Beyond hair loss: Exploring the psychiatric burden of alopecia areata in a large cohort

Abstract

Background: Alopecia areata is a non-scarring autoimmune condition that causes hair loss and is increasingly linked to mental health disorders. This study examined the incidence of psychiatric conditions among patients newly diagnosed with alopecia areata and explored demographic differences in psychiatric outcomes.

Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. A total of 97,925 patients with a new diagnosis of alopecia areata were identified using diagnostic codes. After exclusions, 91,302 patients were included in the final analysis. Over a one-year follow-up period, the incidence of depression, anxiety, schizophrenia, obsessive-compulsive disorder, and adjustment disorders was assessed. Survival analysis and risk calculations were performed, and demographic data were analyzed to identify disparities.

Results: Mental health conditions were common in patients with alopecia areata. Anxiety was the most frequent psychiatric diagnosis, affecting 3.1 % of patients, followed by depression at 1.6 %. Adjustment disorders, schizophrenia, and obsessive-compulsive disorder were less common but still present. Patients diagnosed with these conditions experienced repeated episodes, with the highest average episodes per patient seen in those with depression, followed by anxiety. Kaplan-Meier survival analysis showed high probabilities of remaining free from psychiatric conditions during the study period. The average age of patients was 49 years, and 72.06 percent were female. The racial distribution was predominantly White (58.24 %), followed by Black or African American (16.85 %), with other racial groups represented in smaller proportions.

Conclusion: Patients with alopecia areata face a substantial mental health burden, highlighting the need for integrated medical and psychological care.

Keywords: Alopecia areata; Anxiety; Depression; Psychiatric comorbidity.