Original Article
Depression and psychological distress in US adults with atopic dermatitis

https://doi.org/10.1016/j.anai.2019.06.002Get rights and content

Abstract

Background

Symptoms of anxiety and depression appear to contribute to the overall burden of atopic dermatitis (AD). However, the burden of mental health symptoms and psychological distress in AD have not been fully elucidated.

Objective

To determine the prevalence and predictors of depressive symptoms and psychological distress among US adults with AD and how they compare with psoriasis and other disorders.

Methods

We analyzed the 2004-2015 Medical Expenditure Panel Surveys, a representative sample of US adults. Patient Health Questionnaire-2 (PHQ-2) and Kessler-6 index (K-6) scores assessed depressive symptoms and psychological distress, respectively.

Results

Atopic dermatitis in adults is associated with increased odds of screening positive for depressive symptoms (PHQ-2 ≥2) (44.3% vs 21.9%; adjusted odds ratio [aOR] [95% confidence interval (CI)]: 2.86 [1.14, 7.16]) and severe psychological distress (K-6≥13) (25.9% vs 5.5%; 6.04 [2.28, 15.99]). Adults with vs without AD had increased K6 scores overall (linear regression, P = .04) and severe psychological distress in particular (K-6≥13; logistic regression; adjusted odds ratio [95% CI]: 6.04 [2.28, 15.99]). K-6 scores were associated with lower household income (linear regression; adjusted beta [95% CI]: 6.22 [0.88, 11.56]) and middle income (4.49 [0.39, 8.59]), but inversely associated with black (-7.36 [-11.70, -3.03]) and multiracial/other (-2.85 [-5.67, -0.03]) race/ethnicity.

Conclusion

Atopic dermatitis is associated with more depressive symptoms and psychological distress overall, and even worse than many other chronic diseases. These findings highlight the need for clinicians to consider screening for and monitoring mental health symptoms in AD patients. Future studies are needed to develop interventions to reduce psychological distress in AD.

Introduction

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects 7% of adults1, 2, 3 and 13% of children4 in the United States. Itch is the most burdensome symptom in AD.2 However, other symptoms contribute to the burden of AD, including skin pain,2, 5 oozing/weeping, and sleep disturbance.2, 6, 7, 8 Previous studies found that AD is also associated with greater burdens of anxiety and depression9, 10, 11, 12 and lower physical and social functioning. Symptoms of anxiety and depression appear to contribute to the overall burden of AD.11, 13, 14 It is thus important to understand the burden of mental health symptoms in AD. We hypothesized that adults with AD have significantly higher psychosocial distress.

Mental health symptoms can occur in many chronic diseases.15, 16 However, mental health symptoms may be particularly more likely to occur in AD than in other chronic diseases. We hypothesized that AD is associated with greater symptoms of depression and psychological distress than psoriasis and many other chronic diseases. This study examines depressive symptoms and psychological distress among US adults with AD, psoriasis, and other disorders.

Section snippets

Data Source

Data were analyzed from the 2004-2015 Medical Expenditure Panel Surveys (MEPS), a representative survey of the civilian non-institutionalized population in the United States that is published by the Agency for Healthcare Research and Quality. The MEPS data included sociodemographic characteristics, clinical diagnosis and procedure codes, and health status of approximately 15,000 US households annually. Surveys were administered in-person, using computer-assisted personal interviewing

Population Characteristics

The study cohort comprised a weighted frequency of 2,341,285,705 adults between 2004 and 2015, of which 436,918 reported a diagnosis of AD. Adults with vs without AD were significantly younger (Rao-Scott χ2, P = .02) (Table 1). A diagnosis of psoriasis was associated with older age, higher income, white race, being married, and privately insured (P ≤ .003) (Table 2).

PHQ2 Screening in AD and Psoriasis

Adults with vs without AD had a higher proportion [95% CI] (44.3% [21.1, 67.5%] vs 21.9% [21.5, 22.2%]) and odds (binary logistic

Discussion

This study found increased prevalence and severity of depression or psychological distress in US adults with AD, but not for psoriasis. In particular, this study found significant differences in domains of hopelessness, restlessness, depression, apathy, worthlessness, and social interactions. Psychological distress, as judged by K6 scores, was comparable in those with AD to that of those with anxiety and depression, and higher than in those with psoriasis, urticaria, asthma, other atopic

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    Disclosures: None.

    Funding Sources: This publication was made possible with support from the Dermatology Foundation.

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    © 2019 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.