Reverberating Toll

Donna Shryer
Posted by Donna Shryer

Those with HS and those treating HS need to recognize psychiatric comorbidities associated with the disease, declares numerous studies

An estimated one-third of people diagnosed with a life-changing chronic illness or disease will experience at least some symptoms of depression.1 Here’s another statistic: People with chronic physical illnesses are twice as likely to suffer from anxiety or depression as their physically healthy counterparts.2

Research specific to the prevalence of depression and anxiety in patients with hidradenitis suppurativa (HS) mirrors these figures—confirming that the pain, inflammation, and emotional stress of having HS comes with high burden of depression and anxiety.

Mental health is a top concern for board certified dermatologist Heather Richmond, MD, as she explained in an on demand educational video presented by MyHealthTeams.3 “From my standpoint, I try to control the physical skin condition and alleviate as much of the cause of distress,” Dr. Richmond said. “But many of my patients with HS are emotionally struggling—and it’s partially because of the way HS looks and how they feel self-conscious and embarrassed. I’ll ask, ‘Have you talked to somebody?’ I think people really should not hesitate to speak with a mental health professional.” Dr. Richmond added, “I feel like this is a disease that really takes a toll on a patient’s life.”

Here are three clinical studies and meta-analyses that define just how severe the “toll” is for a person diagnosed with hidradenitis suppurativa.

1. To clear up divergent study results concerning the prevalence of depression and anxiety in patients with HS, a meta-analysis examined 28 studies of depression in HS and 12 studies of anxiety in HS. The researchers concluded that patients with HS have a “high burden of depression and anxiety.” In addition, the study said, “Clinicians need to be vigilant for the presence of depression or anxiety and to refer patients when appropriate.”

The study, published in the JAAD (Journal of the American Academy of Dermatology), showed a prevalence of 21% (95% CI [17-25]) of depression and 12% (95% CI [6-17]) of anxiety in patients with HS, with “very wide variations” in both cases.4

2. In another meta-analysis, which also sought to resolve conflicting reports concerning a link between HS and depression or anxiety, the deduction pointed to a strong association. The researchers concluded, “Patients with HS have higher odds of depression, anxiety, and suicidality.”5

Of the 27 studies with sufficient data for meta-analysis, it was determined that the prevalence of depression was 26.5% higher in those with HS vs 6.6% in those without the disease. As for anxiety, the condition was 18.1% higher in those with HS vs 7.1% in persons with HS. Patients with HS had higher odds of depression in 12 of 13 studies and higher odds of anxiety in 6 of 6 studies.

3. A systematic review and meta-analysis performed according to PRISMA guidelines, and published in the ATM (Annals of Translational Medicine) reported that for dermatologists treating patients with HS, screening for psychiatric comorbidities, offering psychiatric referral as needed, and adequately managing pain will improve the overall wellbeing of patients. 6

Based on the HS cases studied, the meta-analysis reported that those with HS had significantly higher odds of having schizophrenia compared to the control group (OR 1.66, 95% CI: 1.53–1.79, P<0.00001). There was also a significant association with bipolar disorders (OR 1.96,95% CI: 1.65–2.33, P<0.00001), depression (OR 1.75, 95% CI: 1.44–2.13, P<0.00001), anxiety (OR 1.71, 95% CI: 1.51–1.92, P<0.00001), personality disorders (OR 1.50, 95% CI: 1.18–1.92, P=0.001), suicide (OR 2.08, 95% CI: 1.27–3.42, P=0.004), substance-related disorders (OR 2.84, 95% CI: 2.33–3.46, P<0.00001), and alcohol abuse (OR 1.94, 95% CI: 1.43–2.64, P<0.0001).

Until a study out there can say otherwise, the evidence strongly indicates that depression and anxiety are common comorbid conditions in patients with HS. While no one would suggest that a dermatologist treat a patient’s mental health, the studies cited above unanimously suggest that health care providers who treat those with HS might be able to enhance care by developing strategies to recognize psychiatric comorbidities in patients with HS and refer as warranted.

 

  1. Cleveland Clinic. Chronic Illness and Depression. Last reviewed by a Cleveland Clinic medical professional on 03/09/2021. Available from https://my.clevelandclinic.org/health/articles/9288-chronic-illness-and-depression. Accessed on July 20, 2021.
  2. Canadian Mental Health Association. The Relationship Between Mental Health, Mental Illness and Chronic Physical Conditions. Available from https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/. Accessed July 20, 2021 
  3. Watch on Demand: Straight Talk on Skin Conditions With Dr. Kim and Dr. Richmond. Available from https://www.myvitiligoteam.com/resources/watch-on-demand-straight-talk-on-skin-conditions-with-dr-kim-and-dr-richmond. Accessed July 20, 2021
  4. Jalenques, Isabelle & Laura Elena, Ciortianu & Pereira, Bruno & D’Incan, Michel & Lauron, Sophie & Rondepierre, Fabien. (2020). The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: Systematic review and meta-analysis. Journal of the American Academy of Dermatology. 83. 10.1016/j.jaad.2020.03.041. Abstract available at https://www.sciencedirect.com/science/article/abs/pii/S0190962220304618. Accessed July 20, 2021
  5. Patel KR, Lee HH, Rastogi S, Vakharia PP, Hua T, Chhiba K, Singam V, Silverberg JI. Association between hidradenitis suppurativa, depression, anxiety, and suicidality: A systematic review and meta-analysis. J Am Acad Dermatol. 2020 Sep;83(3):737-744. doi: 10.1016/j.jaad.2019.11.068. Epub 2019 Dec 18. PMID: 31862404. Abstract available at https://pubmed.ncbi.nlm.nih.gov/31862404/. Accessed July 20, 2021 
  6. Phan K, Huo YR, Smith SD. Hidradenitis suppurativa and psychiatric comorbidities, suicides and substance abuse: systematic review and meta-analysis. Ann Transl Med. 2020 Jul;8(13):821. doi: 10.21037/atm-20-1028. PMID: 32793666; PMCID: PMC7396254. Available at https://atm.amegroups.com/article/view/46509/html. Accessed July 20, 2021