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Meta-Analysis
. 2023 Mar 1;159(3):281-288.
doi: 10.1001/jamadermatol.2022.6085.

Prevalence and Odds of Depressive and Anxiety Disorders and Symptoms in Children and Adults With Alopecia Areata: A Systematic Review and Meta-analysis

Sophie Lauron  1 , Camille Plasse  1 , Marion Vaysset  1 , Bruno Pereira  2 , Michel D'Incan  3 , Fabien Rondepierre  4 , Isabelle Jalenques  5
Affiliations
Meta-Analysis

Prevalence and Odds of Depressive and Anxiety Disorders and Symptoms in Children and Adults With Alopecia Areata: A Systematic Review and Meta-analysis

Sophie Lauron et al. JAMA Dermatol. .

Abstract

Importance: Two recent meta-analyses reported a high prevalence of both anxiety and depression in patients with alopecia areata (AA), as well as a positive association of AA with anxiety and depression, without distinguishing between disorders and symptoms. Yet, depression and anxiety can manifest either as symptoms identified in questionnaires or as specific diagnoses defined by Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria.

Objective: To perform a large meta-analysis separating the prevalence of depressive and anxiety disorders from that of depressive and anxiety symptoms in patients with AA.

Data sources: PubMed, ScienceDirect, the Cochrane Library, Embase, and PsycINFO databases were searched from inception through August 1, 2020.

Study selection: Studies that contained data on the prevalence of depressive or anxiety disorders or symptoms were included.

Data extraction and synthesis: The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were used. Pooled prevalence was calculated with a random effects model meta-analysis that took into account between- and within-study variability. Meta-regressions were used to study the association between variations in prevalence and study characteristics.

Main outcomes and measures: The prevalence of depressive and anxiety disorders and symptoms in patients with AA.

Results: Thirty-seven articles (29 on depression and 26 on anxiety) that met the inclusion criteria were identified. By distinguishing between disorders and symptoms, the prevalence of both depressive disorders (9%) and unspecified anxiety disorders (13%) in patients with AA was shown to be greater than that in the general population. The prevalence and odds ratio (OR) of depressive disorders (prevalence, 9%; OR, 1.38) and anxiety disorders of which each category had been specifically studied (prevalence, 7%-17%; OR, 1.51-1.69) were markedly lower than that of depressive symptoms (prevalence, 37%; OR, 2.70) and anxiety symptoms (prevalence, 34%; OR, 3.07). Meta-regressions showed that variations in prevalence were mainly associated with methodological differences between studies.

Conclusions and relevance: In this systematic review and meta-analysis, the separate analyses showed that 7% to 17% of patients with AA had depressive or anxiety disorders that require psychiatric care, including specific medication. Additionally, more than one-third of patients had symptoms that are warning signs and that need monitoring because they can develop into disorders.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Article Selection for the Meta-analysis
Studies with irrelevant exposure are studies without data on alopecia areata and those with irrelevant outcomes that provide no data on depression and anxiety prevalence.
Figure 2.
Figure 2.. Meta-analysis of the Prevalence of Psychiatric Disorders in Patients With Alopecia Areata
NA indicates not applicable. a11 Studies included.,,,,,,,,,, b9 Studies included.,,,,,,,, c8 Studies included.,,,,,,,
Figure 3.
Figure 3.. Odds Ratio (OR) Meta-analysis of the Association of Depressive/Anxiety Disorders and Depressive/Anxiety Symptoms With Alopecia Areata
NA indicates not applicable.
See this image and copyright information in PMC

Comment in

References

    1. Lee S, Lee H, Lee CH, Lee W-S. Comorbidities in alopecia areata: a systematic review and meta-analysis. J Am Acad Dermatol. 2019;80(2):466-477.e16. - PubMed
    1. Okhovat J-P, Marks DH, Manatis-Lornell A, Hagigeorges D, Locascio JJ, Senna MM. Association between alopecia areata, anxiety, and depression: a systematic review and meta-analysis. J Am Acad Dermatol. 2019;S0190-9622(19)30890-4. - PubMed
    1. Rønnstad ATM, Halling-Overgaard A-S, Hamann CR, Skov L, Egeberg A, Thyssen JP. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: a systematic review and meta-analysis. J Am Acad Dermatol. 2018;79(3):448-456.e30. - PubMed
    1. Jalenques I, Ciortianu L, Pereira B, D’Incan M, Lauron S, Rondepierre F. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: systematic review and meta-analysis. J Am Acad Dermatol. 2020;83(2):542-553. - PubMed
    1. Jalenques I, Lauron S, Almon S, Pereira B, D’Incan M, Rondepierre F. Prevalence and odds of signs of depression and anxiety in patients with lichen planus: systematic review and meta-analyses. Acta Derm Venereol. 2020;100(18):adv00330. - PMC - PubMed

Supplementary concepts