Yale Child Study Center, Yale University, New Haven, CT, USA.
Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
J Psychiatr Res. 2022 Sep;153:73-81. doi: 10.1016/j.jpsychires.2022.06.058. Epub 2022 Jul 1.
Epidemiological studies have provided varying prevalence estimates of trichotillomania (TTM) and other hair-pulling behaviors. We performed a systematic review and meta-analysis to provide data-driven prevalence estimates of TTM and hair-pulling. PubMed, PsycInfo and Embase were searched on June 2020 (updated in November 2021). Studies reporting the frequency of TTM defined by Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria or hair-pulling behaviors were included. Prevalence data was extracted for both genders, and female-to-male odds ratios (OR) were computed for TTM and any hair-pulling behaviors. Data were pooled through random-effects meta-analyses. Of the 713 records identified through database searches, 30 studies involving 38,526 participants were included. Meta-analyses indicated TTM had a prevalence of 1.14% (95% CI 0.66%, 1.96%), while any hair-pulling behavior had a prevalence of 8.84% (95% CI 6.33%, 12.20%). Meta-analyses demonstrated females were at an increased risk of any hair-pulling when noticeable hair loss was required (OR = 2.23, 95% CI 1.60, 3.10, p < 0.0001), but not of any hair-pulling when noticeable hair loss was not required (OR = 0.90, 95% CI 0.72, 1.64, p = 0.33). Meta-analyses did not indicate female preponderance in TTM (k = 10; N = 22,775; OR = 1.29; 95% CI 0.91, 1.83; I = 28%, p = 0.15), although there was considerable heterogeneity across studies. This study demonstrates that TTM impacts ∼1% of the population, while general hair-pulling behaviors affects ∼8%, highlighting the significant public health impact of this understudied condition. Additional research should clarify the gender distribution of TTM in epidemiological samples.
流行病学研究提供了不同的拔毛癖（TTM）和其他拔毛行为的流行率估计值。我们进行了系统的综述和荟萃分析，以提供 TTM 和拔毛的基于数据的流行率估计值。2020 年 6 月在 PubMed、PsycInfo 和 Embase 上进行了检索（2021 年 11 月更新）。纳入了报告按照《精神障碍诊断与统计手册》（DSM）标准定义的 TTM 频率或拔毛行为的研究。提取了两性的流行率数据，并计算了 TTM 和任何拔毛行为的女性对男性比值（OR）。通过随机效应荟萃分析汇总数据。通过数据库检索确定了 713 条记录，其中包括 30 项涉及 38526 名参与者的研究。荟萃分析表明，TTM 的流行率为 1.14%（95%CI 0.66%，1.96%），而任何拔毛行为的流行率为 8.84%（95%CI 6.33%，12.20%）。荟萃分析表明，当需要明显脱发时，女性发生任何拔毛行为的风险增加（OR=2.23，95%CI 1.60，3.10，p<0.0001），但当不需要明显脱发时，女性发生任何拔毛行为的风险则不会增加（OR=0.90，95%CI 0.72，1.64，p=0.33）。荟萃分析并未表明 TTM 存在女性优势（k=10；N=22775；OR=1.29；95%CI 0.91，1.83；I=28%，p=0.15），尽管研究之间存在很大的异质性。本研究表明，TTM 影响约 1%的人口，而一般的拔毛行为则影响约 8%，突出了这种研究不足的疾病对公共卫生的重大影响。进一步的研究应明确流行病学样本中 TTM 的性别分布。
