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Meta-Analysis
. 2024 Apr 17;14(1):8844.
doi: 10.1038/s41598-024-59162-9.

Interventions for anxiety and depression in patients with atopic dermatitis: a systematic review and meta-analysis

Stella P Hartono #  1 , Sheena Chatrath #  2 , Ozge N Aktas  3 , Stephanie A Kubala  3 , Korey Capozza  4 , Ian A Myles  5 , Jonathan I Silverberg  6 , Alan Schwartz  7
Affiliations
Meta-Analysis

Interventions for anxiety and depression in patients with atopic dermatitis: a systematic review and meta-analysis

Stella P Hartono et al. Sci Rep. .

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with anxiety and depression. Few studies have addressed interventions for symptoms of anxiety and depression in this population. To determine the efficacy of interventions for anxiety and depression in patients with AD. PubMed, MEDLINE, EMBASE, and PsycINFO were searched from inception to November 2023. English-language studies published in peer-reviewed journals evaluating the effect of interventions on anxiety and/or depression using validated assessment tools on patients with AD were included. Titles, abstracts, and articles were screened by at least two independent reviewers. Of 1410 references that resulted in the initial search, 17 studies were included. Fourteen of these studies are randomized controlled trials, while the other 3 studies are prospective controlled trials with pre and post-test designs. Data were extracted using a standardized extraction form, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. To accommodate trials with multiple interventions (each compared to a control group), we conducted a mixed-effects meta-analysis with the trial as a random effect. Prespecified outcomes were changes in symptoms of anxiety and depression in patients with AD as evaluated using standardized assessment tools. Of the 17 studies included in this systematic review, 7 pharmacological intervention studies with 4723 participants examining 5 different medications were included in a meta-analysis. Of these studies, only 1 study evaluated medications prescribed to treat anxiety and/or depression; the rest evaluated medications prescribed to treat AD. Meta-analysis of all the pharmacological interventions resulted in significant improvement in anxiety, depression, and combined anxiety-depression scale scores (standardized mean difference [95% CI]: - 0.29 [- 0.49 to - 0.09], - 0.27 [- 0.45 to - 0.08], - 0.27 [- 0.45 to - 0.08]) respectively. The 10 non-pharmacological studies with 2058 participants showed general improvement in anxiety but not depression. A meta-analysis of the non-pharmacological interventions was not conducted due to variable approaches and limited data. Pharmacological interventions designed to improve AD were found to improve anxiety and depression in patients with moderate-severe disease. More comprehensive studies on non-pharmacological and pharmacological interventions that primarily target anxiety and depression are needed.

Keywords: Anxiety; Atopic dermatitis; Depression; Eczema.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
PRISMA diagram of the study selection for this systematic review. Seventeen studies are included in this systematic review. Seven pharmaceutical interventions out of the seventeen studies are included in the meta-analysis.
Figure 2
Figure 2
Forest plot showing treatment effectiveness of various study arms in anxiety.
Figure 3
Figure 3
Forest plot showing treatment effectiveness of various study arms in depression.
Figure 4
Figure 4
Forest plot showing treatment effectiveness of various study arms in Silverberg et al.,. This study was graphed separately as it used SF-36v MCS to assess emotional and mental health, which we consider a surrogate measurement for depression.
Figure 5
Figure 5
Forest plot showing treatment effectiveness of various study arms in both anxiety and depression combined.
Figure 6
Figure 6
Risk of bias of the pharmaceutical (A) and non-pharmaceutical interventions (B) based on 5 different domains.
See this image and copyright information in PMC

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