Weak Relationship Between Psoriasis or Atopic Eczema and Mental Health Outcomes

Little evidence supports a link between severe mental illness and atopic eczema.

More study is needed into depression, anxiety, and severe mental illness (SMI) in the setting of atopic eczema (AE) and psoriasis, as results from single studies conflict, according to a systematic review and meta-analysis published in the British Journal of Dermatology.

Investigators from the London School of Hygiene & Tropical Medicine in the United Kingdom searched publication databases from inception through February 2022 for studies about mental health outcomes among patients with psoriasis or AE. A total of 10 cross-sectional studies, 5 randomized controlled trials, and 1 cohort study that recruited patients with psoriasis and 5 randomized controlled trials that recruited patients with AE were included in this analysis.

In psoriasis, there was little consistent evidence about the outcome of depression. For example, the overall risk for depression was not associated with age (odds ratio [OR], 1.00; 95% CI, 0.97-1.02; I2, 28.00%), female gender (OR, 1.62; 95% CI, 0.62-4.23; I2, 24.90%), psoriasis severity (OR, 1.15; 95% CI, 0.92-1.44; I2, 26.70%), receipt of systemic therapy (OR, 0.62; 95% CI, 0.30-1.26; I2, 0.00%), or the presence of psoriatic arthritis (OR, 2.26; 95% CI, 0.21-24.23; I2, 0.00%). However, stratified by individual studies, a significant relationship for depression with female gender was reported by 1 study, with psoriasis severity by 1 study, and with the presence of psoriatic arthritis by 2 studies.

For the outcome of anxiety in psoriasis, there were also no overall relationships with age, female gender, psoriasis severity, or receipt of systemic therapy. Anxiety was reported to be related with the presence of psoriatic arthritis in the meta-analysis (OR, 1.98; 95% CI, 1.33-2.94; I2, 0.00%). However, stratified by individual studies, 1 of the 2 relevant studies reported a relationship (OR, 1.92; 95% CI, 1.24-2.98) whereas the other did not (OR, 2.27; 95% CI, 0.88-5.85).

Our review reveals a gap regarding known factors associated with depression, anxiety, and SMI in people with AE or psoriasis.

The cross-sectional study that evaluated the relationship between schizophrenia and psoriasis found that the prevalence of schizophrenia was higher in patients with psoriasis who were 40 to 59 years of age compared with those 20 to 39 years of age.

Patients with AE who received placebo tended to report more symptoms of depression, anxiety, or both compared with patients who received dupilumab or abrocitinib.

The major limitation of this analysis was the lack of available data on the subject.

Study authors concluded, “Our review reveals a gap regarding known factors associated with depression, anxiety, and SMI in people with AE or psoriasis. Evidence on factors associated with mental illness in psoriasis were often conflicting or from single studies. […] Future research should focus on better understanding factors associated with mental illness — particularly SMIs — in people with AE or psoriasis and identifying high-risk groups to reduce mental illness burden on people with skin diseases.”

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

References:

Adesanya EI, Mattewman J, Schonmann Y, et al. Factors associated with depression, anxiety, and severe mental illness among adults with atopic eczema or psoriasis: a systematic review and meta-analysis. Br J Dermatol. 2022;ljac132. doi:10.1093/bjd/ljac132