Mental Health Burden in Atopic Dermatitis: Study Identifies Key Risk Factors for Anxiety and Depression

July 2, 2025

Atopic Dermatitis

Depression and anxiety affect as many as 1 in 4 people with AD, with pruritis, sleep disorders, education level, and comorbidities identified as independent risk factors.

In a retrospective cross-sectional study of 273 individuals with moderate-to-severe atopic dermatitis (AD), Chinese researchers found that nearly 1 in 4 experienced anxiety and 1 in 5 had symptoms of depression, with both conditions significantly linked to worse disease severity and impaired quality of life. Independent risk factors for these psychiatric symptoms included lower education level, frequent medical visits, sleep disorders, allergic comorbidities, and severe pruritus.

The findings, according to the authors, underscore the importance of routine mental health screening and integrated care strategies in the management of AD.

"In the clinical diagnosis and treatment of AD, it is crucial to adhere to a holistic approach that treats both the body and mind. This includes assessing the psychological state of patients and implementing psychological interventions to alleviate symptoms of" compromised mental health, corresponding author Kun Liu, PhD, of the department of dermatology, Shanghai Jinshan Tinglin Hospital, and colleagues wrote.

AD has been consistently linked to increased rates of declining mental health, particularly anxiety, depression, and suicidal ideation.2 Meta-analyses have shown that adults with AD are more than twice as likely to experience depression and anxiety compared with those without the disease, a chronic condition characterized by intense pruritis and recurrent eczematous lesions.2 Despite this emerging data suggesting this strong bidirectional relationship between the dermatologic and psychiatric domains, clinical attention continues to be suboptimal, according to Liu et al.1

The current study, conducted at Shanghai Jinshan Tinglin Hospital from July 2021 to June 2023, sought to identify modifiable risk factors for anxiety and depression among patients with AD and determine how these psychiatric symptoms affect disease prognosis and quality of life.

The researchers used validated instruments, including the Hospital Anxiety and Depression Scale (HADS), Scoring Atopic Dermatitis (SCORAD) index, and Dermatology Life Quality Index (DLQI), to assess psychiatric symptoms, disease severity, and quality of life. Study inclusion required that participants not have received psychological treatment within 6 six months of enrollment, ensuring a more accurate capture of untreated emotional burden.

FINDINGS

According to study results, 24.5% of participants screened positive for anxiety and 19.8% for depression (HADS-A equal to or greater than 8 for both groups).Multivariate logistic regression revealed distinct predictors for each condition.

Anxiety was independently and most strongly associated with increased frequency of outpatient visits (OR = 2.30; 95% CI 1.23–4.25), followed by comorbid allergic rhinitis (OR = 2.05; 95% CI 1.09–3.83), sleep disorders (OR = 2.01; 95% CI 1.03–3.92), and lower education level (OR = 0.34; 95% CI 0.18–0.62).

Depression was most strongly associated with severe pruritus, with the intense itch nearly 7 times more likely to associated with depression (OR = 6.83; 95% CI 1.33–35.13). Other independent risk factors while other risk factors were overlapping, including higher visit frequency (OR = 2.97; 95% CI 1.43–6.20), sleep disturbance (OR = 2.24; 95% CI 1.03–5.02), and comorbid asthma (OR = 2.20; 95% CI 1.00–4.85).

Quality of Life Impact. QoL measurements showed strong correlations between mental health symptoms and disease impact. Participants with anxiety or depression scored significantly higher on the SCORAD index (46.78 and 53.81, respectively) compared to those without such symptoms (39.44 and 38.14; P <.05). Their DLQI scores also reflected poorer QoL, averaging 9.58 and 11.46 for anxiety and depression groups, respectively, vs 7.81 and 7.45 in those without symptoms (P < .05). Correlation analysis confirmed strong associations between DLQI scores and HADS scores, disease severity, number of visits, sleep disturbance, and pruritus (P <.01), highlighting a compounded burden of disease.

Mechanisms Behind Risk Factors. The authors suggest several mechanisms for these relationships. Lower educational attainment may reduce health literacy and coping capacity, increasing disease-related uncertainty and emotional vulnerability, they noted. Frequent medical visits—often necessitated by poorly controlled symptoms—can be a source of emotional strain, frustration, and financial stress. Disordered sleep, commonly reported by people with AD due to nighttime itching, may further dysregulate mood through neurotransmitter disruption and hyperactivation of the hypothalamic-pituitary-adrenal axis. Pruritus, a central and persistent symptom in AD, remains a major physical and emotional stressor, capable of exacerbating both depressive symptoms and disease flares, the authors stressed.

Among the limitations of their study, Liu and colleagues note the cross-sectional design and the use of self-reported psychiatric screening rather than formal diagnostic interviews. The small sample size and single-center setting may also limit generalizability. Nonetheless, they said, the findings offer strong evidence that psychiatric symptoms are both common and clinically relevant in AD.

Holistic, Integrated Care. The authors conclude that anxiety and depression should be considered key components in the assessment and management of patients with AD.

"...Clinical interventions should adopt a multitarget approach: Using antidepressants...to modulate the serotonin system for improved emotional regulation; employing biologics to block interleukin-4/interleukin-13 pathways and reduce pruritus-driven neural activation; and integrating sleep-focused cognitive training to restore healthy circadian rhythms.

"This comprehensive strategy aims to disrupt the self-perpetuating cycle of 'pruritus-neuroendocrine dysregulation-psychological comorbidities.'"

Future studies should investigate longitudinal patterns and evaluate multidisciplinary care models aimed at breaking this cycle of dermatologic and psychological distress, they concluded.

References

1. Liu K, Gao W, Lu H-G, et al. Risk factors for anxiety and depression in patients with atopic dermatitis and their impact on prognosis. World J Psychiatry. 2025;15(6). doi:10.5498/wjp.v15.i6.104738
2. Rønnstad ATM, Halling-Overgaard AS, Hamann CR, et al. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: A systematic review and meta-analysis. J Am Acad Dermatol. 2018;79(3):448-456.e30. doi:10.1016/j.jaad.2018.03.017