Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Patient and Public Advisory Panel, Skin Disease Epidemiology Research Group, London School of Hygiene & Tropical Medicine, London, UK.
BMC Med. 2023 Aug 4;21(1):285. doi: 10.1186/s12916-023-02948-x.
Psoriasis and atopic eczema are common inflammatory skin diseases. Existing research has identified increased risks of common mental disorders (anxiety, depression) in people with eczema and psoriasis; however, explanations for the associations remain unclear. We aimed to establish the risk factors for mental illness in those with eczema or psoriasis and identify the population groups most at risk.
We used routinely collected data from the UK Clinical Practice Research Datalink (CPRD) GOLD. Adults registered with a general practice in CPRD (1997-2019) were eligible for inclusion. Individuals with eczema/psoriasis were matched (age, sex, practice) to up to five adults without eczema/psoriasis. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for hazards of anxiety or depression in people with eczema/psoriasis compared to people without. We adjusted for known confounders (deprivation, asthma [eczema], psoriatic arthritis [psoriasis], Charlson comorbidity index, calendar period) and potential mediators (harmful alcohol use, body mass index [BMI], smoking status, and, in eczema only, sleep quality [insomnia diagnoses, specific sleep problem medications] and high-dose oral glucocorticoids).
We identified two cohorts with and without eczema (1,032,782, matched to 4,990,125 without), and with and without psoriasis (366,884, matched to 1,834,330 without). Sleep quality was imbalanced in the eczema cohorts, twice as many people with eczema had evidence of poor sleep at baseline than those without eczema, including over 20% of those with severe eczema. After adjusting for potential confounders and mediators, eczema and psoriasis were associated with anxiety (adjusted HR [95% CI]: eczema 1.14 [1.13-1.16], psoriasis 1.17 [1.15-1.19]) and depression (adjusted HR [95% CI]: eczema 1.11 [1.1-1.12], psoriasis 1.21 [1.19-1.22]). However, we found evidence that these increased hazards are unlikely to be constant over time and were especially high 1-year after study entry.
Atopic eczema and psoriasis are associated with increased incidence of anxiety and depression in adults. These associations may be mediated through known modifiable risk factors, especially sleep quality in people with eczema. Our findings highlight potential opportunities for the prevention of anxiety and depression in people with eczema/psoriasis through treatment of modifiable risk factors and enhanced eczema/psoriasis management.
银屑病和特应性皮炎是常见的炎症性皮肤病。现有研究已经发现，湿疹和银屑病患者患常见精神障碍（焦虑、抑郁）的风险增加；然而，这些关联的解释仍不清楚。我们旨在确定湿疹或银屑病患者患精神疾病的风险因素，并确定风险最高的人群。
我们使用来自英国临床实践研究数据链接（CPRD）GOLD 的常规收集数据。在 CPRD 注册的符合条件的普通科医生（1997-2019 年）有资格入选。与没有湿疹/银屑病的成年人（年龄、性别、实践）相匹配的湿疹/银屑病患者。我们使用 Cox 回归来估计湿疹/银屑病患者与没有湿疹/银屑病的患者相比，焦虑或抑郁的风险比（HRs）和 95%置信区间（CIs）。我们调整了已知的混杂因素（贫困、哮喘[湿疹]、银屑病关节炎[银屑病]、Charlson 合并症指数、日历期）和潜在的中介因素（有害酒精使用、体重指数[BMI]、吸烟状况，以及仅在湿疹中，睡眠质量[失眠诊断、特定睡眠问题药物]和高剂量口服糖皮质激素）。
我们确定了两个有和没有湿疹的队列（1032782 例，匹配 4990125 例没有），和有和没有银屑病的队列（366884 例，匹配 1834330 例没有）。在湿疹队列中，睡眠质量不平衡，有湿疹的患者在基线时睡眠质量较差的证据是没有湿疹的患者的两倍，包括超过 20%的重度湿疹患者。在调整潜在的混杂因素和中介因素后，湿疹和银屑病与焦虑（调整后的 HR [95%CI]：湿疹 1.14 [1.13-1.16]，银屑病 1.17 [1.15-1.19]）和抑郁（调整后的 HR [95%CI]：湿疹 1.11 [1.1-1.12]，银屑病 1.21 [1.19-1.22]）相关。然而，我们有证据表明，这些增加的风险不太可能随着时间的推移而保持不变，尤其是在研究开始后 1 年。
特应性皮炎和银屑病与成年人焦虑和抑郁的发生率增加有关。这些关联可能通过已知的可改变的风险因素来介导，特别是湿疹患者的睡眠质量。我们的研究结果强调了通过治疗可改变的风险因素和加强湿疹/银屑病管理来预防湿疹/银屑病患者焦虑和抑郁的潜在机会。
