Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: A systematic review

Toussi, Atrin; Barton, Virginia; Le, Stephanie; Agbai, Oma; Kiuru, Maija

doi:10.1016/j.jaad.2020.06.047

Cited by 118 publications

(91 citation statements)

References 80 publications

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“…These findings reflect the results of previous qualitative studies, which have also found AA to be emotionally devastating and to have considerable impact on selfesteem and social confidence [18,20,22,23]. Additionally, our qualitative findings further conceptualize the findings of quantitative studies described in a recent systematic review that identified reduced HRQoL, anxiety and depression as key psychosocial comorbidities of patients with AA [7][8][9][10][11][12][13][14][15]36].…”

Section: Discussionsupporting

confidence: 88%

“‘You lose your hair, what’s the big deal?’ I was so embarrassed, I was so self-conscious, I was so depressed:” a qualitative interview study to understand the psychosocial burden of alopecia areata

Aldhouse¹,

Kitchen²,

Knight³

et al. 2020

J Patient Rep Outcomes

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Background Alopecia areata (AA) is characterized by hair loss that can affect the scalp and body. This study describes the psychosocial burden of AA. Methods Participants diagnosed with AA who had experienced ≥50% scalp hair loss according to the Severity of Alopecia Tool (SALT) were identified by clinicians. A semi-structured interview guide, developed with expert clinician input, included open-ended questions to explore patients’ experiences of living with AA. Data were thematically analyzed to identify concepts and relationships. Results Participants (n = 45, 58% female, mean age 33.3 years [range 15–72], mean SALT 67.2 [range 0–100]) described the AA diagnosis as “devastating”. Both males and females reported emotional and psychological impacts of AA including feeling sad/depressed (n = 21), embarrassed/ashamed (n = 10) and angry/frustrated (n = 3). Patients felt helpless (n = 5) due to the unpredictability of disease recurrence, and anxious (n = 19) about judgement from others. Many patients avoided social situations (n = 18), which impaired relationships and increased isolation. Coping strategies included concealment of hair loss through wigs or make-up, although fear of the displacement of these coverings also caused anxiety and the avoidance of activities that could result in scalp exposure (n = 22). Some patients became more accepting of AA over time, which lessened the emotional impact, though efficacious treatment was still desired. A conceptual framework was developed, and a conceptual model was created to depict the relationship between the physical signs/symptoms and the associated psychosocial effects of AA. Conclusion AA impairs patients’ emotional and psychological wellbeing, relationships and lifestyles. Greater disease awareness and effective treatments are needed.

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Section: Discussionsupporting

confidence: 88%

“‘You lose your hair, what’s the big deal?’ I was so embarrassed, I was so self-conscious, I was so depressed:” a qualitative interview study to understand the psychosocial burden of alopecia areata

Aldhouse¹,

Kitchen²,

Knight³

et al. 2020

J Patient Rep Outcomes

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“…6,7,20,22,23 It is documented that depression is comorbid with AA. 24 Thus, we state that for the differential diagnosis, it is vital to separate grieving as a natural reaction to the altered identity and depression as a mental disorder.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic implications of psychological state in patients with alopecia areata: A qualitative study

Barkauskaite

Serapinas

2020

Dermatologic Therapy

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Hair loss can significantly impact an individual's psychological state, self-image, and can lead to numerous personal, social, and occupational problems. Although these impairments are well documented in primary studies and reviews, and the need for appropriate psychological help is emphasized, there is still a lack of knowledge for a broader and specific picture. The patient's perspective is vital while seeking to understand the content of the variables like "impaired body image" or "low self-esteem." This article advocates the need for studies involving methodologies allowing to explore the complexity and depth of experience. A better understanding of patients' states, reactions, and needs might contribute to the practice of healthcare professionals seeking the best possible help. This study aimed to explore the lived experience of people with alopecia areata in Lithuania using a phenomenological approach. Experiences of six patients with varying degrees of alopecia areata, four women and two men (mean age 27 years), were explored. Data were obtained using an unstructured interview and were analyzed based on Colaizzi's phenomenological approach. This article explores findings related to patient's psychological state covering two superordinate themes: (a) devastating loss of perceived self and (b) grieving and the process of acceptance. The insights for the appropriate therapeutic intervention were formulated.

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“…Nine of them revealed higher existence of anxiety, depression, and other psychiatric morbidities in AA patients compared to the controls. Thus, the authors have recommended that psychological impacts and comorbidities must be addressed while treating AA patients [ 19 ]. Williamson et al reported slightly higher prevalence of depression (74%) as compared to our study.…”

Section: Discussionmentioning

confidence: 99%

Psychological Impact of Alopecia Areata

Marahatta

Agrawal

Adhikari

2020

Dermatology Research and Practice

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Introduction. Alopecia areata is one of the commonest causes of nonscarring alopecia. Since hair is a vital part with very high cosmetic concern, hair loss might have a significant negative impact on patient’s life. Hence, we aimed this to investigate depression and anxiety in patients with alopecia areata. Methods. In this cross-sectional study, a total of 75 consecutive eligible patients of alopecia areata were interviewed over one-year period in the dermatology outpatient department. We recorded the relevant history and examination details in the present proforma. Nepali versions of Beck Depression Inventory and Beck Anxiety Inventory were used for the assessment of depression and anxiety, respectively. Data analysis was done with Statistical Package for the Social Sciences version 11.5. Results. Among 75 patients, the prevalence of depression and anxiety were 66.7% and 73.3%, respectively, with median depression score = 5 (IQR = 0.0–10.0) and median anxiety score = 5 (IQR = 0.0–11.0). Out of all depressed patients, 82.0% had minimal and 18.0% had moderate depression. However, none of them had severe depression. Likewise, out of all patients with anxiety, 89.0% had mild and 11.0% had moderate anxiety, but none of them had severe anxiety. Conclusion. Anxiety and depression are common psychological problems in patients with alopecia areata. Because of their direct impact on treatment outcome, we, treating dermatologist, must be aware of them, and we should counsel our patients for consultation with the psychiatrist on time for their maximum benefit.

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Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: A systematic review

Cited by 118 publications

References 80 publications

“‘You lose your hair, what’s the big deal?’ I was so embarrassed, I was so self-conscious, I was so depressed:” a qualitative interview study to understand the psychosocial burden of alopecia areata

“‘You lose your hair, what’s the big deal?’ I was so embarrassed, I was so self-conscious, I was so depressed:” a qualitative interview study to understand the psychosocial burden of alopecia areata

Therapeutic implications of psychological state in patients with alopecia areata: A qualitative study

Psychological Impact of Alopecia Areata

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