Age differences in psychological comorbidity in atopic dermatitis: a systematic review and meta-analysis

While the association between atopic dermatitis (AD) and psychological comorbidities is established, whether this risk differs across developmental stages remains unclear. This study aimed to quantify and compare this risk and examine key methodological sources of heterogeneity.

We conducted a systematic search of PubMed, Embase, and Cochrane Library for studies published up to October 2025. Pooled effect estimates [hazard ratios (HRs) from cohort/case-control studies and odds ratios (ORs) from cross-sectional studies] were calculated using random-effects models. Ninety-five percent prediction intervals were calculated for all meta-analyses. The study protocol was registered with PROSPERO (CRD420251244849).

We included 28 studies of various observational designs (cohort, cross-sectional, and case-control) in the meta-analysis. The analysis revealed numerically higher risk estimates for depression, anxiety, and suicidality among pediatric and adolescent AD patients compared with adults. Specifically, for depression, the pooled HR from cohort studies in youth was 2.16 (95% CI: 1.56-2.98; I ²=99.1%, P < 0.001) versus 1.32 (95% CI: 1.23-1.41; I ² = 94.9%, P < 0.001) in adults; similarly, the pooled OR from cross-sectional studies in youth was 2.79 (95% CI: 1.52-5.12; I ² = 99.4%, P < 0.001) versus 1.61 (95% CI: 1.22-2.14; I ² = 92.4%, P < 0.001) in adults. A similar pattern was observed for anxiety. Additionally, younger patients exhibited an elevated risk of suicide relative to adults.

The psychological burden of AD appears most pronounced in children and adolescents, but the very high heterogeneity across studies limits the certainty of this finding. Therefore, the results should be interpreted cautiously.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1244849, identifier: CRD420251244849.