Assessment of a Bidirectional Association Between Major Depressive Disorder and Alopecia Areata

Abstract

IMPORTANCE Alopecia areata (AA) is an autoimmune disease characterized by hair loss that can impose a substantial psychological burden on patients, including major depressive disorder (MDD), yet many patients report mental health symptoms prior to the onset of AA. As such, there may be an association between MDD and AA that acts in both directions.OBJECTIVE To assess the bidirectional association between MDD and AA. DESIGN, SETTING, AND PARTICIPANTSThis population-based retrospective cohort study included patients 10 to 90 years of age registered with The Health Improvement Network in general practices in the United Kingdom between January 1, 1986, and May 16, 2012. Statistical analysis was conducted from August 17, 201717, , to April 23, 2018 To assess the risk of AA, the following 2 cohorts were defined: patients with an incident diagnosis of MDD (exposure) and a reference general population cohort. To assess the risk of MDD, the following 2 cohorts were defined: patients with an incident diagnosis of AA (exposure) and a reference general population cohort. Person-time was partitioned into unexposed and exposed time in the exposure cohorts. MAIN OUTCOMES AND MEASURESIn the analysis of the risk of AA, development of incident AA during follow-up was considered the main outcome measure. In the analysis of the risk of MDD, development of incident MDD during follow-up was considered the primary outcome measure. RESULTSIn the analysis of the risk of AA, 405 339 patients who developed MDD (263 916 women and 141 423 men; median age, 36.7 years [interquartile range, 26.6-50.5 years]) and 5 738 596 patients who did not develop MDD (2 912 201 women and 2 826 395 men; median age, 35.8 years [interquartile range, 25.3-52.6 years]) were followed up for 26 years. After adjustment for covariates, MDD was found to increase the risk of subsequently developing AA by 90% (hazard ratio, 1.90; 95% CI, 1.67-2.15; P < .001). Antidepressants demonstrated a protective effect on the risk of AA (hazard ratio, 0.57; 95% CI, 0.53-0.62; P < .001). In the analysis of the risk of MDD, 6861 patients who developed AA (3846 women and 3015 men; median age, 31.5 years [interquartile range, 18.2 years]) and 6 137 342 patients who did not develop AA (3 172 371 women and 2 964 971 men; median age, 35.9 years [interquartile range, 27.0 years]) were followed up for 26 years. After adjustment for covariates, AA was found to increase the risk of subsequently developing MDD by 34% (hazard ratio, 1.34; 95% CI, 1.23-1.46; P < .001).CONCLUSIONS AND RELEVANCE These temporal analyses suggest that, while patients with AA are at risk for subsequently developing MDD, having MDD also appears to be a significant risk factor for development of AA, with antidepressant use confounding this risk.

Depression as a risk factor for the development of psoriasis: a retrospective cohort study in the UK

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The Risk of Depression in Patients with Pemphigus: A Nationwide Cohort Study in Taiwan

“…A previous study demonstrated that dermatologists frequently underestimated the presence of mood disorders in patients with significant skin diseases [13]. In fact, there is extensive research indicating an increased risk of depression in patients with dermatological disorders such as psoriasis, alopecia areata, and atopic dermatitis [23][24][25]. Pemphigus may have a negative impact on the patients' body image [26].…”

Trichopsychodermatology: The Psychiatric and Psychosocial Aspects of Hair Disorders

“…Additionally, a population-based retrospective cohort study identified a bidirectional association between major depressive disorder (MDD) and AA. Although patients with AA were found to have a risk of developing MDD, MDD was also found as a significant risk factor for AA development, mitigated through antidepressant prescription (Vallerand et al, 2019).…”

“…Although patients with AA were found to have a risk of developing MDD, MDD was also found as a significant risk factor for AA development, mitigated through antidepressant prescription(Vallerand et al, 2019). In a cross-sectional study examining the psychosocial effects of AA, signs of anxiety and depression, decreased quality of life, and suicide risk were found in a sample of 126 patients (Vélez-Muñiz, Peralta-Pedrero, Jurado-Santa Cruz, & Morales-Sánchez, 2019).…”