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Comment & Response
April 3, 2019

Problematic Strength of the Association Between Atopic Dermatitis and Suicidality—Reply

Author Affiliations
  • 1Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
  • 2University of California, Irvine School of Medicine, Irvine
  • 3Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles
JAMA Dermatol. 2019;155(5):638. doi:10.1001/jamadermatol.2019.0124

In Reply We welcome the opportunity to discuss the comments by Chen et al regarding our systematic review and meta-analysis of suicidality in patients with atopic dermatitis (AD). In our study, we found a significantly higher risk of suicidal ideation and suicide attempts in those with AD compared with those without AD.1

The letter by Chen and colleagues contains 2 errors. First, the authors stated that “15 of the reviewed studies included control groups of patients with different conditions.” However, as stated in our article, 15 was the total number of studies in the systematic review. Of these, only 3 contained control groups of patients with other conditions2-4; the vast majority of the studies had control groups that consisted of healthy people or those from the general population. Second, Chen et al state that the association was incorrectly estimated by merging crude odds ratios (ORs) with adjusted ORs. However, we did not merge crude ORs with adjusted ORs. As stated in our article, we used all crude ORs in our meta-analyses, in accordance with established methods.5 Of the studies that only reported adjusted ORs, we calculated crude ORs from the raw data provided.

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