Matthewman Julian, Mansfield Kathryn E, Hayes Joseph F, Adesanya Elizabeth I, Smith Catherine H, Roberts Amanda, Langan Sinéad M, Henderson Alasdair D
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Division of Psychiatry, University College London, London, UK.
Clin Epidemiol. 2023 Aug 7;15:891-899. doi: 10.2147/CLEP.S417176. eCollection 2023.
Previous research has shown associations between eczema and psoriasis and anxiety and depression. We investigated whether associations are consistent across different settings of ascertainment for depression and anxiety, including interview and survey responses from UK Biobank (a large longitudinal cohort recruiting individuals aged 40-69 years between 2006-2010), and linked primary care data, with the aim of drawing more reliable conclusions through triangulation.
In cross-sectional studies, we estimated associations between eczema or psoriasis and anxiety or depression, defining anxiety or depression as 1) self-reported previous diagnosis at UK Biobank recruitment interview; 2) PHQ-9/GAD-7 score indicating depression or anxiety from a UK Biobank mental health follow-up survey in 2016; and 3) diagnosis in linked primary care electronic health record data.
We analysed 230,047 people with linked Biobank and primary care data. We found poor agreement between the data sources for eczema, psoriasis, anxiety, and depression. Eg, 9474 had a previous eczema diagnosis in primary care data, 4069 self-reported previous eczema diagnosis at the UK biobank interview, and 1536 had eczema in both data sources (for depression 40,455; 13,320; and 9588 respectively). Having eczema or psoriasis (recorded in primary care or baseline interview) was associated with higher odds of anxiety and depression. Eg, the adjusted odds ratio for depression comparing those with eczema to those without was greater than 1 when defining the outcome from 1) the recruitment interview (1.36, 95% confidence interval 1.27-1.45); 2) the follow-up survey (1.24, 1.09-1.39), and 3) primary care records (1.56, 1.50-1.62).
Our findings support increased prevalence of mental illness in people with psoriasis and eczema across multiple data sources, which should be considered in planning of mental health services. However, we found poor agreement in disease ascertainment between settings, with implications for data interpretation in electronic health records.
先前的研究表明湿疹、银屑病与焦虑和抑郁之间存在关联。我们调查了在不同的抑郁和焦虑确诊背景下这种关联是否一致，这些背景包括来自英国生物银行（一个在2006年至2010年间招募40至69岁个体的大型纵向队列）的访谈和调查回复，以及与之相关的初级保健数据，目的是通过三角测量得出更可靠的结论。
在横断面研究中，我们估计了湿疹或银屑病与焦虑或抑郁之间的关联，将焦虑或抑郁定义为：1）在英国生物银行招募访谈中自我报告的既往诊断；2）2016年英国生物银行心理健康随访调查中表明抑郁或焦虑的PHQ - 9/GAD - 7评分；3）关联的初级保健电子健康记录数据中的诊断。
我们分析了230,047名关联了生物银行和初级保健数据的人。我们发现湿疹、银屑病、焦虑和抑郁的数据来源之间一致性较差。例如，在初级保健数据中有9474人既往被诊断为湿疹，在英国生物银行访谈中有4069人自我报告既往有湿疹诊断，在两个数据来源中都有湿疹诊断的有1536人（抑郁分别为40,455人、13,320人和9588人）。患有湿疹或银屑病（记录在初级保健或基线访谈中）与焦虑和抑郁的较高几率相关。例如，当从以下方面定义结果时，将患有湿疹者与未患湿疹者相比，抑郁的调整优势比大于1：1）招募访谈（1.36，95%置信区间1.27 - 1.45）；2）随访调查（1.24，1.09 - 1.39）；3）初级保健记录（1.56，1.50 - 1.62）。
我们的研究结果支持在多个数据来源中银屑病和湿疹患者中心理疾病患病率增加，这在心理健康服务规划中应予以考虑。然而，我们发现不同背景下疾病确诊的一致性较差，这对电子健康记录中的数据解释有影响。
