The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care

Abby E Macbeth, Susan Holmes, Matthew Harries, Wing Sin Chiu, Christos Tziotzios, Simon de Lusignan, Andrew G Messenger, Andrew R Thompson, Abby E Macbeth, Susan Holmes, Matthew Harries, Wing Sin Chiu, Christos Tziotzios, Simon de Lusignan, Andrew G Messenger, Andrew R Thompson

Abstract

Background: Alopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact.

Objectives: To assess the co-occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment.

Methods: In total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre-existing mental health conditions, rates of mental health-related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521).

Results: Depression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new-onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13-1·69], depressive episodes aHR 1·30 (95% CI 1·04-1·62) and anxiety disorder aHR 1·33 (95% CI 1·09-1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43-1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33-2·49). Higher rates of antidepressant prescribing were also seen in people with AA.

Conclusions: People with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence-based mental health treatment programmes are needed for people with AA.

© 2022 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Figures

Figure 1
Figure 1
Prevalence of common mental health conditions in cases of alopecia areata (AA) and matched controls without AA. Point estimates represent the proportion with each mental health condition in each subgroup. Bars represent 95% confidence intervals. The data underlying the plot are reported in Table S2 (see Supporting Information). Overall P‐values for difference in populations: recurrent depressive disorder P < 0·001, depressive episodes P < 0·001, anxiety disorder P < 0·001. IMD, index of multiple deprivation. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Kaplan–Meier plots for the cumulative incidence of new‐onset common mental health conditions in newly diagnosed cases of alopecia areata (AA) and matched controls. People with a pre‐existing record of each mental health condition (prevalent people) are excluded from the analysis of that condition. Grey shading represents 95% confidence intervals. [Colour figure can be viewed at wileyonlinelibrary.com]

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