The prevalence of anxiety disorders in dermatology outpatients: A systematic review and meta‐analysis

Abstract

Anxiety is common in those with medical conditions and has significant impacts on mental well‐being as well as physical health outcomes. While several systematic reviews have examined the prevalence of anxiety in specific dermatological conditions, no reviews have examined the prevalence across the entire dermatology outpatient setting. This systematic review aims to provide an overview to dermatologists of the prevalence of, and trends in, anxiety in their outpatient clinics. As such, prevalence of anxiety in dermatology outpatient clinics was examined, and variations across type of anxiety and dermatological conditions were assessed. A search of PubMed, Embase, Cochrane and PsycINFO was conducted for studies that assessed anxiety prevalence in dermatology outpatients, with the last search conducted on 7 September 2022. Results underwent title/abstract and full‐text screening, followed by data extraction. Studies of patients 16 years and older and representative of dermatology clinics were included. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Checklist. Meta‐analysis was conducted using CMA software, and subgroup analysis was conducted on relevant variables. 5423 studies were identified, and 32 included, with a total n = 12,812 participants. Under the random effects model, prevalence was estimated at 26.7% (95%CI 22.4–31.4; 95%PI 9.7–55.4). Subgroup analysis revealed a higher prevalence among studies of psoriasis patients than general dermatology studies. Estimates of prevalence were higher when assessed via self‐report screening than diagnostic interview. Anxiety occurred frequently among dermatology outpatients, especially psoriasis outpatients, at a higher rate than common estimates of prevalence in the general population. Given the effect of anxiety on patient outcomes and well‐being, dermatologists are encouraged to consider how anxiety may impact patients in their clinic, and how they can best identify patients with anxiety and subsequently support them.

Anxieties in dermatological disorders—A psychodermatology topic which should be recognized for daily practice

“…The number of published papers showing an association between anxiety and skin disease has increased dramatically from 1947 to the present (Figure 1). In the present JEADV issue, the study by Storer et al 1 showed a percentage of patients with skin disease and anxiety in 26.7% (range: 2.9–67.8) in the meta‐analysis of 12,812 patients. This number should be compared with the percentage of anxiety in the general population, which was almost as high during the COVID pandemic as reported in a meta‐analysis 2 .…”

“…Thus, the ongoing discussion lacks predictors of anxiety in skin patients, which anxiety is most prevalent in skin patients, and studies that look for correlations with stigmatization, loneliness, quality of life, symptom severity, self‐esteem, self‐acceptance, subjective resources and resilience factors are missing. The interesting meta‐analysis by Storer et al 1 should be noted anyway. Dermatologists could pay more attention to psychosocial comorbidities in treatment, and early indication for additive psychosomatic counselling is needed.…”

“…In case–control studies, the differences between skin diseases and healthy controls are always significant, such as in lichen planus or alopecia areata 5,6 . Although the meta‐analysis by Storer et al 1 found the highest prevalence of anxiety in psoriasis patients, there are recent studies showing higher rates in patients with hidradenitis suppurativa 7 . Older age seems to have a protective effect on skin disease anxiety 8 …”

RANZCP 2024 CONGRESS: Book of Abstracts

“…This innovation has been greeted enthusiastically by, for example, Lived Experience Australia, Roses in the Ocean, and ex-Lifeline staff. (Storer et al, 2023a), 26.7% in dermatology (Storer et al, 2023b), and 25.1% in endocrinology (Kershaw et al, 2023). Several significant trends across anxiety types and other variables will be explored.…”