Identifying Patients at Higher Risk of Depression Among Patients with Vitiligo at Outpatient Setting

Abstract

Introduction: Chronic skin diseases including vitiligo could have profound psychological burden. The factors influencing the expression of depression in patients with vitiligo received little attention both nationally and internationally. Aim: The aim of the current study was to estimate the burden and severity of depression and to characterize their associated sociodemographic and clinical characteristics among patients with vitiligo. Methods: A cross-sectional survey study was conducted among patients with vitiligo of both genders attending dermatology outpatient clinics at a tertiary care hospital during 2019. Modified Beck Depression Inventory Scale was used for screening for depression. Results: A total 308 patients with vitiligo have been included in the current analysis. The average age was 27±14.5 years. Approximately 59.7% of the patients were males and the majority (63.6%) were single. A total 168 (54.5%) patients had some depressive symptoms. The majority of these patients had mild depression (52.4%), followed by moderate (33.3%) and severe (14.3%) depression. Moderate and/or severe depression were significantly higher among children and adolescents (p=0.036), single patients (p=0.006), those with lower than high school education (p<0.001), those with shorter duration of the disease (p<0.001), and those using phototherapy (p=0.003). Depression burden and severity were not significantly associated with gender and lesion distribution. Conclusion: Sociodemographic and clinical characteristics can easily characterize the risk of depression among patients with vitiligo. The current findings may help dermatologist to pick patients at higher risk of depression early after diagnosis of vitiligo. Dermatologists should have low threshold for referring such patients to psychiatry clinics.

Psychosocial Effects of Vitiligo: A Systematic Literature Review

“…Depression and anxiety were the most commonly reported psychosocial comorbidities. Forty-one studies reported depression or depressive disorders (including major depressive disorder, bipolar disorder, and dysthymic disorder) in patients with vitiligo, with a prevalence range from 0.1–62.3% [ 15 , 17 , 22 , 23 , 28 , 30 , 32 , 34 , 35 , 39 , 40 , 43 , 44 , 46 , 48 , 50 , 57 , 68 , 69 , 71 , 92 , 100 , 104 , 113 – 115 , 131 , 137 , 138 , 142 , 143 , 145 , 146 , 150 , 154 , 155 , 158 – 160 , 163 , 177 ]. Twenty studies reported anxiety or anxiety-related disorders (including generalized anxiety disorder, agoraphobia, social phobia [not social avoidance], and panic disorder), with a prevalence of 1.9–67.9% [ 22 , 23 , 30 , 34 , 39 , 43 , 44 , 46 , 50 , 57 , 92 , 115 , 137 , 138 , 150 , 154 , 155 , 158 , 159 , 175 ].…”

“…Factors that were significantly associated with higher psychosocial (Fig. 3 ) or overall QoL burden were female sex (30 studies) [ 15 , 21 , 25 , 28 , 30 , 45 , 46 , 49 , 51 , 57 , 62 , 66 – 68 , 70 , 88 , 90 , 99 , 104 , 107 , 109 , 112 , 113 , 120 , 123 , 132 , 143 , 146 , 154 , 158 ], lesion location in visible areas (e.g., face, hands [17 studies]) [ 4 , 25 , 35 , 37 , 49 , 62 , 70 , 80 , 89 , 90 , 92 , 101 , 122 , 123 , 138 , 143 , 151 ] or genitals (eight studies) [ 70 , 89 , 97 , 105 , 115 , 122 , 144 , 151 ], younger age (16 studies; particularly those aged <30 years and more so in adolescents) [ 17 , 25 , 30 , 48 , 49 , 62 , 67 , 68 , 70 ,…”

“…|| Includes one study with a population in Jordan and Germany (n = 167). The number of patients in each country was not available in the published study; thus, the full population is included in both countries on this map [92], Georgia [159], Germany [104], India [22,28,43,100,113,114,137,138,143,145,146,150,177], Italy [142], Iran [30], Japan [163], Jordan [104], South Korea [71], Mexico [115], Nepal [32], Nigeria [44], Saudi Arabia [17,46,48,50], Singapore [68,69], Taiwan [23], Thailand [35], Turkey [34,39,57,155,158], UK [40,160], USA [ [173] comorbidity in vitiligo compared with other skin diseases.…”

“…Factors that were significantly associated with higher psychosocial (Fig. 3) or overall QoL burden were female sex (30 studies) [15,21,25,28,30,45,46,49 [17,25,30,48,49,62,67,68,70,88,100,113,119,132,151,160], and extensive body area involvement (13 studies) [4,25,63,65,70,89,92,96,98,107,151,152,166]. Unmarried and/or single relationship status (nine studies) [17,22,48,49,62,70,93,113,138], longer disease duration (nine studies; particularly duration >5 years) [4,…”

Variations in TAP1 and PSMB9 Genes Involved in Antigen Processing and Presentation Increase the Risk of Vitiligo in the Saudi Community

“… 48 Despite the relatively low prevalence of vitiligo in Saudi Arabia, estimated at 0.4–2.5%, 13 , 16 , 74 the disease is linked to psychosocial burden, as 45–57% of vitiligo patients experience depression. 46 , 75 , 76 …”