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Original Investigation
June 5, 2019

Depression and Anxiety in Adults With Hidradenitis Suppurativa: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Division of Dermatology, Women’s College Hospital, Toronto, Ontario, Canada
  • 2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  • 3Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
  • 4IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
  • 5Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 6Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
  • 7Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
  • 8Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
  • 9Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
  • 10Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
  • 11Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan
  • 12Department of Nursing, College of Human Ecology, Chang Gung University of Science and Technology, Kaohsiung, Taiwan
  • 13Department of Nutrition and Health Sciences, College of Human Ecology, Chang Gung University of Science and Technology, Kaohsiung, Taiwan
  • 14Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Kaohsiung, Taiwan
  • 15Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Kaohsiung, Taiwan
  • 16NICM Health Research Institute, School of Science and Health, University of Western Sydney, Sydney, Australia
  • 17Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
  • 18Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
  • 19Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain
  • 20Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
  • 21Department of Neurosciences, University of Padova, Padova, Italy and Padova Neuroscience Center, University of Padua, Padua, Italy
  • 22Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada
  • 23Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
JAMA Dermatol. Published online June 5, 2019. doi:10.1001/jamadermatol.2019.0759
Key Points

Question  What are the prevalence rates of and odds for depression and anxiety in adults with hidradenitis suppurativa?

Findings  This systematic review and meta-analysis of 10 studies comprising 40 307 participants with hidradenitis suppurativa found a prevalence of depression of 16.9% and a prevalence of anxiety of 4.9%. The odds ratio for depression among people with hidradenitis suppurativa was 1.84.

Meaning  Depression and anxiety are common comorbidities in people with hidradenitis suppurativa; efforts toward recognition, prevention, and management of those psychiatric comorbidities are warranted.

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.

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