Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A.
School of Medicine, University of Pennsylvania Perelman, Philadelphia, PA, U.S.A.
Br J Dermatol. 2019 Sep;181(3):554-565. doi: 10.1111/bjd.17683. Epub 2019 Mar 5.
The relationship between atopic dermatitis (AD), anxiety and depression in the U.S. adult population is not well established.
To determine the relationship of AD and its severity with symptoms and diagnosis of anxiety and depression in U.S. adults.
A cross-sectional, population-based study of 2893 adults was performed. AD was determined using modified U.K. Diagnostic Criteria.
Adults with AD vs. those without AD had higher mean Hospital Anxiety and Depression Scale anxiety (HADS-A) (7·7 vs. 5·6) and depression (HADS-D) (6·0 vs. 4·3) scores and higher prevalences of abnormal (≥ 11) HADS-A (28·6% vs. 15·5%) and HADS-D (13·5% vs. 9·0%) scores. In multivariable linear and logistic regression models controlling for sociodemographics, AD was associated with significantly higher mean HADS-A and HADS-D scores (7·7 and 6·0) and higher odds of abnormal HADS-A [odds ratio (OR) 2·19, 95% confidence interval (CI) 1·65-2·91] and HADS-D scores (OR 1·50, 95% CI 1·04-2·17) (P ≤ 0·03 for all). Mean and abnormal HADS-A and HADS-D scores were increased in moderate and severe/very severe self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD itch and sleep (P < 0·0001 for all). All respondents with severe PO-SCORAD, POEM and PO-SCORAD itch had borderline or abnormal HADS-A and HADS-D scores. Adults with AD vs. those without AD had higher prevalence of self-reported healthcare-diagnosed anxiety or depression in the past year (40·0% vs. 17·5%). Many adults with AD who had borderline and/or abnormal HADS-A or HADS-D scores reported no diagnosis of anxiety or depression.
AD is associated with significantly increased anxiety and depression, which may go undiagnosed. What's already known about this topic? Previous studies found higher rates of anxiety and depression in clinical cohorts of patients with atopic dermatitis. What does this study add? This study found dramatically higher rates of anxiety and depression among adults with atopic dermatitis in the U.S. population, which was primarily driven by atopic dermatitis severity. Anxiety and depression often go undiagnosed in adults with atopic dermatitis.
美国成年人中特应性皮炎（AD）、焦虑和抑郁之间的关系尚未明确。
明确 AD 及其严重程度与美国成年人焦虑和抑郁症状及诊断之间的关系。
对 2893 名成年人进行了横断面、基于人群的研究。采用改良后的英国诊断标准确定 AD。
与无 AD 成年人相比，AD 成年人的医院焦虑和抑郁量表焦虑（HADS-A）评分（7.7 比 5.6）和抑郁（HADS-D）评分（6.0 比 4.3）更高，异常（≥11）HADS-A（28.6%比 15.5%）和 HADS-D（13.5%比 9.0%）评分的比例也更高。在控制社会人口统计学因素的多变量线性和逻辑回归模型中，AD 与 HADS-A 和 HADS-D 评分显著升高（7.7 和 6.0）和异常 HADS-A[比值比（OR）2.19，95%置信区间（CI）1.65-2.91]和 HADS-D 评分（OR 1.50，95%CI 1.04-2.17）的几率更高（所有 P 值均≤0.03）。中度和重度/极重度自报全球 AD 严重程度、患者导向湿疹测量（POEM）、患者导向 AD 评分（PO-SCORAD）、PO-SCORAD 瘙痒和睡眠的 HADS-A 和 HADS-D 评分均增加（所有 P 值均＜0.0001）。所有严重 PO-SCORAD、POEM 和 PO-SCORAD 瘙痒的患者的 HADS-A 和 HADS-D 评分均为边界值或异常。与无 AD 成年人相比，过去 1 年中报告有医疗保健诊断的焦虑或抑郁的 AD 成年人比例更高（40.0%比 17.5%）。许多 HADS-A 和/或 HADS-D 评分处于边界值或异常的 AD 成年人并未报告有焦虑或抑郁的诊断。
AD 与显著增加的焦虑和抑郁显著相关，这些情况可能未被诊断。本研究在何种人群中开展？本研究在美国人群中发现 AD 成年人中焦虑和抑郁的发生率显著增加，主要由 AD 严重程度所致。AD 成年人的焦虑和抑郁往往未被诊断。
