Mental Health Burden, Lower Patient Satisfaction in Adults With Alopecia

Bald spot on the scalp of a child due to alopecia areata.
Mental health outcomes in adults with alopecia are characterized and the association between patient satisfaction with mental health symptoms and diagnoses is assessed.

Alopecia is associated with increased mental health symptoms, and psychological distress and depressive symptoms are associated with lower overall patient satisfaction in adults with alopecia, according to findings from a study published in JAAD International.

Investigators sought to characterize mental health outcomes in adults with alopecia and assess the association of patient satisfaction with mental health symptoms and diagnoses.

The cross-sectional analysis included adults aged 18 years and older with a current diagnosis of alopecia areata and related hair conditions enrolled in the 2004 to 2016 Medical Expenditure Panel Survey (MEPS).

The primary outcome was patient satisfaction, which was assessed in the MEPS with use of the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Psychological status was measured with the 6-item Kessler Psychological Distress Scale (K6) and 2-item Patient Health Questionnaire (PHQ2).

A total of 178,161 US adults were surveyed by the MEPS and completed the CAHPS survey, including 543 (0.3%) adults with alopecia.

Adult patients with alopecia had increased rates of positive PHQ2 screening (adjusted odds ratio [OR] [95% CI], 1.37 [1.05-1.78]; P =.02), positive K6 screening (1.57 [1.02-2.41]; P =.04), and comorbid anxiety (1.85 [1.30-2.63]; P =.0007) and depression (1.68 [1.19-2.39]; P =.004) compared with those without alopecia in logistic regression models adjusted for age, sex, race and ethnicity, education, income, insurance coverage, and multimorbidity.

In addition, 75.5% of adults with alopecia had a negative PHQ2 screen, and 24.5% had a positive PHQ2 screen for depressive symptoms. A positive PHQ2 screening was associated with an increased rate of low patient satisfaction (CAHPS ≤9) (10.7% vs 4.9%; aOR [95% CI], 2.15 [1.13, 4.11]; P =.02).

Among adults with alopecia, 93.5% had 0 to mild psychological distress, and 6.5% had clinically significant psychological distress. Clinically significant psychological distress was associated with 6-fold higher odds of low patient satisfaction (18.7% vs 5.8%; aOR [95% CI], 6.04 [2.60, 14.05]; P <.0001).

A total of 105 (17.9%) patients had comorbid depression, and 84 (17.3%) had anxiety. Anxiety was associated with decreased patient satisfaction (13.54 vs 14.06; -0.53 [-1.02, -0.03]; P =.04). No differences were observed in the rates of low patient satisfaction associated with comorbid anxiety (0.74 [0.33-1.67]; P =.46) and depression (1.42 [0.72- 2.78]; P =.31).

The researchers noted that data were unavailable for patterns of hair loss and treatment regimens, and the cross-sectional design precludes any conclusions about causality or directionality.

“Lower patient satisfaction among those with positive mental health screening and not comorbid psychiatric disorders suggests that the underdiagnosis and undermanagement of mental health symptoms may contribute to lower patient satisfaction,” the study authors concluded. “Clinicians should recognize that baseline mental health symptoms may affect patient satisfaction, and patients may benefit from tailored communication.”


Kim AB, Cheng BT, Hassan S. Association of mental health outcomes and lower patient satisfaction among adults with alopecia: a cross-sectional population-based study. JAAD Int. 2022;8:82-88. doi:10.1016/j.jdin.2022.05.011