,181 individuals (51.2% men; 95.7% White) with at least 1 response to a question about AD and symptoms of depression (8458 individuals for the SMFQ analysis; 10,785 individuals for the SDQ analysis). The children were followed from birth for a mean (SD) duration of 10.0 (2.9) years.

From ages 3 to 18 years, the annual period prevalence of active AD declined from 19.1% to 14.5%. In children and adolescents with active AD, the percentage who had moderate or severe symptoms in the previous 12 months ranged from 21.8% to 40.1%. Children with depression symptoms were more likely to be female (2673 of 4710 [56.8%] vs 2767 of 6471 [42.8%]).

The period prevalence of depression symptoms according to the SMFQ increased from 6.0% at age 10 years to 21.6% at age 18 years. The adjusted odds ratio (aOR) of depressive symptoms in children with AD vs those without AD was 1.14 (95% CI, 0.93-1.40).

Increasing AD severity was associated with increasing odds of depression symptoms and followed a linear trend (P = .03). The participant-specific aOR of depression symptoms in severe AD for all time points was 2.38 (95% CI, 1.21-4.72).

The period prevalence of internalizing behavior based on a score of 4 or greater on the emotional symptoms subscale of the SDQ ranged from 10.4% to 16.0% from ages 4 to 16 years. The mean participant-specific effect for all points was a 41% increase in the odds of internalizing behaviors for those with active AD (aOR, 1.41; 95% CI, 1.17-1.70). The participant-specific aOR of internalizing behaviors for severe AD across all time points was 1.90 (95% CI, 1.14-3.16).

The study authors noted that atopic dermatitis, depression symptoms, and internalizing behaviors were based on parental or self-report, and use of the parent-reported SDQ might lead to an underestimation of the prevalence of internalizing behavior. Also, further research is needed in more diverse settings, they suggest.

“Because many new AD therapies are being brought to market, it is important to study the effect of new therapies on sleep and mental health outcomes among pediatric patients,” stated the investigators. “The large and increasing burden of pediatric mental illness highlights the importance of clinician awareness of the psychosocial needs of children and adolescents with AD.”

Disclosure: Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Kern C, Wan J, LeWinn KZ, et al. Association of atopic dermatitis and mental health outcomes across childhood: a longitudinal cohort study. JAMA Dermatol. Published online September 1, 2021. doi:10.1001/jamadermatol.2021.2657