The role of insomnia in the vulnerability to depressive and anxiety symptoms in atopic dermatitis adult patients

Abstract

Atopic dermatitis (AD) is a common inflammatory chronic skin disease typically associated with atopic comorbidities and other non-atopic conditions such as sleep disturbances, and mood/anxiety disorders. A growing literature proposed a crucial role of sleep disturbances in the development of mental health problems in AD. We tested this assumption by mediation model analyses in adult AD patients.A total of 57 patients (mean age ± std. dev., 34.28 ± 13.07 years; 27 males; range 18–67 years) diagnosed with AD participated in a cross-sectional study. We evaluated self-perceived severity of AD, insomnia, depression, and anxiety symptoms using validated questionnaires: the Patient-Oriented Eczema Measure (POEM), the Insomnia Severity Index (ISI), the Beck Depression Inventory-second edition (BDI-II), and the Generalized Anxiety Disorder-7 scale (GAD-7), respectively. Two mediation models were performed, testing the mediation effect of insomnia symptoms on the relationship between AD severity and depression (model 1) and anxiety (model 2). AD symptoms, as expressed by POEM, were positively associated with insomnia, depression, and anxiety severity. Insomnia fully mediated the effect of AD severity on depression and anxiety. Specifically, insomnia accounted for 81.64% of the relationship between atopic eczema severity and depression, and for 81.84% of the effect of AD severity on anxiety symptoms. The present study proposed a critical role of insomnia in predisposing adult AD patients to experience depression and anxiety. Early interventions focused on treating sleep disturbances could indirectly be beneficial on mental health of patients with AD, counteracting the onset and exacerbation of anxiety and depression disorders.

An Overview on Atopic Dermatitis, Oxidative Stress, and Psychological Stress: Possible Role of Nutraceuticals as an Additional Therapeutic Strategy

“…This study showed a higher incidence of major depression, any depressive disorder, and bipolar disorder in the atopic cohort, with an earlier onset of symptoms [71]. In addition, it was observed that the Beck Depression Inventory and Self-rating Anxiety Scale questionnaires were higher in patients with severe AD [36], in agreement with Salfi et al, who found that more severe forms of AD were associated with more severe symptoms of depression and anxiety [72].…”

“…A recent cross-sectional study observed that more severe AD symptoms were associated with more severe symptoms of insomnia, anxiety, and depression; moreover, the severity of insomnia was correlated with symptoms of anxiety and depression. Thus, insomnia could explain the relationship between AD severity and anxiety/depressive symptoms [72].…”

A Qualitative Tool to Guide in the Interpretation of the Numerical Rating Scale for Pruritus Intensity in Patients with Atopic Dermatitis

“…In this regard, sleep disturbance and/or insomnia can even lead to increased anxiety and depression ( 23 ). Indeed, patients with AD, especially those with moderate-to-severe forms of the disease, report high rates of anxiety and depression ( 24 , 25 ). Our results from the systematic review and those reported from HCPs and patients participating in our project confirm those obtained in previous studies, and highlight the relevance of assessing pruritus in clinical practice.…”

Sleep Disturbance, depression, anxiety and perceived stress in adult atopic dermatitis patients, and their relationship with objective and subjective disease severity

“…Recently, the absence of a causal role of AD in the development of depressive and anxiety disorders has been proposed 44 , supporting the existence of an indirect link between AD and psychological measures driven by other concomitant conditions. In this regard, recent studies suggested that sleep disturbances might predispose AD patients to experience psychological symptoms 45,46 .…”