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Itch and Mental Health in Dermatological Patients

Journal of Investigative Dermatology

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• This study compared the psychological burden of disease and the health-related quality of life among dermatological patients with itch, dermatological patients without itch, and healthy controls across 13 European countries. The prevalence of clinical depression (14.1% vs 5.7%), anxiety (21.4% vs 12.3%), and suicidal ideation (15.7% vs 9.1%) were all higher in patients with itch than in patients without itch but did not vary with itch chronicity or intensity. Adjusted odds ratios also revealed an association among clinical depression (OR, 1.53), suicidal ideation (OR, 1.27), and economic difficulties (OR, 1.24) and presence of itch.

• These findings highlight the contribution of itch to the psychological burden among patients with dermatological diseases and the need for patients with itch to be managed by a multidisciplinary team.

– Margaret Hammond, MD

Written by

 

 

Gil Yosipovitch MD, FAAD

Written by

 

 

Rachel ShireenGolpanian BA

As itch is a common symptom of many dermatologic disorders and has an impact on quality of life, it would not be surprising that it is an important factor associated with mental conditions like depression, anxiety and stress disorders. The present large cross-sectional study in 3,635 patients and 1,359 controls confirms the strong association of itch and mental health. The authors compared mental health problems between dermatologic patients with itch, dermatologic patients without itch, and healthy controls. In this way, the contribution of itch to the psychological burden of dermatologic conditions was elicited. Results of this study showed that the prevalence of depression, anxiety, suicidal ideation, and stress was higher in dermatologic patients with itch than in dermatologic patients without itch and healthy controls. Health-related quality of life was also more impaired in patients with itchy skin diseases than in dermatologic patients without itch and in health controls. Thus, this article provides us with the knowledge that the association of mental health problems and dermatologic disease is even stronger if the skin disease is itchy.

This study was conducted in Europe, however these results are likely applicable to the American itchy population. Regardless of the cause, the contribution of itch to the psychological burden of patients who suffer from dermatologic conditions highlights the importance of prioritizing the management of itch when approaching these patients. Treatment should include aggressive itch management as early as possible, so as to avoid the additional psychological burden it can contribute to skin diseases.

Abstract 

Itch is a highly prevalent and multi-dimensional symptom. We aimed to analyze the association between itch and mental health in dermatological patients. This multi-center study is observational cross-sectional conducted in dermatological clinics across 13 European countries. A total of 3530 patients and 1094 healthy controls were included. Patients were examined clinically. Outcome measures were itch (presence, chronicity and intensity), the Hospital Anxiety and Depression Scale, EQ5D-VAS, sociodemographics, suicidal ideation, stress (negative life events and economic difficulties). Ethical approval was obtained. Results showed significant association between the presence of itch in patients and clinical depression, suicidal ideation and economic difficulties (odds ratios respectively OR 1.53 (95% CI 1.15 to 2.02), OR 1.27 (95% CI 1.01 to 1.60), OR 1.24 (95% CI 1.10 to 1.50). The mean score of reported generic health status assessed by the EQ5D-VAS was 65.9 (SD=20.1) in patients with itch, compared to 74.7 (SD= 18.0) in patients without itch, p value < .001 and 74.9 (SD= 15.7) in controls with itch compared to 82.9 (SD= 15.6) in controls without itch, p value <.001. Itch contributes substantially to the psychological disease burden in dermatological patients and the management of patients should include access to multidisciplinary care.

Journal of Investigative Dermatology

Itch and Mental Health in Dermatological Patients Across Europe: A Cross Sectional Study in 13 Countries

J Invest Dermatol 2019 Sep 03;[EPub Ahead of Print], FJ Dalgard, Å Svensson, JA Halvorsen, U Gieler, C Schut, L Tomas-Aragones, L Lien, F Poot, GBE Jemec, L Misery, C Szabo, D Linder, F Sampogna, S Spillekom-van Koulil, F Balieva, JC Szepietowski, A Lvov, SE Marron, IK Altunay, AY Finlay, S Salek, J Kupfer 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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