Common mental health disorders in adults with inflammatory skin conditions: nationwide population-based matched cohort studies in the UK

Abstract

Background Psoriasis and atopic eczema are common inflammatory skin diseases. Existing research has identified increased risks of common mental disorders (anxiety, depression) in people with eczema and psoriasis; however, explanations for the associations remain unclear. We aimed to establish the risk factors for mental illness in those with eczema or psoriasis and identify the population groups most at risk. Methods We used routinely collected data from the UK Clinical Practice Research Datalink (CPRD) GOLD. Adults registered with a general practice in CPRD (1997–2019) were eligible for inclusion. Individuals with eczema/psoriasis were matched (age, sex, practice) to up to five adults without eczema/psoriasis. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for hazards of anxiety or depression in people with eczema/psoriasis compared to people without. We adjusted for known confounders (deprivation, asthma [eczema], psoriatic arthritis [psoriasis], Charlson comorbidity index, calendar period) and potential mediators (harmful alcohol use, body mass index [BMI], smoking status, and, in eczema only, sleep quality [insomnia diagnoses, specific sleep problem medications] and high-dose oral glucocorticoids). Results We identified two cohorts with and without eczema (1,032,782, matched to 4,990,125 without), and with and without psoriasis (366,884, matched to 1,834,330 without). Sleep quality was imbalanced in the eczema cohorts, twice as many people with eczema had evidence of poor sleep at baseline than those without eczema, including over 20% of those with severe eczema. After adjusting for potential confounders and mediators, eczema and psoriasis were associated with anxiety (adjusted HR [95% CI]: eczema 1.14 [1.13–1.16], psoriasis 1.17 [1.15–1.19]) and depression (adjusted HR [95% CI]: eczema 1.11 [1.1–1.12], psoriasis 1.21 [1.19–1.22]). However, we found evidence that these increased hazards are unlikely to be constant over time and were especially high 1-year after study entry. Conclusions Atopic eczema and psoriasis are associated with increased incidence of anxiety and depression in adults. These associations may be mediated through known modifiable risk factors, especially sleep quality in people with eczema. Our findings highlight potential opportunities for the prevention of anxiety and depression in people with eczema/psoriasis through treatment of modifiable risk factors and enhanced eczema/psoriasis management.

Defining disease severity in atopic dermatitis and psoriasis for the application to biomarker research: an interdisciplinary perspective

“… 35 , 36 Prevalent mental health disorders such as depression and anxiety are also associated with more severe inflammatory skin disease, but these disorders may be the result of severe inflammatory skin disease rather than the cause. 37 , 38 …”

Abnormal brain structure in atopic dermatitis: Evidence from Mendelian randomization study

“…Firstly, the study did not differentiate between different severity levels of AD, which is a standard practice in clinical settings where AD is diagnosed based on scores such as SCORAD (Scoring Atopic Dermatitis). 31,32 This limitation stems from the fact that the study used a public database that did not provide information on the severity of AD. Consequently, the study was unable to examine the relationship between AD and brain structure in individuals with mild, moderate, or severe AD separately.…”

“…Several limitations should be acknowledged. Firstly, the study did not differentiate between different severity levels of AD, which is a standard practice in clinical settings where AD is diagnosed based on scores such as SCORAD (Scoring Atopic Dermatitis) 31,32 . This limitation stems from the fact that the study used a public database that did not provide information on the severity of AD.…”