219 A systematic review and meta-analysis of the association between hidradenitis suppurativa, depression, suicidal ideation, and anxiety

Abstract

Hidradenitis suppurativa (HS) is associated with pain, disfigurement and psychological distress. However, previous studies found conflicting results about whether HS is associated with increased prevalence of depression or anxiety. We sought to determine the complex relationship between HS, depression, and anxiety. A systematic review was performed of all published observational studies in MEDLINE, Pubmed, EMBASE, GREAT, LILACS, Cochrane Library, Scopus and PsychInfo that analyzed depression or anxiety in HS. Two reviewers performed study title/abstract review and data abstraction. Pooled meta-analysis was performed using random-effects weighting. Overall, 39 studies met inclusion criteria; 27 had sufficient data for meta-analysis. The prevalence of depression was higher in persons with vs. without HS (26.6% vs. 6.6%; logistic regression, odds ratio [95% confidence interval]: 2.54 [2.15-3.01]). In particular, HS was associated with higher odds of questionnaire based (2.61 [1.36-6.00]) and physician diagnosed (2.58 [2.15-3.08]) depression. Severe HS was associated with even higher odds of depression (n=3 studies). Similar results were found for anxiety (18.1% vs. 7.1%, 2.00 [1.66-2.42]). HS was associated with higher mean scores for multiple depression (n=11 studies) and anxiety scales (n=3 studies), and higher odds of anti-depressant (n=2 studies) and anxiolytic use (n=1 studies), and suicidality (n=2 studies). In conclusion, HS patients have higher odds of depression, anxiety, and suicidality.