Anxiety, Depression Increasingly Found in UK Patients With Eczema, Psoriasis

Consistent evidence found eczema and psoriasis to be associated with anxiety and depression, according to a study published in Clinical Epidemiology.

The researchers noted that previous evidence suggests that those with existing eczema and psoriasis have a higher prevalence of newly reported depression or anxiety. To increase their confidence in these findings, they aimed to estimate the associations between eczema and psoriasis with anxiety and depression across multiple disease ascertainment settings.

To conduct this study, the authors utilized data from the UK Biobank, a 2016 follow-up mental health questionnaire, and primary care electronic health records. The UK Biobank is a large longitudinal cohort study that includes approximately half a million participants aged 40 to 69 years at recruitment, and it is used regularly for observational research of mental illnesses and skin diseases.

Recently, the UK Biobank linked the primary care data of 230,047 participants, which the researchers used as their study population. Of this population, 55% were female, and 89% reported their ethnicity as British. Eczema and psoriasis exposure were defined using self-reported UK Biobank recruitment interview responses and primary care records.

Additionally, the researchers defined anxiety and depression in 3 different ways, one being through self-reported previous diagnosis at the UK Biobank recruitment interview. They also used Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Assessment (GAD-7) scores indicating depression or anxiety, respectively, from the 2016 UK Biobank mental health follow-up survey. Lastly, they used diagnoses found in linked primary care electronic health record data.

The study showed an increased prevalence of mental illness in those with psoriasis and eczema across multiple data sources. On the other hand, there was poor agreement in disease ascertainment between settings.

They noted poor agreement as they identified more participants with previous eczema, psoriasis, depression, and anxiety diagnoses in their primary care records than in their recruitment interviews. They explained that “11,010 had an eczema record in their electronic health records compared to 5605 reporting previous eczema on recruitment interview; 7187 vs 2557 for psoriasis; 40,455 vs 13,326 for depression; 49,268 vs 3242 for anxiety.”

Also, a small number of patients met the disease definition in both data sources. Seven percent met both for anxiety, 8% for eczema, 22% for depression, and 25% for psoriasis; this demonstrated poor agreement in disease ascertainment settings.

Woman feeling depressed | Image credit: Kittiphan - stock.adobe.com

Of the study population, 70,878 participants responded to the 2016 mental health follow-up survey. The researchers found 4113 (5.8%) had a PHQ-9 score indicating current depression, and 3177 (4.4%) had a GAD-7 score for current anxiety. In comparison, 10,999 patients (15.5%) had a primary care record indicating depression, and 7008 (9.9%) had a record indicating anxiety.

Through this data, the researchers associated having eczema or psoriasis with higher odds of anxiety and depression diagnoses. They found that the adjusted odds ratios (aORs) for these associations were larger when defining anxiety or depression with primary care records compared with UK Biobank interview/survey data; this was true both for recruitment and the mental health survey.

For example, the researchers explained that, “the aOR for depression comparing those with eczema to those without was greater than 1 when defining the outcome from (1) the recruitment interview (OR, 1.36; 95% CI, 1.27-1.45); (2) the follow-up survey (OR, 1.24; 95% CI, 1.09-1.39), and (3) primary care records (OR, 1.56; 95% CI, 1.50-1.62).”

The researchers acknowledged several limitations to their study, one being that the UK Biobank population is subject to selection pressures. They noted that its population consists of predominately White individuals between 40 and 69 years old, limiting the generalizability of their findings.

Because of these limitations, the researchers encouraged future research in multiple areas. They explained that the associations were slightly lower when using interview/survey responses to define anxiety or depression instead of primary care records. To target interventions effectively, the researchers noted that “future research into who does and does not consult their GP [general practitioner] with these symptoms is necessary.”

Reference

Matthewman J, Mansfield KE, Hayes JF, et al. Anxiety and depression in people with eczema or psoriasis: a comparison of associations in UK Biobank and linked primary care data. Clin Epidemiol. 2023;15:891-899. doi:10.2147/CLEP.S417176