Association between hidradenitis suppurativa, depression, anxiety, and suicidality: A systematic review and meta-analysis

Abstract

Background: Previous studies found conflicting results about whether hidradenitis suppurativa (HS) is associated with depression or anxiety.

Objectives: To determine the relationship of HS with depression and anxiety.

Methods: A systematic review was performed of published observational studies in MEDLINE, PubMed, Embase, Global Resource for Eczema Trials (GREAT), Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane, Scopus, and PsychInfo that analyzed depression or anxiety in HS. Two reviewers performed title/abstract review and data extraction. Meta-analysis was performed with random-effects weighting.

Results: Thirty-eight studies met inclusion criteria; 27 had sufficient data for meta-analysis. The prevalences of depression (26.5% vs 6.6%) and anxiety (18.1% vs 7.1%) were higher in persons with versus without HS. Patients with HS had higher odds of depression in 12 of 13 studies and pooled analysis (odds ratio, 2.54; 95% confidence interval, 2.15-3.01), and anxiety in 6 of 6 studies and pooled analysis (odds ratio, 2.00; 95% confidence interval, 1.66-2.42). Similar results were found in sensitivity analyses for different methods of HS diagnosis (physician diagnosed and chart review) and control groups (healthy and dermatologic control individuals). HS was associated with higher antidepressant and anxiolytic use and with suicidality, but not mean depression and anxiety scale scores.

Limitations: Individual-level data were unavailable.

Conclusions: Patients with HS have higher odds of depression, anxiety, and suicidality.

Keywords: acne inversa; antidepressant; anxiety; anxiolytic; comorbidity; depression; evidence; hidradenitis suppurativa; mood; suicidal ideation; suicide.