Depression and anxiety are greater risks for patients with alopecia areata, highlighting the clinical importance of routinely assessing these conditions among patients and referring them to other specialists when needed, according to study results published in the Journal of the American Academy of Dermatology.
This systematic review included 6010 individuals with alopecia areata from 8 studies collected from PsychINFO, Embase, Web of Science, and Medline, 4 of which were case-control and 4 of which were cross-sectional studies. A total of 20,961 healthy control participants were also included in the 8 studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were used to select relevant articles for meta-analysis.
A single reviewer performed data extraction, collecting information on participant age and sex; type of study design; country; alopecia areata assessment; depression/anxiety scores, assessment, and prevalence; and total number of participants. Investigators performed quality assessment with the Newcastle-Ottawa Scale for observational studies.
In the quantitative analysis, alopecia areata was found to positively correlate with depression (pooled odds ratio [OR] 2.71 [95% CI, 1.52-4.82]) and anxiety (pooled OR 2.5 [95% CI, 1.54-4.06]). An Egger regression test indicated potential publication bias (P =.023). Several studies in the qualitative analysis failed to show a link between alopecia areata and depression and anxiety. Participants who were younger and who had less severe alopecia areata tended to show less of an association between anxiety, depression, and alopecia areata.
Limitations to this study include a lack of severity-based subanalyses and the potential for publication bias.
The study researchers concluded that “patients with [alopecia areata] are at an increased risk of anxiety and depression. This seems to be particularly true for adult patients with more severe hair loss. The qualitative analysis did not demonstrate a significant association between [alopecia areata], anxiety, and depression in younger patients or those with less severe [alopecia areata], and further studies are needed to better understand how psychiatric comorbidities in [alopecia areata] patients may be affected by these factors.”
Okhovat JP, Marks DH, Manatis-Lornell A, Hagigeorges D, Locascio JJ, Senna MM. Association between alopecia areata, anxiety, and depression: a systematic review and meta-analysis [published online June 1, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.05.086