Chinese research linking atopic dermatitis to mental health underscores need for holistic care

The study aimed to examine the global prevalence of Attention Deficit Hyperactivity Disorder (ADHD), depression, anxiety, and suicidal ideation among people with AD.

The research, spanning continents and involving a diverse patient population, uncovered evidence linking this common skin condition to a range of mental health disorders.

The study identified prevalence rates of mental comorbidities in patients with AD, including ADHD (7%), depression (17%), anxiety (21%), and suicidal ideation (13%).

Adult prevalence rates were lower for ADHD (4%) than children at 9%.

However, rates for adults were higher for depression (20%), anxiety (24%), and suicidal ideation (16%).

Correspondingly, the prevalence rates were lower in children at 11%, 14%, and 10% respectively.

Variances across the continents

It also identified striking differences in the prevalence rates of mental comorbidities across the world.

Notably, African adults with AD had the highest prevalence rates of depression (35%) and anxiety (44%), while Asian adults led in ADHD (7%) and suicidal ideation (20%).

Of all continents, only Asia reported the prevalence of suicide among children with AD. The highest rates of suicidal ideation were in South Korean patients across all age groups.

North American children aged under 18 with AD emerged with the highest rates of ADHD (10%), depression (13%), and anxiety (20%).

The study noted that regions affected by social wars and conflicts, such as North Africa and the Middle East, demonstrated higher rates of depression, providing a potential explanation for the observed prevalence in African patients with AD.

The team utilised seven electronic databases including PubMed and the Cochrane Library to identify relevant studies on the topic. It investigated cases from 1998 to October 2022.

Contributing factors

The investigation highlighted a significant correlation between ADHD and AD, with prevalence rates increasing with the severity of the skin condition.

Sleep disorders, prevalent in ADHD, were identified as potential contributors to the higher prevalence of ADHD in AD patients, particularly in North America.

Chronic pruritus, severe itching, is a prominent symptom of AD. It was found to disrupt sleep in patients, contributing to a higher psychosocial burden and an increased risk of developing mental disorders.

“Itching is the main symptom of AD; itching exacerbates anxiety symptoms, and anxiety makes itching worse,” the research noted.

“As symptoms of chronic pruritus can disturb sleep in patients with AD, they are more likely to experience a higher psychosocial burden and are at higher risk of developing mental disorders than adults without AD; thus, AD substantially affects the quality of life.”​

The study also delved into the biological underpinnings of the link between AD and mental health.

It found that elevated levels of proinflammatory cytokines associated with AD could impact the central nervous system, potentially contributing to the development of mental disorders.

Furthermore, Substance P (SP), an important pruritic mediator, emerged as a potential key linking AD to psychological disorders.

Patients with depression exhibited progressively higher levels of SP, suggesting its role in the complex interplay between AD and mental health.

The study concluded by underscoring the crucial role of appropriate AD treatment in mitigating the severity of mental disturbances, emphasising the need for mental health assessment and interventions.

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Epidemiology of mental health comorbidity in patients with atopic dermatitis: An analysis of global trends from 1998 to 2022​

Source: Journal of the European Academy of Dermatology and Venereology (JEADV)

Authors: Cai et al.

DOI: 10.1111/jdv.19686