Depressive and Anxiety Disorders, Symptoms Common With Alopecia Areata

Among patients with alopecia areata (AA), 7% to 17% have depressive or anxiety disorders that require psychiatric care and more than one-third have depressive or anxiety symptoms, according to study results published in JAMA Dermatology.

Researchers conducted a systematic review and meta-analysis and searched PubMed, ScienceDirect, the Cochrane Library, Embase, and PsycINFO databases for relevant studies published before August 2020. Eligible studies were either observational or interventional, and included data on the prevalence of depressive or anxiety disorders or symptoms with no restrictions in language or patient age.

Meta-regression analysis was used when a study’s sample size was large enough to evaluate associations between variations in prevalence and assessment method (ie, interview; specific diagnoses per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; unspecified medical records; or self-administered questionnaire), study quality, sex, number and age of patients, study design, and geographic area or region.

A total of 29 articles on depression and 26 on anxiety were included in the meta-analysis.

For depressive disorders, the mean prevalence among patients with AA was 9% (95% CI, 6%-12%), with wide heterogeneity observed (I², 97.4%). In interview-based studies, the prevalence was 20% (95% CI, 9%-31%), and 4% (95% CI, 1%-6%) for those that used medical records. In case-control studies, an association was found between depressive disorders and AA (odds ratio [OR], 1.38; 95% CI, 1.11-1.72). The ORs were 3.95 (95% CI, 1.65-9.44) in interview-based studies and 1.29 (95% CI, 1.09-1.52) for those that used medical records. Compared with European studies, an increased prevalence in studies from the Middle East and a lower prevalence in those from Asia.

Regarding depressive symptoms, the mean prevalence among patients was 37% (95% CI, 28%-46%), with wide heterogeneity occurring (I², 92.8%). The prevalence was 57% (95% CI, 44%-71%) in studies that used a researcher-administered questionnaire and 32% (95% CI, 21%-42%) in those involving a self-administered questionnaire. In case-control studies, an association was observed between depressive symptoms and AA (OR, 2.70; 95% CI, 1.81-4.04). The OR was 4.48 (95% CI, 2.12-9.44) in studies that used a researcher-administered questionnaire and 2.17 (95% CI, 1.27-3.71) in those with a self-administered questionnaire.

For unspecified anxiety disorders, the mean prevalence was 13% (95% CI, 9%-16%), with wide heterogeneity (I², 97.6%). The prevalence was 27% (95% CI, 15%-39%) in interview-based studies and 6% (95% CI, 2%-10%) for those involving medical records. In case-control studies, an association was observed between unspecified anxiety disorders and AA (OR, 1.51; 95% CI, 1.33-1.72), with no heterogeneity (I², 0%). A lower prevalence was observed in studies from Asia.

The mean prevalence of generalized anxiety disorders was 17% (95% CI, 14%-21%), with no heterogeneity occurring (I², 0%). The prevalence was 18% (95% CI, 14%-23%) for studies that used a self-administered questionnaire and 17% (95% CI, 12%-21%) for those with an interview.

The mean prevalence of anxiety symptoms was 34% (95% CI, 22%-47%), with wide heterogeneity observed (I², 94.6%). The prevalence was 52% (95% CI, 42%-62%) for studies involving a researcher-administered questionnaire and 28% (95% CI, 16%-39%) in those that used a self-administered questionnaire. For case-control studies, an association between anxiety symptoms and AA was found (OR, 3.07; 95% CI, 1.96- 4.81), with no heterogeneity (I², 0%). For studies that used a researcher-administered questionnaire, the OR was 3.50 (95% CI, 1.88-6.50) vs 2.67 (95% CI, 1.39-5.10) for those that used a self-administered questionnaire.

Limitations of the study include heterogeneity and a possible association between atopic dermatitis severity and the prevalence of depression that could not be evaluated.

“The substantial difference between the prevalence of disorders and that of symptoms is a strong argument in favor of using a multimodal assessment approach in research studies that could lead to a better detection of psychiatric disorders in patients with dermatological diseases,” the researchers conclude.