Depression and Anxiety in Adults With Hidradenitis Suppurativa

Abstract

IMPORTANCE Previous studies suggest that depression and anxiety are common in patients with hidradenitis suppurativa (HS), more so than other dermatological conditions. Yet, to the authors' knowledge, no previous systematic review or meta-analysis has estimated the prevalence or odds ratio (OR) for those psychiatric comorbidities in this population. OBJECTIVE To assess the prevalence and odds for depression and anxiety in patients with HS. DATA SOURCES From July 25 to September 30, 2018, observational studies investigating the prevalence and odds for depression and anxiety in adults with HS were systematically searched without language restriction from the inception of each database to July 25, 2018, in PubMed/MEDLINE, Embase, and PsycINFO databases. Searches used various configurations of the terms hidradenitis suppurativa; acne inversa; depressive disorder; depression; anxiety; anxiety disorders; phobia, social; suicide; and suicide, attempted. In addition, the reference lists of included references were screened manually. STUDY SELECTION Two investigators independently screened references that measured prevalence rates and odds for depressive and anxiety symptoms in patients with HS. Of 136 unique references, 10 ultimately met inclusion criteria. DATA EXTRACTION AND SYNTHESIS Relevant data were extracted from eligible references. Authors were contacted to provide further information when necessary. Methodological quality of included studies was assessed through a modified version of the Newcastle-Ottawa Scale. Random-effects models were used to synthesize available evidence. MAIN OUTCOMES AND MEASURES Prevalence rates and ORs for depression and anxiety in adults with HS were the primary outcome measures. Heterogeneity across studies was assessed with the I 2 statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses. RESULTS Ten studies comprising 40 307 participants with HS met inclusion criteria. The overall prevalence of depression was 16.9% (95% CI, 9.9%-27.2%). Heterogeneity was large. In the subgroup of studies that considered a clinical criteria-based diagnosis of depression, the prevalence of depression was 11.9% (95% CI, 4.9%-26.2%), compared with 26.8% (95% CI, 20.4%-34.5%) in studies that used a screening instrument. The methodological quality of included studies moderated those findings. The OR for depression in individuals with HS compared with individuals without HS was 1.84 (95% CI, 1.57-2.15). The prevalence of anxiety was 4.9% (95% CI, 1.7%-13.2%); there were insufficient data to determine an odds ratio for anxiety in persons with HS because 2 studies included a comparison group. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis indicates that depression and anxiety are common comorbid conditions in patients with HS. Results suggest that the development of strategies to recognize and treat those psychiatric comorbidities in patients with HS is warranted.

Review of Comorbidities of Hidradenitis Suppurativa: Implications for Daily Clinical Practice

“…A recent meta-analysis of the literature suggested that depression and anxiety were very common comorbid conditions in HS patients. Depression was found to be correlated with disease activity and an association between inflammation (CRP levels) and depression has also been identified [29,34]. Recent evidence from a nationwide population-based study suggested that HS was associated with schizophrenia, after adjusting for demographic factors and smoking status [35].…”

“…Reduced quality of life, social isolation [28,29] Sexual dysfunction [31] Depression, anxiety, schizophrenia [29,34,35] Increased antidepressant drug use [36] Increased suicide risk [36] Development of strategies to recognize and treat those psychiatric comorbidities in patients with HS is warranted Older patients, smokers, and patients with depression may benefit from periodic screening for long-term opioid use HS hidradenitis suppurativa, CD Crohn's disease of subclinical atherosclerosis [14]. In a crosssectional Danish general population study, mean resting heart rate in patients with severe HS was significantly higher compared with controls [15].…”

The Role of the Cutaneous Microbiome in Hidradenitis Suppurativa—Light at the End of the Microbiological Tunnel

“…Hidradenitis suppurativa is a chronic, debilitating inflammatory skin disease whose pathophysiology remains poorly understood [92]. Although the disease itself is relatively uncommon, it is frequently associated with significant physical and psychological morbidity [93] and undoubtedly represents an area of unmet clinical need [2]. Whilst it has long been recognized that HS is associated with changes in the resident bacterial flora, only now are metagenomic studies starting to shed new light on the diversity, complexity and regulation of the cutaneous microbiome in HS.…”

The impact of hidradenitis suppurativa on general health is higher than that of hypertension, congestive heart failure, type 2 diabetes, myocardial infarction and depression

“…6 The impact of HS on mental health is also noteworthy. In previous studies, as well as in a recent systematic review, 7 it has been shown that HS was associated with depression and anxiety, 8 and even with an increased suicide risk. 9 It must be noted that, in our study population, even when the disease was clinically 'mild/ moderate' according to the IHS4 severity scale, BP scores were the worst compared to patients with either medical or psychiatric conditions, and the mental health component was very similar to psychiatric conditions.…”