Abstract
BackgroundAtopic eczema is a common and debilitating condition associated with depression and anxiety, but the nature of this association remains unclear.ObjectiveTo explore the temporal relationship between atopic eczema and new depression/anxiety.MethodsThis matched cohort study used routinely collected data from the UK Clinical Practice Research Datalink, linked to hospital admissions data. We identified adults with atopic eczema (1998-2016) using a validated algorithm, and up to 5 individuals without atopic eczema matched on date of diagnosis, age, sex, and general practice. We estimated the hazard ratio (HR) for new depression/anxiety using stratified Cox regression to account for age, sex, calendar period, Index of Multiple Deprivation, glucocorticoid treatment, obesity, smoking, and harmful alcohol use.ResultsWe identified 526,808 adults with atopic eczema who were matched to 2,569,030 without. Atopic eczema was associated with increased incidence of new depression (HR, 1.14; 99% CI, 1.12-1.16) and anxiety (HR, 1.17; 99% CI, 1.14-1.19). We observed a stronger effect of atopic eczema on depression with increasing atopic eczema severity (HR [99% CI] compared with no atopic eczema: mild, 1.10 [1.08-1.13]; moderate, 1.19 [1.15-1.23]; and severe, 1.26 [1.17-1.37]). A dose-response association, however, was less apparent for new anxiety diagnosis (HR [99% CI] compared with no atopic eczema: mild, 1.14 [1.11-1.18]; moderate, 1.21 [1.17-1.26]; and severe, 1.15; [1.05-1.25]).ConclusionsAdults with atopic eczema are more likely to develop new depression and anxiety. For depression, we observed a dose-response relationship with atopic eczema severity.
Highlights
IntroductionAtopic eczema (eczema, atopic dermatitis) is a chronic relapsing inflammatory skin disease
Atopic eczema is a chronic relapsing inflammatory skin disease
Atopic eczema was associated with increased incidence of new depression (HR, 1.14; 99% CI, 1.12-1.16) and anxiety (HR, 1.17; 99% CI, 1.14-1.19)
Summary
Atopic eczema (eczema, atopic dermatitis) is a chronic relapsing inflammatory skin disease. Mental health disorders are one of the leading causes of disability worldwide,[8] with depression and anxiety together accounting for more than half of that burden.[9] Depression, manifesting as loss of interest and enjoyment in ordinary things and experiences, affects approximately 4.4% of the global population; anxiety disorders, characterized by excessive fear, anxiousness, or avoidance of perceived threats, affect approximately 3.6%.10 Both depression and anxiety are associated with increased morbidity and mortality.[11,12,13,14,15] Atopic eczema has been shown to be associated with common mental disorders (depression and anxiety) and suicidality in cross-sectional studies that have frequently relied on self-reported exposures and outcomes.[16,17,18,19,20,21,22,23,24,25] Individuals with atopic eczema may be more likely to experience depression and anxiety through the effects of itch and discomfort, disfigurement, and perceived social-stigmatization2628; in addition, poor sleep related to atopic eczema may increase the risk of mental illness.[29,30] Inflammatory mediators in atopic eczema could contribute to the development of depression.[22,31] those with depression and anxiety could be more likely to consult for a physical condition such as atopic eczema. A dose-response association, was less apparent for new anxiety diagnosis (HR [99% CI] compared with no atopic eczema: mild, 1.14 [1.11-1.18]; moderate, 1.21 [1.17-1.26]; and severe, 1.15; [1.05-1.25])
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