Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults

Abstract

Background: The relationship between atopic dermatitis (AD), anxiety and depression in the U.S. adult population is not well established.

Objectives: To determine the relationship of AD and its severity with symptoms and diagnosis of anxiety and depression in U.S. adults.

Methods: A cross-sectional, population-based study of 2893 adults was performed. AD was determined using modified U.K. Diagnostic Criteria.

Results: Adults with AD vs. those without AD had higher mean Hospital Anxiety and Depression Scale anxiety (HADS-A) (7·7 vs. 5·6) and depression (HADS-D) (6·0 vs. 4·3) scores and higher prevalences of abnormal (≥ 11) HADS-A (28·6% vs. 15·5%) and HADS-D (13·5% vs. 9·0%) scores. In multivariable linear and logistic regression models controlling for sociodemographics, AD was associated with significantly higher mean HADS-A and HADS-D scores (7·7 and 6·0) and higher odds of abnormal HADS-A [odds ratio (OR) 2·19, 95% confidence interval (CI) 1·65-2·91] and HADS-D scores (OR 1·50, 95% CI 1·04-2·17) (P ≤ 0·03 for all). Mean and abnormal HADS-A and HADS-D scores were increased in moderate and severe/very severe self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD itch and sleep (P < 0·0001 for all). All respondents with severe PO-SCORAD, POEM and PO-SCORAD itch had borderline or abnormal HADS-A and HADS-D scores. Adults with AD vs. those without AD had higher prevalence of self-reported healthcare-diagnosed anxiety or depression in the past year (40·0% vs. 17·5%). Many adults with AD who had borderline and/or abnormal HADS-A or HADS-D scores reported no diagnosis of anxiety or depression.

Conclusions: AD is associated with significantly increased anxiety and depression, which may go undiagnosed. What's already known about this topic? Previous studies found higher rates of anxiety and depression in clinical cohorts of patients with atopic dermatitis. What does this study add? This study found dramatically higher rates of anxiety and depression among adults with atopic dermatitis in the U.S. population, which was primarily driven by atopic dermatitis severity. Anxiety and depression often go undiagnosed in adults with atopic dermatitis.

Figure 1

Proportions (95% confidence intervals) of responses to Hospital Anxiety and Depression Scale (HADS) questions among U.S. adults with and without atopic dermatitis. AD, atopic dermatitis.

Figure 2

(a) Combined effects of mild‐to‐moderate and severe atopic dermatitis (AD) [Patient‐Oriented Scoring Atopic Dermatitis (PO‐SCORAD)], frequency of symptoms (Patient‐Oriented Eczema Measure) and severity of pruritus (PO‐SCORAD itch) on weighted mean [95% confidence interval (CI)] Hospital Anxiety and Depression Scale anxiety (HADS‐A) and depression (HADS‐D) scores and (b) the proportion of borderline and abnormal HADS‐A and HADS‐D scores. All subsets of combined AD severity had significantly higher HADS‐A and HADS‐D scores compared with patients with mild‐to‐moderate scores for all three assessments (P < 0.001). Overall, 100% of respondents with severe scores for all three assessments had borderline and/or abnormal HADS‐A and HADS‐D scores. NRS, numeric rating scale.