Trends in Depression in Patients With Atopic Dermatitis

The symptoms of atopic dermatitis (AD) can contribute to decreased self-esteem and symptoms of depression. These depressive symptoms are closely related to AD symptomology and fluctuate with AD severity, according to results of a study published in the Journal of the American Academy of Dermatology.

This longitudinal practice-based study was conducted at Northwestern University from 2013 to 2020. Adults (N=695) with AD self-administered questionnaires about their skin-related and mental health-related symptoms before consultation with their clinician at baseline and at every 6-month follow-up. Predictors of the longitudinal course of depressive symptoms were evaluated.

Patients were mean age 44.2 (range, 18.01-97.86) years, 63.69% were women, 66.38% were White, eczema area and severity index (EASI) score was 9.2±11.5 points, and itch score was 4.8±3.1 points at baseline.

Patients at baseline had minimal (65.32%), mild (20.00%), moderate (8.20%), moderately severe (3.88%), and severe (2.59%) Patient Health Questionnaire-9 (PHQ-9) scores for depression. Over time, the greatest fluctuation in depressive symptoms was observed in patients with moderate scores at baseline, followed by mild, severe, and moderately severe scores.

In the bivariate model, worsening depression over time was predicted by age older than 65 years compared with young adults (β, 0.330; P =.0092); Hispanic ethnicity (β, 0.312; P <.0001), Black ethnicity (β, 1.739; P <.0001), and Asian or Pacific Islander ethnicity (β, -1.184; P <.0001) compared with White ethnicity; male sex compared with female sex (β, 0.838; P <.0001); high school graduate or General Educational Development (GED) holder (β, 3.449; P <.0001) and more than high school education (β, 2.918; P <.0001) compared with less than high school education; and young adult AD onset (β, -2.629; P <.0001) and geriatric AD onset (β, -1.376; P <.0001) compared with pediatric onset.

In the multivariate model, after adjusting for demographic characteristics, 27 skin and 7 sleep characteristics predicted the fluctuations of PHQ-9 scores over time. The significant skin predictors tended to increase predictive power with severity of scalp, facial, eyelid, anterior neck, nipple, and flexural lesions (β range, -3.87 to 3.328), hand and foot dermatitis (β range, 0.879-1.569), xerosis (β range, 1.034-1.986), keratosis pilaris (β, 0.704-4.524), ichthyosis (severe only: β, 3.596), and pityriasis alba (mild only: β, 2.317) compared with patients who did not have these skin symptoms. The sleep predictors were greater severity of sleep disturbances (β, 0.055-4.1295) and more days of sleep disturbance due to eczema in the past week (β, 1.8283-6.8733) compared with patients who did not experience sleep disturbances.

The major limitation of this study was the reliance on self-reported mental health outcomes.

These data indicated to researchers that many patients with AD reported some symptoms of depression, and that the persistence of depressive symptoms was related to more severe AD symptoms and sleep disturbances. The study authors recommended that, “Future AD treatments should incorporate strategies for improving mental health and wellness in addition to the treatment of physical symptoms.”

Disclosure: Several authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.