Patients with hidradenitis suppurativa had significantly higher risks of developing new-onset depression and anxiety compared with matched individuals from the general population, according to a nationwide Danish cohort study involving 10,206 patients and 40,125 controls. The mental health risk remained consistent across all levels of disease severity and treatment type.
Researchers found that hidradenitis suppurativa (HS) was independently associated with depression and anxiety. This elevated risk did not appear to depend on the severity of HS as measured by treatment received or surgical history.
“These findings emphasize the fact that clinicians should be aware of mental health disorders across all severity groups of patients with HS and not solely those with severe disease,” said Nikolaj Holgersen of Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark. Mental health screening should be a part of clinical routine for this patient group.
The study analyzed patients who received various treatments—including topical therapies, systemic medications, biologics— or who received no treatment, as well as patients who underwent different numbers of HS-related surgical procedures. Across all categories, including patients with no active treatment or mild disease history, individuals with HS consistently had a greater likelihood of developing depression or anxiety compared to the general population, suggesting that treatment type or surgical intervention may not be reliable indicators of psychiatric risk
Although patients with HS were more likely to have a history of depression or anxiety at the start of the study, they did not have a higher risk of experiencing recurrent episodes during follow-up compared to individuals without HS. The increased risk was primarily observed in new-onset cases.
The study relied on data from national health registries and used treatment patterns and hospitalization frequency as proxies for disease severity. These indirect measures may not fully capture clinical presentation and could introduce misclassification. Additionally, the registry-based design may have excluded milder HS cases managed in primary care. The study also did not assess treatment adherence. As the cohort was drawn from a predominantly White Danish population, findings may have limited generalizability to more diverse populations.
The authors explained that the increased risk of depression and anxiety among HS patients does not appear to be driven by disease severity as defined by medical or surgical treatment. Instead, the psychosocial burden of HS—including chronic pain, flares, scarring, and body image concerns—may contribute more significantly to psychiatric vulnerability.
The researchers emphasized the need to incorporate mental health screening and referral into routine dermatologic care for all patients with HS, regardless of clinical severity. They also called for further studies to identify modifiable risk factors and evaluate whether early intervention or targeted therapies can reduce psychiatric comorbidity in this population.
Full disclosures can be found in the published study.
Source: JAMA Dermatology
