Symptoms and diagnosis of anxiety and depression in atopic dermatitis in US adults

Background The relationship between atopic dermatitis (AD), anxiety and depression in the U.S. adult population is not well established. Objectives To determine the relationship of AD and its severity with symptoms and diagnosis of anxiety and depression in U.S. adults. Methods A cross-sectional, population-based study of 2893 adults was performed. AD was determined using modified U.K. Diagnostic Criteria. Results Adults with AD vs. those without AD had higher mean Hospital Anxiety and Depression Scale anxiety (HADS-A) (7 center dot 7 vs. 5 center dot 6) and depression (HADS-D) (6 center dot 0 vs. 4 center dot 3) scores and higher prevalences of abnormal (>= 11) HADS-A (28 center dot 6% vs. 15 center dot 5%) and HADS-D (13 center dot 5% vs. 9 center dot 0%) scores. In multivariable linear and logistic regression models controlling for sociodemographics, AD was associated with significantly higher mean HADS-A and HADS-D scores (7 center dot 7 and 6 center dot 0) and higher odds of abnormal HADS-A [odds ratio (OR) 2 center dot 19, 95% confidence interval (CI) 1 center dot 65-2 center dot 91] and HADS-D scores (OR 1 center dot 50, 95% CI 1 center dot 04-2 center dot 17) (P <= 0 center dot 03 for all). Mean and abnormal HADS-A and HADS-D scores were increased in moderate and severe/very severe self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD itch and sleep (P < 0 center dot 0001 for all). All respondents with severe PO-SCORAD, POEM and PO-SCORAD itch had borderline or abnormal HADS-A and HADS-D scores. Adults with AD vs. those without AD had higher prevalence of self-reported healthcare-diagnosed anxiety or depression in the past year (40 center dot 0% vs. 17 center dot 5%). Many adults with AD who had borderline and/or abnormal HADS-A or HADS-D scores reported no diagnosis of anxiety or depression. Conclusions AD is associated with significantly increased anxiety and depression, which may go undiagnosed. What's already known about this topic? Previous studies found higher rates of anxiety and depression in clinical cohorts of patients with atopic dermatitis. What does this study add? This study found dramatically higher rates of anxiety and depression among adults with atopic dermatitis in the U.S. population, which was primarily driven by atopic dermatitis severity. Anxiety and depression often go undiagnosed in adults with atopic dermatitis.