Ethical Obligations to Screen for Psychiatric Disorders and Suicidal Ideation in Patients with Alopecia Areata

Alopecia areata (AA) is associated with substantial psychosocial morbidity. Population-based studies have identified increased suicide-related risks, although findings are heterogeneous, which raises an ethical question regarding dermatologists' obligation to screen for psychiatric morbidity. Routine screening for depression and psychologic distress may reasonably form part of AA care. In contrast, formal suicide risk assessment should follow identification of suicidal ideation or other concerning clinical findings rather than be universally administered. This proportionate approach balances beneficence and nonmaleficence with the risks of overmedicalization, false-positive results, and limited referral resources. Screening should occur within a defined response pathway that includes assessment of positive findings, safety measures when indicated, crisis resources, and mental health referral. This approach allows dermatologists to address foreseeable psychologic harm while maintaining appropriate professional boundaries.