Older age, itch, pain predict depression in atopic dermatitis

Depressive symptoms are common among adults with atopic dermatitis (AD) severity and may fluctuate over time, reveals a study. Persistent depression is significantly associated with older age, male sex, severe itch, and skin pain, among others.

“Improved control of AD signs and symptoms, particularly itch, may secondarily improve mental health,” suggests the investigators.

A prospective, dermatology practice-based study was conducted to determine the predictors and longitudinal course of depressive symptoms in 695 adults with AD. The investigators then assessed AD signs, symptoms, and severity, as well as the patient health questionnaire-9 (PHQ-9).

Of the participants, 454 (65.32 percent) had minimal, 139 (20.00 percent) had mild, 57 (8.20 percent) had moderate, 27 (3.88 percent) had moderately severe, and eight (2.59 percent) had severe depression at baseline. Most of them had fluctuating levels of depressive symptoms, of which the most persistent were feeling bad, thoughts of self-harm, difficulty concentrating, and slow movement.

Predictors of persistent depression were as follows: older age, non-White race, male sex, public or no insurance, more severe itch, skin pain, facial erythema, nipple eczema, sleep disturbance, and presence of pityriasis alba.

In a 2019 systematic review and meta-analysis, results showed that patients with AD were more likely to experience depression and suicidality. Specifically, AD correlated with markedly higher depression scale scores, parental depression, antidepressant use, and suicidality. [J Am Acad Dermatol 2022;80:402-410]

The current study was limited by its single-centre design.

“AD is associated with eczematous lesions, pruritus, pain, and sleep disturbance, which may negatively impact mental health over time,” the investigators said.