Meta-Analytic Review of High Anxiety Comorbidity among Patients with Vitiligo

Abstract

Background. Vitiligo is a disfiguring skin disease with profound psychosocial impacts, such as anxiety, but the reported effect sizes of associations vary. We aimed to conduct a meta-analysis to quantify the strength of association between anxiety and vitiligo and to estimate the prevalence of anxiety among individuals with vitiligo. Methods. A systematic literature search was performed in five online databases (MEDLINE, Embase, Web of Science, Cochrane Library, and PsycINFO) from inception until March 20, 2020. All of the eligible studies were comprehensively reviewed, and all of the available data were analyzed according to our predefined criteria. Results. Twenty-one studies involving 3259 patients in 11 countries were included in this meta-analysis. Compared with the healthy control group, patients with vitiligo often had concomitant anxiety ( OR = 6.14 [95% CI: 3.35–11.24], I 2 = 30.1 % ). The pooled prevalence of anxiety in female patients was significantly higher than that in males ( OR = 2.24 [95% CI: 1.31–3.84], I 2 = 0.0 % ). Subgroup analysis showed that the pooled prevalence of clinical anxiety disorder and anxiety symptoms was 12% (95% CI: 7%–16%, I 2 = 76.3 % ) and 34% (95% CI: 21%–46%, I 2 = 94.7 % ), respectively. No publication bias has been detected by Begg’s funnel plot and Egger’s test. Conclusion. Patients with vitiligo have high anxiety comorbidity, with female predominance. Dermatologists and psychiatrists should be vigilant to the presence of anxiety, apply appropriate interventions to reduce the psychological impacts in a timely manner, and thus promote recovery in vitiligo patients. However, due to some objective limitations (poor information about the OR and diversity in assessment tools among included studies), findings should be interpreted with caution.

Occludin Promotes Adhesion of CD8+ T Cells and Melanocytes in Vitiligo via the HIF-1α Signaling Pathway

“…Vitiligo is an acquired disease characterized by skin depigmentation, which affects about 0.5%–2% of the general population [ 24 , 25 ]. Patients with vitiligo often suffer from heavy psychological burden because the skin lesions occur in the exposed areas [ 26 , 27 ].…”

The mental health associations of vitiligo: UK population-based cohort study

“…However, the prevalence of diagnosed depression and anxiety in our vitiligo cohort are similar to those in studies in which these data have been actively captured, with rates of clinically diagnosed depression of 8–25% 5 , 6 , 9 and rates of clinically diagnosed anxiety of 12–15%. 7 , 8 A further potential limitation is the risk of capture bias, whereby people interacting more frequently with primary care are more likely to have a recorded diagnosis of both vitiligo and mental health conditions. We explored this in our sensitivity analysis by excluding controls with no primary care interaction in the year preceding their index date (cases have at least one interaction by definition), which did not alter effect estimates.…”

“…4 Reliable population-based estimates of the psychological burden associated with vitiligo are important to gain a better understanding of the condition, and to ensure patients are provided with appropriate psychological support following diagnosis. Recent systematic reviews suggest that people with vitiligo are significantly more likely to suffer from depression 3,5,6 and anxiety, 3,7,8 although there is a lack of knowledge regarding other psychological conditions. 9 However, these reviews noted high heterogeneity between studies, which have typically involved small patient numbers and are mostly from non-representative cohorts such as secondary care patients.…”

Psychosocial impact of vitiligo in patients with skin of color

“…Similarly, anxiety has also been reported to be statistically significantly more common in patients with vitiligo as compared to the general population. A recent meta‐analysis reported the pooled odds of vitiligo patients having anxiety to be 6.14 times higher than controls 5 . The pooled prevalence of self‐reported anxiety symptoms ranged from 33% to 34%, while that of anxiety disorder was 12%–15% among patients with vitiligo 5,38 .…”

“…Earlier studies on the psychosocial burden of vitiligo in modern medical English literature were largely in psychiatry journals 1 . Much of the literature focussing on the psychological aspects of vitiligo, including systematic reviews and meta‐analysis, has emerged in the last decade 2–5 . It is now well recognized that the effect of vitiligo on a patient's life may not correlate with the extent of depigmentation 6 .…”