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Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: A systematic review and meta-analysis

      Background

      Atopic dermatitis (AD) has been associated with anxiety and depression, but the magnitude of the alleged association is unknown.

      Objective

      To perform a systematic review and meta-analysis of the association between AD in children and adults and, respectively, depression, anxiety, and suicidal behavior.

      Methods

      The medical databases PubMed, Embase, and PsychINFO were searched.

      Results

      There was a significant association between adult AD and, respectively, depression (pooled odds ratio [OR], 2.19; 95% confidence interval [CI], 1.87-2.57) and anxiety (pooled OR, 2.19; 95% CI, 1.75-2.73). AD was also associated with depression in children (pooled OR, 1.27; 95% CI, 1.12-1.45); few data were available for anxiety. A positive association was found between AD in adults and adolescents and suicidal ideation (pooled OR, 4.32; 95% CI, 1.93-9.66). Only a few studies examined the risk of completed suicide, but the majority showed a positive association between completed suicide and AD.

      Limitations

      Included studies used different definitions of depression and anxiety, and few studies examined the severity of AD.

      Conclusion

      Depression, anxiety, and suicidal ideation should be considered by doctors when treating patients with AD. Because AD disease improvement appears to reduce these risks, this should be a priority.

      Key words

      Abbreviations used:

      AD (atopic dermatitis), CI (confidence interval), NOS (Newcastle-Ottawa scale), OR (odds ratio)
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      Supplemental References

        • Shirata K.
        • Nishitani Y.
        • Fujino Y.
        • et al.
        The importance of mental support to the patients with adult atopic dermatitis.
        Osaka City Med J. 1996; 42: 45-52
        • Zachariae R.
        • Zachariae C.
        • Ibsen H.H.
        • et al.
        Psychological symptoms and quality of life of dermatology outpatients and hospitalized dermatology patients.
        Acta Derm Venereol. 2004; 84: 205-212
        • Bahreinian S.
        • Ball G.D.
        • Colman I.
        • et al.
        Depression is more common in girls with nonatopic asthma.
        Chest. 2011; 140: 1138-1145
        • Mizara A.
        • Papadopoulos L.
        • McBride S.R.
        Core beliefs and psychological distress in patients with psoriasis and atopic eczema attending secondary care: the role of schemas in chronic skin disease.
        Br J Dermatol. 2012; 166: 986-993
        • Zachariae R.
        • Lei U.
        • Haedersdal M.
        • et al.
        Itch severity and quality of life in patients with pruritus: preliminary validity of a Danish adaptation of the itch severity scale.
        Acta Derm Venereol. 2012; 92: 508-514
        • Yaghmaie P.
        • Koudelka C.W.
        • Simpson E.L.
        Mental health comorbidity in patients with atopic dermatitis.
        J Allergy Clin Immunol. 2013; 131: 428-433
        • Lind N.
        • Nordin M.
        • Palmquist E.
        • et al.
        Psychological distress in asthma and allergy: the Vasterbotten Environmental Health Study.
        Psychol Health Med. 2014; 19: 316-323
        • Augustin M.
        • Radtke M.A.
        • Glaeske G.
        • et al.
        Epidemiology and comorbidity in children with psoriasis and atopic eczema.
        Dermatology. 2015; 231: 35-40
        • Cheng C.M.
        • Hsu J.W.
        • Huang K.L.
        • et al.
        Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study.
        J Affect Disord. 2015; 178: 60-65
        • Dalgard F.J.
        • Gieler U.
        • Tomas-Aragones L.
        • et al.
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        J Invest Dermatol. 2015; 135: 984-991
        • Kim S.
        • Lee J.Y.
        • Oh J.Y.
        • et al.
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        • Kim S.H.
        • Hur J.
        • Jang J.Y.
        • et al.
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        Medicine (Baltimore). 2015; 94: e949
        • Yu S.H.
        • Silverberg J.I.
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        J Invest Dermatol. 2015; 135: 3183-3186
        • Drucker A.
        • Stemart A.
        • Amand C.
        • et al.
        Burden of atopic dermatitis: a claims-based analysis.
        J Am Acad Dermatol. 2016; 1: AB85
        • Sato Y.
        • Hiyoshi A.
        • Melinder C.
        • et al.
        Asthma and atopic diseases in adolescence and antidepressant medication in middle age.
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        • Emir B.
        • Seitzman R.
        • et al.
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        Curr Med Res Opin. 2016; : 1-7
        • Dieris-Hirche J.
        • Gieler U.
        • Petrak F.
        • et al.
        Suicidal ideation in adult patients with atopic dermatitis: a German cross-sectional study.
        Acta Derm Venereol. 2017;
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        • Ballardini N.
        • Kull I.
        • et al.
        Association between preschool eczema and medication for attention-deficit/hyperactivity disorder in school age.
        Pediatr Allergy Immunol. 2017; 28: 44-50
        • Lee S.
        • Shin A.
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        BMC Psychiatry. 2017; 17: 3
        • Radtke M.A.
        • Schafer I.
        • Glaeske G.
        • et al.
        Prevalence and comorbidities in adults with psoriasis compared to atopic eczema.
        J Eur Acad Dermatol Venereol. 2017; 31: 151-157
        • Thyssen J.P.
        • Hamann C.R.
        • Linneberg A.
        • et al.
        Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with psychiatric hospitalization or suicide.
        Allergy. 2018; 73: 214-220
        • Catal F.
        • Topal E.
        • Soylu N.
        • et al.
        Psychiatric disorders and symptoms severity in preschool children with atopic eczema.
        Allergol Immunopathol (Madr). 2016; 44: 120-124
        • Kimata H.
        Prevalence of suicidal ideation in patients with atopic dermatitis.
        Suicide Life Threat Behav. 2006; 36: 120-124
        • Dieris-Hirche J.
        • Milch W.E.
        • Kupfer J.P.
        • et al.
        Suicidal ideation, anxiety and depression in German adult patients with atopic dermatitis.
        Acta Derm Venereol. 2009; 89: 578
        • Ahmar H.
        • Kurban A.K.
        Psychological profile of patients with atopic dermatitis.
        Br J Dermatol. 1976; 95: 373-377
        • Faulstich M.E.
        • Williamson D.A.
        • Duchmann E.G.
        Psychophysiological analysis of atopic dermatitis.
        J Psychosom Res. 1985; 29: 415-417
        • King R.M.
        • Wilson G.V.
        Use of a diary technique to investigate psychosomatic relations in atopic dermatitis.
        J Psychosom Res. 1991; 35: 697-706
        • Hashiro M.
        • Okumura M.
        The relationship between the psychological and immunological state in patients with atopic dermatitis.
        J Dermatol Sci. 1998; 16: 231-235
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        • Raj L.
        • Kaur H.
        • et al.
        Psychological disturbances in Indian children with atopic eczema.
        J Dermatol. 2004; 31: 448-454
        • Arima M.
        • Shimizu Y.
        • Sowa J.
        • et al.
        Psychosomatic analysis of atopic dermatitis using a psychological test.
        J Dermatol. 2005; 32: 160-168
        • Seiffert K.
        • Hilbert E.
        • Schaechinger H.
        • et al.
        Psychophysiological reactivity under mental stress in atopic dermatitis.
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        • Pae C.U.
        • Jeong J.T.
        • et al.
        Temperament and character dimensions in patients with atopic dermatitis.
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        • Kanai N.
        Personality and parent-child relationship in patients with atopic dermatitis.
        Acta Derm Venereol. 2009; 89: 573
        • Hetzel S.
        • Essex M.J.
        Anxiety and depression in adolescents with atopic dermatitis.
        Brain Behav Immun. 2009; 23: S56
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