Psychiatric Risk in Chronic Spontaneous Urticaria: A Retrospective Cohort Study

Chronic spontaneous urticaria (CSU) has been associated with psychiatric comorbidity, but previous studies have often been limited by cross-sectional designs, reverse causation and surveillance bias. We conducted a retrospective matched cohort study using the TriNetX US Collaborative Network to evaluate the risk of incident psychiatric disorders after CSU diagnosis. Adults with newly diagnosed CSU and no prior psychiatric diagnosis were propensity score matched 1 : 1 to non-CSU controls. Outcomes were depression, reaction to severe stress and adjustment disorders, schizophrenia and suicidal ideation or suicide attempts during 3 years of follow-up. After matching, 98,785 individuals were included in each group. CSU was associated with a modestly increased risk of reaction to severe stress and adjustment disorders (hazard ratio 1.15, 95% confidence interval 1.09-1.22), consistent across sensitivity analyses. No consistent increased risk was observed for depression, schizophrenia or suicide-related outcomes. A complementary asso ciation analysis including patients with pre-existing psychiatric disease reproduced previously reported associations with depression and stress-related disorders. These findings suggest that CSU is not broadly associated with incident psychiatric disease but is linked to a small, reproducible increase in stress-related psychiatric morbidity.