Depression and psychological distress in US adults with atopic dermatitis

Symptoms of anxiety and depression appear to contribute to the overall burden of atopic dermatitis (AD). However, the burden of mental health symptoms and psychological distress in AD have not been fully elucidated.

To determine the prevalence and predictors of depressive symptoms and psychological distress among US adults with AD and how they compare with psoriasis and other disorders.

We analyzed the 2004-2015 Medical Expenditure Panel Surveys, a representative sample of US adults. Patient Health Questionnaire-2 (PHQ-2) and Kessler-6 index (K-6) scores assessed depressive symptoms and psychological distress, respectively.

Atopic dermatitis in adults is associated with increased odds of screening positive for depressive symptoms (PHQ-2 ≥2) (44.3% vs 21.9%; adjusted odds ratio [aOR] [95% confidence interval (CI)]: 2.86 [1.14, 7.16]) and severe psychological distress (K-6≥13) (25.9% vs 5.5%; 6.04 [2.28, 15.99]). Adults with vs without AD had increased K6 scores overall (linear regression, P = .04) and severe psychological distress in particular (K-6≥13; logistic regression; adjusted odds ratio [95% CI]: 6.04 [2.28, 15.99]). K-6 scores were associated with lower household income (linear regression; adjusted beta [95% CI]: 6.22 [0.88, 11.56]) and middle income (4.49 [0.39, 8.59]), but inversely associated with black (-7.36 [-11.70, -3.03]) and multiracial/other (-2.85 [-5.67, -0.03]) race/ethnicity.

Atopic dermatitis is associated with more depressive symptoms and psychological distress overall, and even worse than many other chronic diseases. These findings highlight the need for clinicians to consider screening for and monitoring mental health symptoms in AD patients. Future studies are needed to develop interventions to reduce psychological distress in AD.