Half of all adults with eczema experience anxiety or depression
Peer Reviewed | Observational Study | People
50 percent of adults with eczema have been diagnosed with anxiety or depression in the last 12 months, or show signs of these mental health problems, according to new research in the British Journal of Dermatology.
The risk of anxiety and depression is dramatically higher in adults with eczema than those without, as this figure falls to 27.3 percent amongst adults without eczema.
The research, carried out by dermatologists and allergists in the US, also found the severity of eczema symptoms to be strongly linked to the risk of anxiety and depression, with these mental health complications often going undiagnosed in adults in the US.
The study looked at a common type of eczema called atopic dermatitis, a common skin condition which causes red, itchy and sore skin. The condition usually begins in childhood, however it often continues into adulthood, affecting one in 12 adults in the UK.
The study included 2893 US adults, 602 of whom had eczema. Participants completed an online survey which was designed to reveal the severity of their eczema if they had the condition and the state of their mental wellbeing.
Eczema severity was defined using three different assessments which considered factors such as sleep disturbance, itchiness and the extent of dry skin. Severity was categorised ranging from mild to very severe based on the assessment scores.
The mental health assessment was completed using the Hospital Anxiety and Depression Scale (HADS), which translated to anxiety and depression scores. Participants were also asked if they had been diagnosed with depression or anxiety by a healthcare professional within the past year.
40 percent of adults with eczema reported having been medically diagnosed with anxiety or depression in the past year, compared to 17.5 percent of people without eczema.
Using the HADS scores, eczema was found to be associated with a significantly higher chance of experiencing symptoms of anxiety and depression. Borderline or abnormal scores for anxiety, depression and for both anxiety and depression were reported in 48.4 percent, 34.5 percent and 26.6 percent of adults with eczema, respectively. This is compared to 29.4 percent, 19.5 percent and 14.1 percent in those without eczema.
In combination, 50 percent of adults with eczema and 27 percent of adults without eczema had abnormal HADS anxiety or depression scores or reported a healthcare diagnosis for either mental health condition.
Anxiety and depression scores increased significantly with each eczema severity category, suggesting that disease severity is a major driver of anxiety and depression in eczema patients. 100 percent of adults with severe eczema, scored across all three measurement criteria, had borderline or abnormal anxiety and depression HADS scores.
Lead study author Dr. Jonathan Silverberg, associate professor of dermatology at Northwestern University Feinberg School of Medicine, said:
“This research confirms previous studies that rates of anxiety and depression are higher among adults with eczema. The mental health burden of eczema is greatly underappreciated, particularly in patients with severe symptoms. We therefore suggest that people with moderate or severe eczema would benefit from routine screening for signs of mental health problems. Eczema patients warrant a multi-disciplinary approach to assessing their eczema and comorbid medical and mental health disorders.”
Holly Barber of the British Association of Dermatologists said:
“There is a strong link between our skin and our mental health. This study confirms the need to ensure mental health services are accessible to patients with skin conditions, and where possible integrate mental and physical care at the earliest opportunity.
“Unfortunately, few dermatology departments currently have the resources to consistently apply this approach, to achieve this will require more investment. Those who feel that the level of mental health support they are getting is inadequate should discuss this with their dermatologist or GP. For those who prefer self-help methods, the British Association of Dermatologists has set up the Skin Support website to provide these types of resources.”
Skin Support (www.skinsupport.org.uk), is a website designed to provide psychological support and self-help resources for people with skin conditions.
Understanding the cause of anxiety and depression in eczema patients, such as the severity of symptoms, may help to improve mental health care for patients with common skin conditions.
Symptoms and diagnosis of anxiety and depression in atopic dermatitis in US adults
J.I. Silverberg1, J.M. Gelfand2, D.J. Margolis2, M. Boguniewicz3, L. Fonacier4, M.H. Grayson5, P.Y. Ong6, Z.C. Chiesa Fuxench2, and E.L. Simpson7
1Northwestern University Feinberg School of Medicine, Chicago, IL, 2University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 3National Jewish Health and University of Colorado School of Medicine, Denver, CO, 4NYU Winthrop Hospital, Mineola, NY, 5Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, OH, 6Children’s Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, CA, 7Oregon Health & Science University, Portland, OR
J.I. Silverberg, J.M. Gelfand, D.J. Margolis, M. Boguniewicz, L.Fonacier, M.H. Grayson, P.Y. Ong, Z.C. Chiesa Fuxench and E.L. Simpson (2019), Symptoms and diagnosis of anxiety and depression in atopic dermatitis in US adults. Br J Dermatol. DOI
This study was conducted in partnership with the Asthma and Allergy Foundation of America and the National Eczema Association with support from Sanofi Genzyme and Regeneron.
The study will be available online on Wednesday 6th March 2019 at 05.01hrs GMT here: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17683
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The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk
The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley-Blackwell. The British Journal of Dermatology is one of the top dermatology journals in the world, and publishes papers on all aspects of the biology and pathology of the skin. https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133