Atopic Dermatitis and Mental Health

Atopic dermatitis can lead to depression and anxiety among adults, children and teens that increases with the severity of the disease, finds a new study recently published in Dermatitis.

Jessica Johnson

“It's important to understand patients’ and caregivers’ perspectives on this topic, because when people are aware of the connection between mental health and eczema symptoms, they may be more likely to seek support,” Jessica Johnson, co-author of the study and director of community research and engagement at National Eczema Association (NEA), said in a news release. The NEA funded this study.

Researchers aimed to evaluate patient-reported mental health symptoms, their correlation with atopic dermatitis severity and the perceived impact on mental health.

Adult patients, as well as the primary caregivers of children and teens ages 8 to 17 years completed a survey, which included questions about atopic dermatitis symptoms, mental health symptoms and experiences accessing mental health services. The survey asked about trouble sleeping; difficulty concentrating; poor appetite; feeling tired; little interest or pleasure in activities; and feeling hopeless.

In total, 1,496 people took the survey and 991 of then met inclusion criteria for inclusion in the analysis. An additional 37 responses were removed for those who finished less than of the survey questions.

Researchers used the Hospital Anxiety and Depression Scale (HADS), a self-reporting scale that measures anxiety and depression that has been validated for use in adults with atopic dermatitis.

Researchers found that majority of adults and children were impact by atopic dermatitis. In fact, 70% of respondents reported that either their own or their child's mental health was impacted during the past year. Those with more severe atopic dermatitis symptoms were more likely to have 10+ days of poor mental health than those with less severe symptoms.

Most adults (65.5%) with atopic dermatitis had anxiety scores that were borderline abnormal or abnormal, and nearly half (46.4%) had borderline abnormal or abnormal depression scores.

Both adults and caregivers of children and teens reported worsening mental health symptoms during flares and right before flares, and many also reported apprehension about future flares. On average, 55% of patients and 62% of caregivers worried about whether they or child would have a flare. And 42% of patients were concerned about being seen public while experience a flare.

One limitation of the study is that the HADS scale used has not been validated to assess the depression and anxiety of children with atopic dermatitis. The study relied on reporting by caregivers. Researchers also said that while survey demographics indicated diverse patients based on race, ethnicity and disease severity, there is a possibility of response bias. Survey respondents, the researchers said, may be more engaged in their health.

Researchers suggest a future study could look at the barriers of accessing mental health services. “Despite the known association between mental health symptoms and AD, there remains opportunities to improve the standard of care for diagnosis and discussion around mental health and AD,” they wrote.