Association of Chronic Spontaneous Urticaria With Anxiety and Depression in Adolescents: A Mediation Analysis

Abstract

Background: Chronic spontaneous urticaria (CSU) is related to psychiatric comorbidities. It is not clear whether the relationship is affected by modifiable factors.Objectives: To investigate whether the effect of CSU on anxiety and depression in adolescents is mediated by the symptoms of itching and sleep disturbance.Methods: Questionnaire survey was conducted among newly enrolled college students. Dermatologists diagnose skin diseases, including CSU, during health examination. Anxiety and depression were measured by the Generalized Anxiety Disorder Scale and Patient Health Questionnaire, respectively. Sleep quality was measured by the Pittsburgh Sleep Quality Index. The symptoms of itching were measured by the numeric rating scale. According to the hypothesis, the mediating effect model was put forward and the structural equation model is used to build the mediation effect model. The mediation effect model was proposed according to the hypothesis and established using a structural equation model.Results: A total of 2,358 students with no history of systemic disease and no pruritus disease (except CSU) were included in the analysis. A total of 393 CSU patients were included, and 1,965 healthy controls were selected based on age and sex matching. CSU was significantly associated with both anxiety and depression when the symptoms of itching and sleep quality were not modeled. A mediation model was proposed as CSU → itching → sleep disturbance → anxiety or depression. Itching and sleep quality mediated 65.4 and 77.6% of CSU's effects on anxiety and depression, respectively, and CSU had no significant direct effect on anxiety or depression in the mediation models.Conclusions: The associations of CSU with anxiety and depression were mediated by the symptoms of itching and sleep disturbance. Effectively reducing the symptoms of itching thereby could increase natural sleep, which can further treat the emotional disorders among patients with CSU.

Acupuncture Decreases Risk of Hypertension in Patients with Chronic Spontaneous Urticaria in Taiwan: A Nationwide Study

“…A study by Hamam suggested that physicians treating patients with hypertension should be aware of the role that anxiety and depression play in treatment efficacy and compliance [39]. Several studies have revealed that patients with CSU frequently have anxiety and depression, which are probably exacerbated by the symptoms of itching and sleep disturbance [40][41][42][43]. Studies have suggested that acupuncture treatment can alleviate anxiety and depression [44][45][46][47], which may benefit patients with CSU by decreasing the risk of hypertension.…”

White paper on psychodermatology in Europe: A position paper from the EADV Psychodermatology Task Force and the European Society for Dermatology and Psychiatry (ESDaP)

“…Skin diseases for which correlations between the occurrence of the disease and/or the severity of skin symptoms and psychological factors such as anxiety or depression have been shown include—but are not limited to—atopic dermatitis, psoriasis, chronic urticaria and prurigo 12–17 . Also, there is a relationship between psychological stress and the occurrence and exacerbation of symptoms of various skin diseases 18–21 .…”

“…7,10,11 Skin diseases for which correlations between the occurrence of the disease and/or the severity of skin symptoms and psychological factors such as anxiety or depression have been shown include-but are not limited to-atopic dermatitis, psoriasis, chronic urticaria and prurigo. [12][13][14][15][16][17] Also, there is a relationship between psychological stress and the occurrence and exacerbation of symptoms of various skin diseases. [18][19][20][21] It is supposed that under stress patients with skin disorders develop dysfunctional coping such as catastrophizing thoughts, which may contribute, on one hand, to a worsening of the disease, and on the other hand, to higher suicidality rates.…”

Omalizumab for Patients with Chronic Spontaneous Urticaria: A Narrative Review of Current Status

“…Patients with CSU experience higher rates of anxiety and depression relative to healthy controls [ 36 , 37 ], which is linked to emotional distress [ 38 ] and increased impairment in QoL [ 39 ]. As an explanation, a mediation model proposed that anxiety and depression develop because itching associated with CSU leads to sleep disturbance [ 40 ], which is associated with risk of depression [ 41 ] and anxiety [ 42 ].…”