Abstract
Background:
Chronic dermatological conditions such as psoriasis, atopic dermatitis, and acne are recognized as diseases with a high psychological burden. Visible skin disorders can have an impact on social functioning, self-esteem and general well-being and can result in higher prevalence of psychiatric co-morbidities such as depression and anxiety. Knowing the magnitude of such mental health outcomes is crucial in enhancing holistic dermatology.
Objectives:
The purpose of this systematic review and meta-analysis was to examine the prevalence of depressive and anxiety disorders in patients with psoriasis, atopic dermatitis, and acne and to determine the general burden of depressive comorbidity of these dermatological conditions.
Methods:
A systematic review was performed using standard systematic review methodology. Six observational studies on psychiatric outcomes in patients with psoriasis, atopic dermatitis, or acne were included in the final analysis. The included studies applied validated psychological assessment instruments such as the Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9) and State-Trait Anxiety Inventory (STAI). Data was extracted for study characteristics, sample sizes, psychiatric assessment tools, and prevalence of depression and anxiety. A pooled quantitative analysis was performed using prevalence data of the included studies.
Results:
A total of six studies with 823 patients with chronic inflammatory skin diseases were included in the meta-analysis. In the set of reviewed studies, 343 out of 823 patients had depressive symptoms, giving a pooled prevalence of 41.7% (95% CI: 34.2–49.4%), with fair heterogeneity (I2 = 62%). Anxiety outcomes were reported in four studies with 151 of 495 patients having clinically significant anxiety symptoms, with a pooled prevalence of 30.5%, (95% CI: 24.3-37.4%), moderate heterogeneity (I2 = 58%). Inflammatory skin diseases were also associated with sleep disturbance, Sleep disturbance and reduced quality of life were frequently reported across studies, which showed a significant impairment of the quality of sleep. Quality of life evaluation based on Dermatology Life Quality Index demonstrated significant impact across studies, with 77.3% patients with psoriasis and 63.2% patients with atopic dermatitis with moderate-to-extremely large quality of life impairment, whereas patients with acne exhibited moderate quality of life impairment as reported in DLQI score with mean DLQI = 6.19 ± 5.23.
Conclusion:
This systematic review and meta-analysis showed a significant prevalence of psychiatric comorbidities among patients with chronic dermatological diseases. Approximately two out of five patients suffered from depression and almost one-third suffered from anxiety. These results demonstrate that mental health screening and psychological assistance should be considered as core elements of regular dermatological practice in order to enhance the general patient outcomes.