There is currently a suicide epidemic most prevalent in children and young adults, making the need for increased mental health awareness and decreased stigma towards seeking help more important than ever before.  It’s also important to try to understand the causes of severe depression and suicidal ideation which makes a new study analyzing the impact of atopic dermatitis (AD), more commonly known as ‘eczema,’ on mental health an intriguing look at one of the potential triggers.AD most commonly presents as red, itchy, and cracked skin, although there are different symptoms linked to different types.  There are also differing levels of severity.  The most severe cases can include yellowish to light brown crust or pus-filled blisters that sometimes need to be treated with antibiotics.Researchers from the University of California, San Francisco, the University of Pennsylvania, and the London School of Hygiene and Tropical Medicine collaborated on a cohort study of more than 11,000 children between the ages of 3 and 18 years.  They found, “Children with severe atopic dermatitis (AD) are about twice as likely to develop depression and internalizing behavior as those without this condition.”  Their findings were published this month in JAMA Dermatology.

Photo by Pavel Danilyuk from Pexels

For those with active AD, compared those without the condition, the risk of developing depression overall “was not significant after adjustment for variables such socioeconomic factors,” the team, led by senior author Katrina Abuabara, MD, associate professor of dermatology and epidemiology at UCSF, noted. “However, among children with severe AD, the risk was more than twofold greater even after adjustment (adjusted OR, 2.38; 95% confidence interval, 1.21- 4.72).”Moreover, internalizing behavior, which is significantly linked to many poor mental health outcomes, “was more common in children with any degree of AD relative to those without AD: After adjustment, the risk climbed from a 29% increased risk in those with mild AD (aOR, 1.29; 95% CI, 1.06-1.57) to a more than 80% increased risk in children with moderate AD (aOR, 1.84; 95% CI, 1.40-2.41) and in children with severe AD (aOR, 1.90; 95% CI, 1.14-3.16).”For this particular study, depression was measured with the Short Moods and Feelings Questionnaire (SMFQ).  Parental response to the Emotional Symptoms subscale of the Strength and Difficulties Questionnaire (SDQ) was used to measure internalizing behaviors.  The findings emphasize the need for "clinical awareness of the psychosocial needs of children and adolescents with AD," the team suggested.Last year, a study published in the Journal of Allergy and Clinical Immunology: In Practice found there is also a link between AD and both depression and anxiety in adults.  The team wrote, “The link to chronic mental illness further supports the view of atopic eczema as a systemic disorder.  Our results suggest that the association between atopic eczema and depression/anxiety is not substantially mediated through glucocorticoid treatment, obesity, smoking, or harmful alcohol intake.”The 2020 journal article also indicated, “Our findings suggest that atopic eczema was more strongly associated with depression and anxiety in those aged 40 to 59 years (compared with younger and older age groups).”  The team noted that it is unclear way this population is most affected, but it could be because of other factors associated with entering later ‘middle age.’Published data, overall, suggests there is a link between AD and poor mental health outcomes across multiple populations.  Depression, anxiety and suicidal ideation need to be considered as risk factors clinicians are aware of when treating patients with AD.

Sources:

Atopic Dermatitis Doubles Risk of Mental Health Issues in ChildrenEczema SymptomsAtopic Eczema in Adulthood and Risk of Depression and Anxiety: A Population-Based Cohort Study