Health-Related Quality of Life, Depression, and Self-esteem in Patients With Androgenetic Alopecia: A Systematic Review and Meta-analysis

Abstract

Importance: Androgenetic alopecia (AGA) is associated with trichodynia, anxiety, low self-esteem, and depression, which have implications for quality of life. However, no systematic evaluation has been performed on the association of AGA with health-related quality of life (HRQOL).

Objective: To systematically examine the association of AGA with HRQOL and psychiatric disorders.

Data sources: Cochrane Library, PubMed, Embase, and WanFang databases were searched from inception through January 24, 2021.

Study selection: Case series, case-control studies, cross-sectional studies, cohort studies, and randomized clinical trials that examined either HRQOL or psychiatric disorders in patients with AGA were included. Studies published in languages other than English and Mandarin were excluded.

Data extraction and synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used. The risk of bias in included studies was assessed with the Risk of Bias in Non-randomized Studies of Intervention (ROBINS-I) tool. A random-effects model meta-analysis was performed to calculate the pooled effect on HRQOL. A subgroup analysis according to sex and geographic regions was also conducted.

Main outcomes and measures: The outcome was HRQOL of patients with AGA.

Results: A total of 41 studies involving 7995 patients was included. The pooled Dermatology Life Quality Index score was 8.16 (95% CI, 5.62-10.71). The pooled Hair-Specific Skindex-29 score indicated moderate impairment of emotions, with the meta-analysis showing a score of 29.22 (95% CI, 24.17-34.28) in the emotion dimension. The pooled Center for Epidemiologic Studies Depression Scale score did not indicate depression, with the meta-analysis showing a score of 14.98 (95% CI, 14.28-15.68). Factors that had a direct association with HRQOL included married or coupled status and receipt of medical treatments, whereas factors that had an inverse association with HRQOL included higher self-rated hair loss severity, lower visual analog scale score, and higher educational level.

Conclusions and relevance: This systematic review and meta-analysis found a significant association of AGA with moderate impairment of HRQOL and emotions, but no association was found with depressive symptoms. The findings suggest that patients with AGA may need psychological and psychosocial support.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. PRISMA Study Flowchart

Figure 2.. Risk of Bias of Included Studies

Dots with + indicate low risk of bias; ?, unclear risk of bias; and −, high risk of bias.

Figure 3.. Forest Plots of Dermatology Life Quality Index (DLQI) of Patients With Androgenetic Alopecia

The meta-analysis illustrated a significant impairment of quality of life in patients with androgenetic alopecia (pooled DLQI, 8.16; 95% CI, 5.62-10.71). MD indicates mean difference.

Figure 4.. Forest Plots of Hair-Specific Skindex-29 Scores of Patients With Androgenetic Alopecia

The meta-analysis illustrated moderate impairment in emotion dimension (pooled score, 29.22; 95% CI, 24.17-34.28) and mild impairment in both symptom (pooled score, 21.95; 95% CI, 18.42-25.47) and function (pooled score, 18.52; 95% CI, 14.23-22.80) dimensions. MD indicates mean difference.

Figure 5.. Forest Plots of Center for Epidemiologic Studies Depression Scale (CES-D) Score of Patients With Androgenetic Alopecia

The meta-analysis illustrated no depression in patients with androgenetic alopecia (pooled CES-D score, 14.98; 95% CI, 14.28-15.68). MD indicates mean difference.