Anxiety/depression AD

Atopic dermatitis (AD) puts an important burden on patients. They suffer from itch, often have trouble sleeping and the appearance of lesions on exposed areas of the skin can have a profound psychological effect. As such, it is no surprise to see that the literature indicates a higher incidence of anxiety and depression among AD patients. During EADV 2024, Dr Elise Vandersichel, dermatologist at the University Hospital Brussels with a special interest for psychodermatology presented two posters focusing on the factors that influence the development of anxiety or depression.^1,2

In a first step, a systematic literature search was performed to identify these influencing factors. In total, more than 7000 papers were found of which 75 were withheld for the analysis. Not surprisingly, the severity of AD, the level of itch and the level of sleep disturbance proved to have an important negative effect on anxiety. In addition, also the psychological and emotional health of the patient and the need for medical interventions had a negative effect. While this exercise predominantly found factors with a negative influence, some factors also proved to have a protective effect. For example, being able to work was shown to have a positive effect on the development of anxiety and depression.¹

To shed some more light on these protective factors several in-depth patient interviews were performed. In a next step, the factors influencing anxiety and depression that came forward in these interviews were grouped into 6 themes: treatment (e.g., corticosteroid use, skin care, etc.), feelings (e.g., guilt, shame, injustice, etc.), limitations (e.g., work absence, financial impact, stress, etc.), the role of the physician (e.g., ease of access, feeling of being helped, trust, etc.), protective factors (e.g., work, humor, friends and family, etc.) and other (e.g., patient organization, stop smoking, etc.). While many of the factors that were identified in these interviews are similar to what was found in the literature, the interviews provide some important nuance. For example, the interviews confirmed the protective effect of work, but also showed that going to work with visible symptoms may also have a negative impact.²

In a next step, a quality check of the literature review will be performed and the themes deducted from the interviews will be further refined. Finally, the information of the interviews and the literature search will be bundled in a questionnaire that can be distributed more broadly among AD patients. This will allow a more detailed evaluation of potentially protective factors for anxiety and depression which in turn could inform the development of suitable interventions.