From the Journals

Atopic dermatitis linked to psychiatric disorders but not hospitalizations



Atopic dermatitis (AD) is associated with anxiety, depression, and suicidal thoughts but does not lead to increased psychiatric hospitalization or suicide, according to a Danish study.

While previous literature has indicated a connection between AD and depressive symptoms, these findings indicated the psychiatric burden is not severe.

A left hand in a fist, showing atopic dermatitis aniaostudio/Thinkstock
“Our results suggest that, while depression, anxiety, and suicidal ideation occur more frequently in AD patients, this may be restricted to milder symptoms,” according to Jacob P. Thyssen, PhD, department of dermatology and allergy, University of Copenhagen. “While suicidal ideation obviously should be a cause for concern, especially in depressed patients with AD, it is reassuring that suicides rarely occurred in our study and at no higher risk than in the general population”

A total of 9,656 patients selected from the Danish study of Functional Disorders (DanFunD) during 2011-2015 were asked to fill out a questionnaire concerning clinical diagnoses and psychiatric symptoms.

Investigators also conducted an analysis of 4,259,457 patient records gathered the Danish National Patient Register.

The 1,044 AD patients from the DanFunD were slightly younger on average, at 50 years, compared with an average of 53 years in the 8,612-person control group; there were more women (65%) in the AD group, compared with a relatively even split (53%) in the control group.

Patients with AD were more likely to have clinically diagnosed depression (odds ratio, 1.76) or anxiety (OR, 1.61) than were those in the control group.

The report was published in the journal Allergy.

Among the 568 individuals with symptoms consistent of major depressive disorder, those with AD (112) were almost twice as likely to report these symptoms on the questionnaire (OR, 1.92) and more than twice as likely to report anxiety attacks (OR, 2.32), despite differences in psychiatric hospitalizations remaining insignificant.

The investigators hypothesized the treatment methods for AD patients may be part of the reason that suicide and hospitalization rates were not higher.

“These more severe outcomes of suicide and psychiatric hospitalization could be mitigated in AD patients due to their increased general health care and psychiatric health care utilization leading to, for example, earlier and more aggressive antidepressant therapy,” according to Dr. Thyssen and his fellow investigators.

In an analysis of the general Danish population, medication was most aggressive in patients with moderate-severe AD, who were significantly more likely to use antidepressants (hazard ratio,1.24) and anxiolytic drugs (HR, 1.66), while those with milder symptoms had only a slightly increased likelihood.

Because of the observational nature of the study, investigators could not determine what the specific cause of these psychiatric symptoms were.

The DanFunD Study was supported by TrygFonden and Lundbeck Foundation. Dr. Thyssen is supported by a grant from the Lundbeck Foundation. Some of the investigators received financial support from various pharmaceutical companies or their foundations. The remaining investigators reported no relevant financial disclosures.

SOURCE: Thyssen JP et al. Allergy. 2018 Jan;73(1):214-20.

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