Patients, Caregivers Highlight Holistic Approach to AD to Address Mental Health Impacts

Patients with atopic dermatitis (AD) and their caregivers experience large mental health impacts, yet their preferences for care and support have been poorly understood. The results of a new study published in Dermatitis found patients and caregivers prefer effective AD management as the method for improving mental health.

The majority of patients with AD have type 2 inflammation, and patients with excessive type 2 inflammation often have other, related conditions, such as asthma, chronic rhinosinusitis and eosinophil esophagitis. Patients with type 2 inflammatory disease often experience frequent disease flares along with intense itch and a poor quality of life.

In the new study, researchers led by Albert C. Chong, M.P.H., of the Keck School of Medicine, University of Southern California, Los Angeles, sought to understand patient and caregiver preferences for mental health and support in AD through the use of a survey.

Patients with type 2 inflammation often experience frequent disease flare ups with intense itch, which impact quality of life.

"Vigilance for psychiatric symptoms has become a recognized component of AD care, yet specific guidance on how clinicians may address AD-related mental health challenges, and what type of assistance patients and caregivers may prefer, is lacking,” the authors explained.

New targeted therapies have been shown to improve disease severity and itch, but more aggressive treatment with these therapies has financial cost implications and access to specialists to receive the prescriptions remain a challenge, they noted.

The survey was administered through social media channels, online newsletters and SurveyMonkey’s global survey panel and it was open to English-speaking patients and caregivers globally. Respondents were asked about the diagnosis history, disease severity over the worst two weeks, overall self-rated mental health during the worst two weeks and more.

The final analysis included 433 respondents from 26 countries. Of these 279 were adult patients and 154 were caregivers. Among adult patients, 33.6% rated their AD as moderate and 41.6% as severe; among caregivers, 56.5% rated their child’s AD as moderate and 28.6% as severe.

The majority of caregivers reported they had not sought mental health help for eczema (75%), while the adult patients were evenly split with 50.9% not having sought help and 49.1% reporting that they had sought mental health help.

Overall, the majority of all respondents said they see a general practitioner for AD (42.7%), but caregivers were far more likely than adult patients to report this (57.1% vs 34.8%). Adult patients were most likely to say they see a dermatologist as their primary provider for their condition (45.9%).

During their worst two weeks of AD:

• 70% of adults and 78% of caregivers scored in the at-risk range for general anxiety disorder (GAD)
• 55% of adults and 62% of caregivers score in the at-risk range for major depressive disorder (MDD)
• 47% of adults and 58% of caregivers reported their mental health was “poor”

During this two-week period, caregivers had significantly worse overall mental health and GAD risk than adult patients, but there was no significant difference for MDD risk. Greater AD severity was a predictor of worse overall mental health and increased risk for GAD and MDD.

“Results highlight the striking impacts of AD on caregivers, who may suffer even greater mental health impacts as compared with patients regarding overall mental health and anxiety,” the researchers noted. They added that caregivers may be focused on improving their child’s health at the expense of their own and they may not have an obvious health care provider to help them since they are seeking care from a pediatric provider for their child.

Adult patients indicated that their preferred top mental health strategies were treating the AD (58%), managing the itch (51%), wearing clothing to cover skin (44%), avoiding social situations (43%) and spending time alone (41%). These strategies were the top regardless of disease severity.

For caregivers, the top strategies for their own mental health were managing their child’s itch (76%) and treating their child’s AD (75%). Their top mental health strategies for their children were managing itch (75%) and treating the AD (61%).

Among the limitations were the internet sampling of the survey, which may have resulted in respondents who are more active in online AD communities and experience greater impacts of AD. In addition, responses may have been biased since respondents were informed of the study’s purpose.

“Taken together, our findings inform a holistic approach to AD that addresses both its physical and mental health impacts, even as improvements in treatments lead us toward a more hopeful future in which patients and caregivers experience less suffering from this condition,” the authors concluded.