Patients with atopic dermatitis face significantly higher risks of depression and anxiety, according to recent research that examined the mental health burden.
Adults with atopic dermatitis (AD) were two to three times more likely to experience depression or anxiety than those without the disease. Among children and adolescents, the risk was approximately 1.5 times higher. These symptoms were most common in patients with moderate to severe or poorly controlled AD.
The mental health impact appeared closely linked to disease activity, including itching, flares, and disrupted sleep. For many, symptoms of depression and anxiety intensified during flare-ups.
Jennifer S. LeBovidge, PhD, and Lynda C. Schneider, MD, drew on data from multiple population-based studies. In the United Kingdom, a longitudinal analysis found that adults with AD had a 14% increased risk of newly diagnosed depression and a 17% increased risk of anxiety. In Taiwan, adolescents with AD were four times more likely to develop major depressive disorder and five times more likely to be diagnosed with anxiety compared with their peers. Among adults, those figures rose to a sevenfold increase for depression and a threefold increase for anxiety.
Sleep disruption was identified as a major contributor to poor mental health. Between 33% and 87% of adults and up to 80% of children with AD reported disturbed sleep. This was associated with daytime mood and behavioral problems and, in some cases, directly contributed to worsening mental health symptoms, noted Dr. Schneider and LeBovidge, of the Division of Immunology, Boston Children's Hospital, Boston, Mass.
Psychosocial challenges such as stigma, bullying, and self-consciousness over visible skin lesions were also reported. Some patients avoided school, work, or social settings to hide their symptoms or prevent flare-ups. Adolescents expressed a desire to appear “normal” and to be better understood by others.
Stress was both a result of and a trigger for AD symptoms. The two researchers noted that stress-induced scratching and inflammation could create a feedback loop that worsened both skin and mental health. Chronic stress was also associated with impaired skin barrier function and immune activation, further aggravating symptoms.
Some pharmacologic treatments used for AD—such as biologics and Janus kinase inhibitors—were associated with improvements in mood symptoms. One Japanese study examined a treatment targeting anxiety and found mental health gains in patients with AD.
Psychological interventions, including cognitive-behavioral therapy and acceptance and commitment therapy, also showed promise. The approaches helped patients reduce negative thought patterns, improve coping skills, and stay engaged in meaningful daily activities.
Despite the documented link between AD and mental health, the study results showed that screening for depression and anxiety was rarely conducted during routine clinic visits. Tools such as PHQ-2, PHQ-9, and GAD-7 were recommended to identify patients in need of further support. Referrals to mental health professionals were advised for those with elevated symptoms or suicidal ideation.
"HCPs have an opportunity to normalize and validate the burden of AD on patient and caregiver mental health, facilitate discussion of mental health concerns during clinic visits, and provide reliable education and support resources as a part of routine AD care," noted Dr. Schneider and LeBovidge. They called for further research into the effectiveness of psychological interventions in pediatric patients and those with clinically diagnosed psychiatric disorders.
Full disclosures are available in the published study.