Atopic dermatitis and skin disease
Mental health comorbidity in patients with atopic dermatitis

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Background

Recent data, primarily from Europe, suggest that children with atopic dermatitis (AD) might be at increased risk of mental health disorders.

Objective

We aimed to quantify the mental health burden associated with pediatric AD in the United States.

Methods

A cross-sectional study design was used analyzing data from the 2007 National Survey of Children's Health, a survey reporting on the health status of 92,642 noninstitutionalized children aged 0 to 17 years. The lifetime prevalence of various provider-diagnosed mental health conditions was calculated for those with and without a history of AD.

Results

The odds of having attention deficit hyperactivity disorder was significantly increased in children with AD compared with the odds in control subjects without AD (odds ratio, 1.87; 95% CI, 1.54-2.27), even after controlling for known confounders. The adjusted odds ratios for depression, anxiety, conduct disorder, and autism were 1.81 (95% CI, 1.33-2.46), 1.77 (95% CI, 1.36-2.29), 1.87 (95% CI, 1.46-2.39), and 3.04 (95% CI, 2.13-4.34), respectively, and these estimates were all statistically significant. A clear dose-dependent relationship was observed between the prevalence of a mental health disorder and the reported severity of the skin disease.

Conclusions

Our data reveal a striking association between mental health disorders and AD in the US pediatric population. The severity of the skin disease alters the strength of the association. Prospective cohort studies are needed to verify these associations and to explore underlying mechanisms. Strategies to prevent AD or to aggressively treat early skin inflammation might modify the risk of mental health disorders in at-risk children.

Section snippets

Data source

We used data from the 2007 National Survey of Children's Health of 91,642 households, which was designed to estimate the prevalence of various child health issues, including physical, emotional, and behavioral factors. The 2007 National Survey of Children's Health was sponsored by the Maternal and Child Health Bureau and the US Department of Health and Human Services. The National Center for Health Statistics conducted a total of 91,642 interviews by using the State and Local Area Integrated

Results

Overall, 91,642 children were represented in the survey. Of these, 79,667 had seen a provider in the previous year and were included in the analyses. Characteristics of the overall population and the AD population are shown in Table I. The prevalence of the classic atopic comorbidities asthma, hay fever, and food allergy were all increased in the AD population compared with the non-AD population, as would be expected. The overall 12-month period prevalence of AD for 2007 was 12.98% (12.43% to

Discussion

Our study examining data from the 2007 National Survey of Children's Health found strong associations between AD and several mental health disorders in the US pediatric population. These data represent the first comprehensive evaluation of the mental health burden associated with pediatric AD in the United States. We found that children with AD have an increased prevalence of ADHD, depression, anxiety, conduct disorder, and autism compared with their unaffected peers. The probability of having

References (37)

  • C.L. Carroll et al.

    The burden of atopic dermatitis: impact on the patient, family, and society

    Pediatr Dermatol

    (2005)
  • M.A. Ben-Gashir et al.

    Quality of life and disease severity are correlated in children with atopic dermatitis

    Br J Dermatol

    (2004)
  • P.E. Beattie et al.

    A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases

    Br J Dermatol

    (2006)
  • J.C. Su et al.

    Atopic eczema: its impact on the family and financial cost

    Arch Dis Child

    (1997)
  • E.L. Simpson

    Comorbidities in atopic dermatitis

    Curr Dermatol Rep

    (2012)
  • S.L. Chamlin

    The psychosocial burden of childhood atopic dermatitis

    Dermatol Ther

    (2006)
  • C.M. Absolon et al.

    Psychological disturbance in atopic eczema: the extent of the problem in school-aged children

    Br J Dermatol

    (1997)
  • S.L. Chamlin et al.

    Effects of atopic dermatitis on young American children and their families

    Pediatrics

    (2004)
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    Supported by the National Eczema Association, a Mentored Patient-oriented Research Career Development Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health (5K23AR057486), and the OHSU School of Medicine Bacon Award. Support was also obtained from the Oregon Clinical and Translational Research Institute (OCTRI; grant no. 5 KL2 RR024141-04) from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research.

    Disclosure of potential conflict of interest: E. L. Simpson has received grants from the National Eczema Association, the National Institutes of Health, the Oregon Health and Science University School of Medicine Bacon Award, the Oregon Clinical and Translational Research Institute, and the National Center for Research Resources and has consultant arrangements with Alcimed, Amgen, Asubio, Brickell Biotech, Celgen Corporation, Centocor, Clarion Healthcare, Galderma Laboratories, LEK Consulting, Medicis Pharmaceutical, Panmira Pharmaceuticals, Regeneron, and Versant Ventures. The rest of the authors declare that they have no relevant conflicts of interest.

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