Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Psychology, Sapienza University of Rome, Rome, Italy.
Arch Dermatol Res. 2023 Aug;315(6):1577-1582. doi: 10.1007/s00403-023-02538-0. Epub 2023 Feb 7.
Atopic dermatitis (AD) is a common inflammatory chronic skin disease typically associated with atopic comorbidities and other non-atopic conditions such as sleep disturbances, and mood/anxiety disorders. A growing literature proposed a crucial role of sleep disturbances in the development of mental health problems in AD. We tested this assumption by mediation model analyses in adult AD patients.A total of 57 patients (mean age ± std. dev., 34.28 ± 13.07 years; 27 males; range 18-67 years) diagnosed with AD participated in a cross-sectional study. We evaluated self-perceived severity of AD, insomnia, depression, and anxiety symptoms using validated questionnaires: the Patient-Oriented Eczema Measure (POEM), the Insomnia Severity Index (ISI), the Beck Depression Inventory-second edition (BDI-II), and the Generalized Anxiety Disorder-7 scale (GAD-7), respectively. Two mediation models were performed, testing the mediation effect of insomnia symptoms on the relationship between AD severity and depression (model 1) and anxiety (model 2). AD symptoms, as expressed by POEM, were positively associated with insomnia, depression, and anxiety severity. Insomnia fully mediated the effect of AD severity on depression and anxiety. Specifically, insomnia accounted for 81.64% of the relationship between atopic eczema severity and depression, and for 81.84% of the effect of AD severity on anxiety symptoms. The present study proposed a critical role of insomnia in predisposing adult AD patients to experience depression and anxiety. Early interventions focused on treating sleep disturbances could indirectly be beneficial on mental health of patients with AD, counteracting the onset and exacerbation of anxiety and depression disorders.
特应性皮炎（AD）是一种常见的炎症性慢性皮肤病，通常与特应性合并症和其他非特应性疾病有关，如睡眠障碍和情绪/焦虑障碍。越来越多的文献提出睡眠障碍在 AD 患者心理健康问题的发展中起着关键作用。我们通过对成年 AD 患者的中介模型分析来检验这一假设。
共有 57 名（平均年龄±标准差，34.28±13.07 岁；27 名男性；年龄范围 18-67 岁）被诊断为 AD 的患者参与了横断面研究。我们使用经过验证的问卷评估了患者自我感知的 AD 严重程度、失眠、抑郁和焦虑症状：患者导向的湿疹量表（POEM）、失眠严重程度指数（ISI）、贝克抑郁量表第二版（BDI-II）和广泛性焦虑症-7 量表（GAD-7）。进行了两个中介模型，分别测试了失眠症状在 AD 严重程度与抑郁（模型 1）和焦虑（模型 2）之间的关系中的中介效应。POEM 表达的 AD 症状与失眠、抑郁和焦虑严重程度呈正相关。失眠完全介导了 AD 严重程度对抑郁和焦虑的影响。具体来说，失眠解释了特应性皮炎严重程度与抑郁之间 81.64%的关系，以及 AD 严重程度对焦虑症状的 81.84%的影响。本研究提出了失眠在使成年 AD 患者易患抑郁和焦虑方面的关键作用。早期干预侧重于治疗睡眠障碍，可能会间接有益于 AD 患者的心理健康，从而阻止焦虑和抑郁障碍的发生和恶化。
