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Suicidal Thoughts, Attempts Common With Atopic Dermatitis


Atopic dermatitis appears to put patients at higher risk for having suicidal thoughts and attempting suicide, a systematic review and meta-analysis found.

When compared with individuals who did not have atopic dermatitis, patients with the condition had a 36% greater chance of attempting suicide (pooled odds ratio 1.36, 95% CI 1.09-1.70), and they also had a 44% greater chance of having suicidal thoughts (pooled OR 1.44, 95% CI 1.25-1.65), reported April Armstrong, MD, MPH, of University of Southern California Keck School of Medicine in Los Angeles, and colleagues in JAMA Dermatology.

The skin condition is apparent, so patients with atopic dermatitis suffer from a number of psychosocial challenges. Previous reports have drawn associations between children with atopic dermatitis and poor academic performance versus other children. And adults with atopic dermatitis have fewer career opportunities and don’t do as well at work, the researchers noted.

Other findings have linked atopic dermatitis with depression and anxiety, the investigators highlighted. “However, the evidence for an association between [atopic dermatitis] and suicidality is inconclusive,” Armstrong’s group continued.

When a patient’s screening results point to suicidality, “the dermatology provider should send a referral to the patient’s primary care or mental health provider for follow-up care,” the investigators wrote. And when a patient admits to having a suicide plan, “this patient should be urgently referred to the emergency department for further assessment.”

Clinicians should also refer patients to resources like the suicide prevention hotline and even suicide awareness brochures in nonemergent cases, the study authors noted.

Armstrong and colleagues reviewed 15 studies conducted in Europe, Africa, North America, and Asia published over the past 20 years. Those investigations included more than 4.5 million patients. Among them, 310,681 had atopic dermatitis and 52.7% were female. All studies included were observation and examined suicidality in all forms. Case series or case reports were excluded.

Data from the analysis showed inconsistencies when it came to completed suicides in patients with atopic dermatitis, the investigators noted. For example, one study showed that when compared to control participants, there was a greater risk of completed suicide in patients with atopic dermatitis as the relative risk was 1.4 (95% CI 1.1-1.8). Another study showed no significant risk for complete suicides, with point estimates for hazard ratios less than 1. Overall, the pooled data did not show a clear increase in risk for completed suicides.

Studies also showed varying results for suicidal thoughts and attempts, with some indicated significant risk associated with atopic dermatitis across the board, whereas others only found increased risk for certain subgroups such as female children. But the pooled data did indicate a significant risk for suicidal thoughts and attempts associated with the skin condition.

“Despite these findings, there is a shortage of studies investigating subpopulations, and more studies are needed to better understand these associations,” the study authors wrote.

The data analysis was funded by the Southern California Clinical and Translational Science Institute and the National Center for Advancing Translational Science of the National Institutes of Health.

Armstrong disclosed relationships with AbbVie, Janssen, Lilly, Pfizer, UCB, Dermira, Ortho Dermatologics, Sanofi, Regeneron, Science 37, and Modernizing Medicine.