Myrela O Machado1, Vicky Stergiopoulos2,3, Michael Maes4,5, Paul A Kurdyak2,3,6, Pao-Yen Lin7,8, Liang-Jen Wang9, Yu-Chiau Shyu10,11,12,13,14,15, Joseph Firth16,17,18, Ai Koyanagi19,20, Marco Solmi21, Afsaneh Alavi1,22, Vincent Piguet1,22,23, Andre F Carvalho1,2,3. 1. Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada. 2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. 3. Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada. 4. IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia. 5. Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 6. Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada. 7. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 8. Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 9. Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 10. Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan. 11. Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan. 12. Department of Nursing, College of Human Ecology, Chang Gung University of Science and Technology, Kaohsiung, Taiwan. 13. Department of Nutrition and Health Sciences, College of Human Ecology, Chang Gung University of Science and Technology, Kaohsiung, Taiwan. 14. Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Kaohsiung, Taiwan. 15. Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Kaohsiung, Taiwan. 16. NICM Health Research Institute, School of Science and Health, University of Western Sydney, Sydney, Australia. 17. Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom. 18. Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia. 19. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain. 20. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. 21. Department of Neurosciences, University of Padova, Padova, Italy and Padova Neuroscience Center, University of Padua, Padua, Italy. 22. Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada. 23. Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom.
Abstract
IMPORTANCE: Previous studies suggest that depression and anxiety are common in patients with hidradenitis suppurativa (HS), more so than other dermatological conditions. Yet, to the authors' knowledge, no previous systematic review or meta-analysis has estimated the prevalence or odds ratio (OR) for those psychiatric comorbidities in this population. OBJECTIVE: To assess the prevalence and odds for depression and anxiety in patients with HS. DATA SOURCES: From July 25 to September 30, 2018, observational studies investigating the prevalence and odds for depression and anxiety in adults with HS were systematically searched without language restriction from the inception of each database to July 25, 2018, in PubMed/MEDLINE, Embase, and PsycINFO databases. Searches used various configurations of the terms hidradenitis suppurativa; acne inversa; depressive disorder; depression; anxiety; anxiety disorders; phobia, social; suicide; and suicide, attempted. In addition, the reference lists of included references were screened manually. STUDY SELECTION: Two investigators independently screened references that measured prevalence rates and odds for depressive and anxiety symptoms in patients with HS. Of 136 unique references, 10 ultimately met inclusion criteria. DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted from eligible references. Authors were contacted to provide further information when necessary. Methodological quality of included studies was assessed through a modified version of the Newcastle-Ottawa Scale. Random-effects models were used to synthesize available evidence. MAIN OUTCOMES AND MEASURES: Prevalence rates and ORs for depression and anxiety in adults with HS were the primary outcome measures. Heterogeneity across studies was assessed with the I2 statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses. RESULTS: Ten studies comprising 40 307 participants with HS met inclusion criteria. The overall prevalence of depression was 16.9% (95% CI, 9.9%-27.2%). Heterogeneity was large. In the subgroup of studies that considered a clinical criteria-based diagnosis of depression, the prevalence of depression was 11.9% (95% CI, 4.9%-26.2%), compared with 26.8% (95% CI, 20.4%-34.5%) in studies that used a screening instrument. The methodological quality of included studies moderated those findings. The OR for depression in individuals with HS compared with individuals without HS was 1.84 (95% CI, 1.57-2.15). The prevalence of anxiety was 4.9% (95% CI, 1.7%-13.2%); there were insufficient data to determine an odds ratio for anxiety in persons with HS because 2 studies included a comparison group. CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis indicates that depression and anxiety are common comorbid conditions in patients with HS. Results suggest that the development of strategies to recognize and treat those psychiatric comorbidities in patients with HS is warranted.
IMPORTANCE: Previous studies suggest that depression and anxiety are common in patients with hidradenitis suppurativa (HS), more so than other dermatological conditions. Yet, to the authors' knowledge, no previous systematic review or meta-analysis has estimated the prevalence or odds ratio (OR) for those psychiatric comorbidities in this population. OBJECTIVE: To assess the prevalence and odds for depression and anxiety in patients with HS. DATA SOURCES: From July 25 to September 30, 2018, observational studies investigating the prevalence and odds for depression and anxiety in adults with HS were systematically searched without language restriction from the inception of each database to July 25, 2018, in PubMed/MEDLINE, Embase, and PsycINFO databases. Searches used various configurations of the terms hidradenitis suppurativa; acne inversa; depressive disorder; depression; anxiety; anxiety disorders; phobia, social; suicide; and suicide, attempted. In addition, the reference lists of included references were screened manually. STUDY SELECTION: Two investigators independently screened references that measured prevalence rates and odds for depressive and anxiety symptoms in patients with HS. Of 136 unique references, 10 ultimately met inclusion criteria. DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted from eligible references. Authors were contacted to provide further information when necessary. Methodological quality of included studies was assessed through a modified version of the Newcastle-Ottawa Scale. Random-effects models were used to synthesize available evidence. MAIN OUTCOMES AND MEASURES: Prevalence rates and ORs for depression and anxiety in adults with HS were the primary outcome measures. Heterogeneity across studies was assessed with the I2 statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses. RESULTS: Ten studies comprising 40 307 participants with HS met inclusion criteria. The overall prevalence of depression was 16.9% (95% CI, 9.9%-27.2%). Heterogeneity was large. In the subgroup of studies that considered a clinical criteria-based diagnosis of depression, the prevalence of depression was 11.9% (95% CI, 4.9%-26.2%), compared with 26.8% (95% CI, 20.4%-34.5%) in studies that used a screening instrument. The methodological quality of included studies moderated those findings. The OR for depression in individuals with HS compared with individuals without HS was 1.84 (95% CI, 1.57-2.15). The prevalence of anxiety was 4.9% (95% CI, 1.7%-13.2%); there were insufficient data to determine an odds ratio for anxiety in persons with HS because 2 studies included a comparison group. CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis indicates that depression and anxiety are common comorbid conditions in patients with HS. Results suggest that the development of strategies to recognize and treat those psychiatric comorbidities in patients with HS is warranted.
Authors: John W Frew; Kristina Navrazhina; David Grand; Mary Sullivan-Whalen; Patricia Gilleaudeau; Sandra Garcet; Jonathan Ungar; James G Krueger Journal: J Am Acad Dermatol Date: 2020-05-13 Impact factor: 11.527
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