Adesanya Elizabeth I, Matthewman Julian, Schonmann Yochai, Hayes Joseph F, Henderson Alasdair, Mathur Rohini, Mulick Amy R, Smith Catherine H, Langan Sinéad M, Mansfield Kathryn E
Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Br J Dermatol. 2023 Mar 30;188(4):460-470. doi: 10.1093/bjd/ljac132.
Evidence suggests an association between atopic eczema (AE) or psoriasis and mental illness; however, the factors associated with mental illness are unclear.
To synthesize and evaluate all available evidence on factors associated with depression, anxiety and severe mental illness (SMI) among adults with AE or psoriasis.
We searched electronic databases, grey literature databases and clinical trial registries from inception to February 2022 for studies of adults with AE or psoriasis. Eligible studies included randomized 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 synthesized results narratively, and if at least two studies were sufficiently homogeneous, we pooled effect estimates in a random effects meta-analysis.
We included 21 studies (11 observational, 10 RCTs). 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 that female sex and psoriatic arthritis were associated with depression [female sex: odds ratio (OR) 1.62, 95% confidence interval (CI) 1.09-2.40, 95% prediction intervals (PIs) 0.62-4.23, I2 = 24.90%, τ2 = 0.05; psoriatic arthritis: OR 2.26, 95% CI 1.56-3.25, 95% PI 0.21-24.23, I2 = 0.00%, τ2 = 0.00] and anxiety (female sex: OR 2.59, 95% CI 1.32-5.07, 95% PI 0.00-3956.27, I2 = 61.90%, τ2 = 0.22; psoriatic arthritis: OR 1.98, 95% CI 1.33-2.94, I2 = 0.00%, τ2 = 0.00). Moderate/severe psoriasis was associated with anxiety (OR 1.14, 95% CI 1.05-1.25, I2 0.00%, τ2 = 0.00), but not depression. Evidence from RCTs suggested that adults with AE or psoriasis given placebo had higher depression and anxiety scores compared with comparators given targeted treatment (e.g. biologic agents).
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 that AE and psoriasis treated with placebo was associated with higher depression and anxiety scores compared with skin disease treated with targeted therapy; however, follow-up was limited. Therefore, long-term effects on mental health are unclear.
有证据表明特应性皮炎（AE）或银屑病与精神疾病之间存在关联；然而，与精神疾病相关的因素尚不清楚。
综合并评估所有关于成年AE或银屑病患者中与抑郁、焦虑及严重精神疾病（SMI）相关因素的现有证据。
我们检索了从数据库建立至2022年2月的电子数据库、灰色文献数据库和临床试验注册库，以查找有关成年AE或银屑病患者的研究。符合条件的研究包括随机对照试验（RCT）、队列研究、横断面研究或病例对照研究，这些研究报告了与抑郁、焦虑或SMI相关因素的效应估计值。我们未设置语言或地域限制。我们使用预后研究质量工具评估偏倚风险。我们对结果进行叙述性综合，如果至少两项研究足够同质，我们将在随机效应荟萃分析中汇总效应估计值。
我们纳入了21项研究（11项观察性研究，10项RCT）。AE的观察性研究均未符合我们的纳入标准。银屑病患者的观察性研究大多调查了与抑郁或焦虑相关的因素——一项横断面研究调查了与精神分裂症相关的因素。汇总效应估计表明，女性和银屑病关节炎与抑郁相关[女性：优势比（OR）1.62，95%置信区间（CI）1.09 - 2.40，95%预测区间（PI）0.62 - 4.23，I² = 24.90%，τ² = 0.05；银屑病关节炎：OR 2.26，95% CI 1.56 - 3.25，95% PI 0.21 - 24.23，I² = 0.00%，τ² = 0.00]以及焦虑相关（女性：OR 2.59，95% CI 1.32 - 5.07，95% PI 0.00 - 3956.27，I² = 61.90%，τ² = 0.22；银屑病关节炎：OR 1.98，95% CI 1.33 - 2.94，I² = 0.00%，τ² = 0.00）。中度/重度银屑病与焦虑相关（OR 1.14，95% CI 1.05 - 1.25，I² 0.00%，τ² = 0.00），但与抑郁无关。RCT的证据表明，给予安慰剂的成年AE或银屑病患者与给予靶向治疗（如生物制剂）的对照者相比，抑郁和焦虑评分更高。
我们的综述强调了关于成年AE或银屑病患者中与抑郁、焦虑和SMI相关因素的现有研究有限。关于银屑病患者中与抑郁或焦虑相关因素的观察性证据相互矛盾或来自单一研究，但一些确定的因素与一般人群中的因素一致。关于AE或银屑病患者中与SMI相关因素的证据尤其有限。RCT的证据表明，与接受靶向治疗的皮肤病相比，给予安慰剂治疗的AE和银屑病与更高的抑郁和焦虑评分相关；然而，随访有限。因此，对心理健康的长期影响尚不清楚。
