Factors associated with depression, anxiety and severe mental illness among adults with atopic eczema or psoriasis: a systematic review and meta-analysis

Abstract

Background Evidence suggests an association between atopic eczema (AE) or psoriasis and mental illness. However, factors associated with mental illness are unclear. Objectives To synthesise and evaluate all available evidence on factors associated with depression, anxiety, and severe mental illness (SMI) among adults with AE or psoriasis. Methods We searched electronic databases, grey literature databases, and clinical trial registries from inception to February 2022 for studies in adults with AE or psoriasis. Eligible studies were randomised controlled trials (RCTs), cohort, cross-sectional or case-control studies where effect estimates of factors associated with depression, anxiety, or SMI were reported. We did not apply language or geographical restrictions. We assessed risk of bias using the Quality in Prognosis Studies tool. We synthesised results narratively, and if at least two studies were sufficiently homogenous, we pooled effect estimates in a random-effects meta-analysis. Results We included 21 studies (11 observational, 10 RCT). No observational studies in AE fulfilled our eligibility criteria. Observational studies in people with psoriasis mostly investigated factors associated with depression or anxiety – one cross-sectional study investigated factors associated with schizophrenia. Pooled effect estimates suggest being female, and psoriatic arthritis, were associated with depression (female sex:OR = 1.62,95%CI = 1.09-2.40,95%PI = 0.62-4.23, I2 = 24.90%, Tau2 = 0.05; psoriatic arthritis:OR = 2.26,95%CI = 1.56-3.25,95%PI = 0.21-24.23, I2 = 0.00%, Tau2 = 0.00) and anxiety (female sex:OR = 2.59,95%CI = 1.32-5.07,95%PI = 0.00-3956.27, I2 = 61.90%, Tau2 = 0.22; psoriatic arthritis:OR = 1.98,95%CI = 1.33-2.94, I2 = 0.00%, Tau2 = 0.00). Moderate/severe psoriasis was associated with anxiety (OR = 1.14,95%CI = 1.05-1.25, I2 = 0.00%, Tau2 = 0.00), but not depression. Evidence from RCTs suggested adults with AE or psoriasis given placebo had higher depression and anxiety scores compared to comparators given targeted treatment (e.g., biologic agents). Conclusions Our review highlights limited existing research on factors associated with depression, anxiety, and SMI in adults with AE or psoriasis. Observational evidence on factors associated with depression or anxiety in people with psoriasis was conflicting or from single studies, but some identified factors were consistent with those in the general population. Evidence on factors associated with SMIs in people with AE or psoriasis was particularly limited. Evidence from RCTs suggested AE and psoriasis treated with placebo was associated with higher depression and anxiety scores compared to skin disease treated with targeted therapy, however, follow-up was limited, therefore long-term effects on mental health are unclear.

Analysis of Clinical and Genetic Factors of Obesity and Psoriasis Concomitance—The Influence of Body Mass Composition, Prevalence of Mood Disorders, Environmental Factors and FTO Gene Polymorphisms (rs9939609, rs1558902)

“…Consequently, body weight emerges as a significant cofactor influencing the prevalence of mood disorders among psoriatic patients, in addition to the severity of skin lesions. Interestingly, contrary to our results, a recent meta-analysis proposed a greater predisposition of female sex among psoriatic patients (OR = 1.62, 95% CI 1.09–2.40) [ 45 ]. A nationwide population-based cross-sectional study in Taiwan identified female sex and major comorbid diseases, including cardiovascular disease, as major risk factors associated with depression among psoriatic patients [ 46 ].…”

Ethnic differences in depression and anxiety among adults with atopic eczema: Population‐based matched cohort studies within UK primary care

“…CPRD is an ongoing, nationwide database of routinely collected primary care records including information on demographics, diagnoses, symptoms, and prescriptions 31 . Morbidity code lists and all analytic codes used in this study are available for download 32 …”

“…We used a directed acyclic graph (DAG) and a systematic review to inform covariate selection (Appendix S2 ). 38 , 39 We matched age, sex, and practice (as an indirect means of accounting for differences in coding practice, rural/urban location, and socioeconomic deprivation). We considered age, sex, calendar period (2006–2010, 2011–2015, 2016–2020) and deprivation (quintiles of individual‐level Carstairs Index used when available, and practice‐level Carstairs if not) as potential confounders.…”

Severe Mental Illness Among Adults with Atopic Eczema or Psoriasis: Population-Based Matched Cohort Studies within UK Primary Care

“…We used directed acyclic graphs (DAGs) and a systematic review to inform covariate selection ( Appendix S2 ). 31 , 32 We matched on age, sex, and general practice, and considered calendar time (1997–2003, 2004–2009, 2010–2015, 2016–2020) and deprivation (quintiles of patient-level Carstairs Index used when available, otherwise practice-level Carstairs Index used) as potential confounders. 33 We considered the following variables as potential mediators: comorbidity burden (using the Charlson Comorbidity Index), 34 body mass index (BMI), smoking status, harmful alcohol use, and in AE only, sleep problems and high-dose glucocorticoid use.…”