Depression and Anxiety in Adults With Hidradenitis Suppurativa: A Systematic Review and Meta-analysis | Anxiety Disorders | JAMA Dermatology


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.

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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