Severe atopic dermatitis associated with depression, internalizing behaviors in children

Severe atopic dermatitis is associated with depression and internalizing behaviors in childhood and adolescence, according to a study.

“Atopic dermatitis (also known as eczema or atopic eczema) is the most common inflammatory skin disease; globally, it is estimated that AD affects up to 15% to 20% of pediatric populations and 10% of adult populations,” Chloe Kern, BA, of the department of dermatology at the University of California San Francisco, and colleagues wrote. “Published research has highlighted many important systemic comorbidities, and among them, a growing body of evidence supports an association between AD and anxiety, depression and suicidality.”

Most studies, however, have focused on the impact of these comorbidities on adults, despite AD most commonly presenting in children.

This longitudinal, population-based cohort study included 11,181 children from birth through age 10 using data from the U.K. Avon Longitudinal Study of Parents and Children.

The children reported symptoms of depression using the Short Moods and Feelings Questionnaire from ages 10 to 18, while internalizing behaviors were measured by maternal report of the Strength and Difficulties Questionnaire’s emotional symptoms subscale from ages 4 to 16.

Internalizing symptoms were defined by the presence of somatic symptoms such as headaches or stomachaches, cognitive symptoms such as worrying, unhappiness and fears, and signs of low self-esteem.

Severe AD was associated with depression symptoms (adjusted OR = 2.38; 95% CI, 1.21-4.72), as well as internalizing symptoms (aOR = 1.9; 95% CI, 1.14-3.16).

Mild or moderate AD did not have associations with depression, however there was a 29% to 84% increased risk of internalizing behaviors beginning at age 4.

AD and sleep quality were also found to be associated, while sleep duration and internalizing behavior were not connected.

“These findings are important because childhood depression and internalizing behavior have been linked to adult depression and anxiety, other psychiatric disorders and poor general health,” the authors wrote.

“The large and increasing burden of pediatric mental illness highlights the importance of clinician awareness of the psychosocial needs of children and adolescents with AD.”