Depressive symptoms, suicidal ideation and acne: a study of male Finnish conscripts

Suicide and Suicidality in Children and Adolescents with Chronic Skin Disorders: A Systematic Review

Suicide in young children is rare; the incidence increases towards the end of adolescence. Skin disorders confer a high prevalence of psychiatric and psycho-logical comorbidities. However, published research on suicidal behaviour in adolescents and children with skin disorders is sparse. The aim of this study was to identify the prevalence of suicidal behaviour in children and adolescents under 18 years of age with chronic skin disorders and associated contributing risk factors. MEDLINE, PsycINFO, EMBASE, CINAHL and Cochrane databases were searched from inception to October 2020 for suicide or suicide attempts in patients under 18 years old with chronic skin disorders. The study protocol was logged on PROSPERO (CRD42020083528). Returned texts were reviewed independently by 2 authors. Bias was assessed according to Joanna Briggs Institute criteria. Five studies met the inclusion criteria; 4 cross-sectional surveys and 1 retrospective matched-cohort study. A total of 31,641 patients with acne, atopic dermatitis, body dysmorphic disorder or psoriasis were identified. Prevalence of suicidal ideation was 0.45% (psoriasis) to 67% (body dysmorphic disorder). The prevalence of suicidal attempts ranged from 0.08% (psoriasis) to 21.9% (acne). Patients with acne or atopic dermatitis had significantly increased odds ratio for suicidal attempts. Meta-analysis could not be performed owing to the heterogeneity and sparsity of data. Suicidal risk in skin disorders amongst adolescents and children under the age of 18 years old is broad and complex. The suicidal risk remained after adjusting for depression, suggestive of an alternative mechanism.

Psychodermatologic pathology in adolescents: findings from the Colombian National Mental Health Survey

Background Associations between mental health and dermatology have generated a new branch of study called psychodermatology, which includes relevant conditions to the adolescent population. However, there is limited research focusing on this field and this specific population. Objective To estimate the prevalence of dermatological pathologies in the Colombian adolescent population and their possible associations with mental health conditions. Methods We performed a secondary analysis of the Colombian National Mental Health Survey results. A representative sample of the adolescent Colombian population answered questions regarding dermatological conditions and mental health disorders. We estimated the prevalence and evaluated associations using the chi squared independence test. Results Of 1753 adolescents, 8.3% (CI95%=[6.8-10.1]) had dermatitis or skin allergies and 4.5% (CI95%=[3.3-6.1]) acne. For dermatitis, we found associations with age, education, and family dysfunction (p-Values=0.024; <0.001; 0.046 respectively). Acne was associated with age, sex, educational level, the number of social groups involved in, alcohol consumption, psychoactive substances use and previous violent experiences (respective p-Values=0.007; 0.004; 0.005; 0.036; 0.002; 0.003; 0.044). Regarding mental health, dermatological conditions were associated with depression, affective disorders, suicide attempt and suicide ideation. Conclusion Our results are the first to describe the prevalence of these disorders in Colombia. This is an exploratory study; nonetheless, it is of great value since it is the first to describe these associations in adolescents in a middle-income country, which should be considered during clinical examinations. Further longitudinal studies evaluating possible causal relationship between psychiatric and dermatological conditions are fundamental to establish causal links.

Acne vulgaris and risk of depression and anxiety: A meta-analytic review

BACKGROUND

Several studies have shown an association of acne vulgaris with depression and anxiety, but a quantitative review has not yet been conducted.

OBJECTIVE

We sought to conduct a systematic review and meta-analysis that elucidates the association of acne vulgaris with depression and anxiety.

METHODS

A systematic review and meta-analysis of literature published before October 1, 2019 from the PubMed, PsycINFO, MEDLINE, and Cochrane databases was conducted. We used a metaanalytic approach to perform a random effects analysis comparing individuals with and without acne. Subgroup analyses between studies included age, study setting, and geographic region.

RESULTS

Forty-two studies were included. We found a significant association of acne vulgaris with depression (r = 0.22 [95% confidence interval 0.17-0.26, P < .00001]) and anxiety (r = 0.25 [95% confidence interval 0.19-0.31, P < .00001]). Subgroup analyses and comparisons showed moderating influences based on factors including age, study setting, and geographic region.

LIMITATIONS

Inconsistency between publications regarding acne and outcome ascertainment, data reporting, and studies with no control group posed considerable barriers to synthesizing all available published literature.

CONCLUSIONS

Because of an increased risk for depression and anxiety, clinicians should pursue aggressive treatment of acne and consider psychiatric screening or referrals.

Isotretinoin was not associated with depression or anxiety: A twelve-week study

AIM: To investigate the frequency and severity of depression and/or anxiety in isotretinoin (ITT)-treated subjects and in a non-ITT control group.

METHODS: Sixty consecutively-admitted non-psychiatric outpatients with acne were assigned to either ITT at a fixed dose of 30 mg/d (n = 36) or “other treatment” group (OT; n = 24). The Zung depression or anxiety scales (with cut-off points), two locally developed scales for depression (GeDepr) and anxiety (Ansilet) (without cut-off points) and clinical global impression scales of acne severity were administered at baseline and at weeks 6 and 12 of treatment. Data was analyzed with the chi-squared test and covariance analysis.

RESULTS: Gender distribution, age, marital status and education level did not differ between both treatment groups. The frequency of depression, as defined by the Zung scale cut-off points was similar in the ITT and in the non-ITT groups: Weeks 6 and 12: 8.3% in both groups, P = 0.9. The frequency of anxiety was similar in the groups as well: Week 6: ITT = 8.3%; OT = 0.0%, P > 0.05; week 12: ITT = 11.1%, OT = 4.2%, P > 0.05. The scores in both scales’ sets did not differ between the treatment groups at any evaluation time point (P > 0.05). Five ITT-treated subjects (13.8%) and two from the OT-treated group (8.3%) developed clinically significant anxiety and/or depression during treatment (P > 0.05).

CONCLUSION: Our study confirms the safety of ITT regarding psychological side effects in regular dermatological patients. Susceptible subjects may exist but their identification requires additional strategies.

Cross-sectional survey of awareness and behavioral pattern regarding acne and acne scar based on smartphone application

BACKGROUND

Although acne scar is a permanent sequela that may be induced by improper management of active acne lesion, patient behavior patterns and awareness regarding acne are unclear. The aim of this study was to identify awareness and behavioral patterns concerning acne and acne scar of people having acne and differences between those with and without acne scars.

METHODS

The survey was performed via smartphone application for 900 participants in their second to fourth decade having current or previous acne lesions. They were further categorized into two groups based on the presence of acne scar (scar and scarless groups) with no statistical difference in demographic composition.

RESULTS

The mean age of all participants was 24.6 ± 5.3. The scar group had a longer disease duration (4.9 years) than those of the scarless group (2.2 years). Participants in the scar group thought that acne scarring affected psychosocial aspects more negatively compared with those in the scarless group. Participants in the scarless group visited dermatology clinics earlier than those in the scar group. In the scar group, 62.1% of participants have never had their acne scars treated medically. Most (88.6%) participants from both groups believed that non-dermatologic treatment caused side effects or aggravated their acne.

CONCLUSIONS

Participants with acne scars tended to treat their acne and acne scars improperly, which could negatively affect their daily lives. Acne scars are sequelae of acne and should be regarded as a distinct disease entity, requiring a patient's early visit to dermatologic clinics.

Female gender and acne disease are jointly and independently associated with the risk of major depression and suicide: a national population-based study

Acne is a common disease in adolescence with female preponderance. It could cause poor self-esteem and social phobia. Previous studies based on questionnaires from several thousands of adolescents showed that acne is associated with major depression and suicide. However, the gender- and age-specific risk of depression and suicide in patients with acne remain largely unknown. Using a database from the National Health Insurance, which included 98% of the population of Taiwan in 2006, we identified patients of acne, major depression, and suicide based on ICD-9-CM codes. Totally 47111 patients with acne were identified (16568 males and 30543 females) from 1 million subjects. The youths of 7–12 years had the highest prevalence of acne (14.39%). Major depression was more common in those with acne (0.77%) than controls (0.56% , P < 0.0001) regardless of gender. Multiple logistic regression showed an increased risk of major depression in women without acne (OR = 1.85, 95% CI 1.75–1.96). The risk is additive in women with acne (OR = 2.78, 95% CI 2.43–3.17). Similar additive risk of suicide was noticed in women with acne. In conclusion, acne and gender, independently and jointly, are associated with major depression and suicide. Special medical support should be warranted in females with acne for the risk of major depression and suicide.

Suicide risk in skin disorders

Suicide accounts for about 1,000,000 deaths worldwide every year and is among the leading causes of death in young adults. Reports of high prevalence of suicidal ideation and increased suicide risk in several skin diseases raised concerns about deliberate self-harm in dermatological patients. The literature consistently points to an increased suicide risk in patients with psoriasis, atopic dermatitis, and acne, with higher risk in patients in whom the skin condition is associated with clinically significant emotional distress, changes in body image, difficulties in close relationships, and impaired daily activities. Other risk factors for suicide include a history of suicide attempts, severe mental or physical disorders, alcoholism, unemployment, bereavement or divorce, and access to firearms or other lethal means. Dermatologists may play an important role in recognizing suicidal ideation and preventing fatal self-harm in their patients. Increasing dermatologists' awareness of the issue of suicide and developing mental health consultation-liaison services within dermatology settings would be instrumental in contributing to suicide prevention in this population.

Psychological impairments in the patients with acne

BACKGROUND

The psychological impacts of acne appearance and its-related negative emotional reactions have been proved; however, these reactions are varied in different populations.

AIM

We investigated whether acne and its severity affected psychological functioning in those who suffered from this disorder among Iranians.

MATERIALS AND METHODS

One hundred and six patients with acne vulgaris who consecutively attended the dermatology outpatient clinics in Semnan city in 2008 were included. Among them, 103 patients met the study's inclusion criterion and agreed to participate. One hundred and six age and gender cross-matched healthy volunteers were included as controls that attended the clinic with their diseased relatives. All acne patients were evaluated using the Symptom Check List-90 (SCL-90).

RESULTS

According to the American Academy of Dermatology classification, 25.2% of the patients had mild acne, 50.5% moderate acne, and 24.3% severe acne. A higher percentage of participants than controls required further evaluation and psychological consultant when studying each psychological problem. The most common psychological symptoms requiring treatment due to disturbed daily activities in acne group were psychoticism (34.0%) and depression (31.1%), respectively. Significant positive correlations were observed between the duration of illness and SCL-90 total score. When evaluating the SCL-90 scores, patients with multiple sites of involvement were affected more severely than those with a single site of involvement.

CONCLUSION

Acne vulgaris has significant effects on psychological status. Effective concomitant anti-acne therapy and psychological assessment make significant contributions for the mental health and should be strongly recommended.

Cumulative life damage in dermatology

Cumulative life damage is an old concept of considerable face validity, which has attracted more scientific interest in the fields of sociology and psychology than in medicine over the years. The research examines the interconnectivity of the many factors which shape the development of individuals or institutions over time. By focussing on time, context and process, life course research highlights the different effects seemingly similar events may have at different points in time and in different contexts.

Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study

We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning to acne severity among adolescents aged 18-19 years. A total of 4,744 youth were invited and 3,775 (80%) participated. In all, 14% reported having substantial acne (a lot and very much). Among those with very much acne, as compared those with no/little acne, suicidal ideation was twice as frequently reported among girls (25.5 vs. 11.9%) and three times more frequently reported among boys (22.6 vs. 6.3%). Suicidal ideation remained significantly associated with substantial acne (odds ratio 1.80, 95% confidence interval 1.30-2.50) in a multivariate model including adjustments of symptoms of depression, ethnicity, and family income. Mental health problems, as assessed by the Strengths and Difficulties Questionnaire (2.25, 1.69-3.00), low attachment to friends (1.52, 1.21-1.91), not thriving at school (1.41, 1.12-1.78), never having had a romantic relationship (1.35, 1.05-1.70), and never having had sexual intercourse (1.51, 1.21-1.89) were all associated with substantial acne in a multivariate model. Acne is frequently found in late adolescence and is associated with social and psychological problems. Adverse events including suicidal ideation and depression that have been associated with therapies for acne may reflect the burden of substantial acne rather than the effects of medication.

Is the association between acne and mental distress influenced by diet? Results from a cross-sectional population study among 3775 late adolescents in Oslo, Norway

BACKGROUND

Several studies with conflicting findings have investigated the association between acne and mental health problems. Acne usually starts in adolescents, as does an increase in the prevalence of depression and anxiety. Recently, there has been more focus on the link between diet and acne and diet and mental health problems. The objective of this study is to investigate the association between acne and mental distress and to explore a possible influence of dietary factors on the relation.

METHODS

A population-based cross-sectional study in Oslo of 18 or 19 year old adolescents. The participation rate was 80%. Acne was self-reported. To measure mental distress, the Hopkins Symptom Checklist 10 was used. Diet and lifestyle variables were also collected by questionnaire and socio-demographic variables were obtained from Statistics Norway.

RESULTS

The prevalence of acne was 14.4% among the males and 12.8% among the females. The mean score of mental distress increased when the severity of acne increased. In the crude analyses, the significant associations with acne among the males were: mental distress OR = 1.63, frequent consumption of chocolate/sweets OR = 1.40, frequent consumption of potato chips OR = 1.54. The significant crude associations with acne among the females were: mental distress OR = 2.16, infrequent consumption of raw vegetables OR = 1.41, non-Western background OR = 1.77 and low family income OR = 2.14. No crude associations with acne were identified in either gender for the consumption of sugary soft drinks, fatty fish, cigarette smoking or alcohol. In adjusted models which included diet and socio-demographic variables, the association between acne and mental distress was unchanged for both males (OR = 1.68) and females (OR = 2.04), and between acne and infrequent consumption of raw vegetables among the females (OR = 1.38).

CONCLUSION

Among late adolescents in Oslo, self-reported acne is significantly associated with mental distress and, among girls, with infrequent consumption of raw vegetables. Our finding does not support the hypothesis that dietary factors alter the relationship between acne and mental distress.

Current concepts in psychodermatology

Dermatology is a discipline in which psychosomatic issues serve a key purpose in helping us understand the etiology and progression of skin diseases and determining appropriate treatment protocols. Emotional factors appear to significantly influence most skin diseases, and the correlation between stressful life events and disease flares is well recognized in dermatology. In this article, recent research is highlighted for major cutaneous disease states, as well as psychiatric disorders with symptoms that present as skin disorders. The role of the expanding field of psychoneuroimmunology as it pertains to dermatologic disorders is discussed. The author also presents recommendations for optimal evaluation and management of psychosocial concerns in the dermatology patient population.