Medicine
®
OBSERVATIONAL STUDY
Psychological Distress in Young Adult Males with Atopic Dermatitis A Cross-Sectional Study Si-Heon Kim, MD, Jae Hur, MD, Jae-Yeon Jang, PhD, Hae-Sim Park, MD, PhD, Chang Hyung Hong, MD, PhD, Sang Joon Son, MD, PhD, and Ki Jung Chang, MD
Abstract: The relationship between atopic dermatitis (AD) and
INTRODUCTION
psychological distress has been well established for children and adolescents. However, it is unclear whether this relationship exists in young adults. This study aimed to assess the relationship between AD and psychological distress in young male adults in South Korea. A cross-sectional study was conducted using regional conscription data from 2008 to 2012. A dermatologist diagnosed AD based on historical and clinical features, and determined severity using the eczema area and severity index. A psychiatrist used medical records, an interview, and a psychological test to examine psychological distress (depression, anxiety, and somatization). The relationship between psychological distress and AD was assessed by multivariate logistic regression analyses. Among the 120,508 conscripts, 1517 (1.2%) presented with AD. The odds of having each type of psychological distress were significantly greater for individuals with AD compared with those without AD. The adjusted odds ratios for depression, anxiety, and somatization were 1.79 (95% CI 1.40–2.29), 1.38 (95% CI 1.08–1.76), and 1.75 (95% CI 1.40–2.20), respectively. Moderate-to-severe AD was significantly related to depression and somatization to a greater extent compared with mild AD. Depression, anxiety, and somatization are strongly and independently associated with AD in young adult males. Early treatment of skin inflammation might modify the risk of psychiatric problems. Prospective cohort studies are needed to verify causal relationships.
topic dermatitis (AD) is a chronic skin disease characterized by pruritus and eczematous skin lesions, and is often associated with other atopic disorders, such as allergic rhinitis and asthma.1 AD is a widely prevalent disease, as it affects 5% to 15% of children and accounts for 2% to 4% of adults.2,3 It is a global public health concern with increasing prevalence and substantial burden.4 Patients with AD have lower health-related quality of life compared with the general population, and increasing disease severity is related to greater impairment of life quality.5 –7 The resultant psychological distress is one of the common comorbidities linked to AD, and could negatively affect quality of life.8 The association between AD and mental health comorbidities in children and adolescents has been well established.9,10 Recent large population-based studies have demonstrated that AD in children and adolescents is associated with mental health disorders including attention deficit hyperactivity disorder, depression, anxiety, conduct disorder, and autism.11,12 Additionally, there is a dose-dependent relationship between AD severity and mental health problems.11,13 In a prospective cohort study in Germany, children with infant-onset eczema were at increased risk for mental health problems in their childhood.14 Suicidal ideation is also more prevalent in adolescents with AD compared with healthy individuals, and both are significantly associated in a multivariate model.15 In a few studies that use adult samples, it has been reported that patients with AD have higher levels of depression and anxiety than controls.16–18 However, these studies have some inherent limitations such as small sample sizes, lack of controlling for potential confounders, or not considering AD severity. A study using a large general population found, after multivariate analyses, that somatization considerably contributes to the association between depression/anxiety and eczema.19 However, the authors in that study did not separate eczema into atopic and nonatopic, and were unable to show solely the effects of AD. Despite mental health problems in a young person potentially leading to many adverse outcomes, including significant impairments in work, education, and social interaction,20 there are no studies investigating the associations between AD and psychological distress in a large population of young adults. Therefore, the aim of the present study was to perform a comprehensive evaluation using a substantial amount of conscription data to examine psychological distress in young adults with AD.
(Medicine 94(23):e949) Abbreviations: AD = atopic dermatitis, CI = confidence interval, KMPI = Korean Military Multiphasic Personality Inventory, OR = odds ratio.
Editor: Peter Mclaughlin. Received: February 25, 2015; revised: May 5, 2015; accepted: May 10, 2015. From the Department of Preventive Medicine and Public Health (SHK, JYJ); Department of Allergy and Clinical Immunology (HSP); Department of Psychiatry (CHH, SJS, KJC), Ajou University School of Medicine, Suwon; and Cheonan Soo Skin Clinic (JH), Cheonan, South Korea. Correspondence: Ki Jung Chang, Department of Psychiatry, Ajou University School of Medicine, San-5 Wonchon-dong, Youngtong-gu, Suwon, South Korea (e-mail: [email protected]). The authors have no funding or conflicts of interest to disclose. Copyright # 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. ISSN: 0025-7974 DOI: 10.1097/MD.0000000000000949
Medicine
Volume 94, Number 23, June 2015
A
METHODS Data Source In South Korea, it is mandatory for all men around 19 years of age to be examined for military conscription by the Military www.md-journal.com |
1
Medicine
Kim et al
Volume 94, Number 23, June 2015
TABLE 1. Characteristics of the Study Population Variable Age (years, mean SD) Level of education, years
Economic status
Family structure
Strata
Total Population (n ¼ 120,508), n (%)
AD Population (n ¼ 1,517), n (%)
Non-AD Population (n ¼ 118,991), n (%)
6 7–12 13 Very low Low Middle High Very high Nonparent Single parent Dual parent
20.0 1.2 564 (0.5) 36,384 (30.2) 83,560 (69.3) 11,915 (9.9) 29,029 (24.1) 63,868 (53.0) 11,295 (9.4) 4,401 (3.7) 1,125 (0.9) 15,758 (13.1) 103,625 (86.0)
19.8 1.0 11 (0.7) 565 (37.2) 941 (62.0) 168 (11.1) 125 (8.2) 935 (61.6) 163 (10.7) 126 (8.3) 21 (1.4) 184 (12.1) 1,312 (86.5)
20.0 1.2 553 (0.5) 35,819 (30.1) 82,619 (69.4) 11,747 (9.9) 28,904 (24.3) 62,933 (52.9) 11,132 (9.4) 4,275 (3.6) 1,104 (0.9) 15,574 (13.1) 102,313 (86.0)
P Value
®
OBSERVATIONAL STUDY
Psychological Distress in Young Adult Males with Atopic Dermatitis A Cross-Sectional Study Si-Heon Kim, MD, Jae Hur, MD, Jae-Yeon Jang, PhD, Hae-Sim Park, MD, PhD, Chang Hyung Hong, MD, PhD, Sang Joon Son, MD, PhD, and Ki Jung Chang, MD
Abstract: The relationship between atopic dermatitis (AD) and
INTRODUCTION
psychological distress has been well established for children and adolescents. However, it is unclear whether this relationship exists in young adults. This study aimed to assess the relationship between AD and psychological distress in young male adults in South Korea. A cross-sectional study was conducted using regional conscription data from 2008 to 2012. A dermatologist diagnosed AD based on historical and clinical features, and determined severity using the eczema area and severity index. A psychiatrist used medical records, an interview, and a psychological test to examine psychological distress (depression, anxiety, and somatization). The relationship between psychological distress and AD was assessed by multivariate logistic regression analyses. Among the 120,508 conscripts, 1517 (1.2%) presented with AD. The odds of having each type of psychological distress were significantly greater for individuals with AD compared with those without AD. The adjusted odds ratios for depression, anxiety, and somatization were 1.79 (95% CI 1.40–2.29), 1.38 (95% CI 1.08–1.76), and 1.75 (95% CI 1.40–2.20), respectively. Moderate-to-severe AD was significantly related to depression and somatization to a greater extent compared with mild AD. Depression, anxiety, and somatization are strongly and independently associated with AD in young adult males. Early treatment of skin inflammation might modify the risk of psychiatric problems. Prospective cohort studies are needed to verify causal relationships.
topic dermatitis (AD) is a chronic skin disease characterized by pruritus and eczematous skin lesions, and is often associated with other atopic disorders, such as allergic rhinitis and asthma.1 AD is a widely prevalent disease, as it affects 5% to 15% of children and accounts for 2% to 4% of adults.2,3 It is a global public health concern with increasing prevalence and substantial burden.4 Patients with AD have lower health-related quality of life compared with the general population, and increasing disease severity is related to greater impairment of life quality.5 –7 The resultant psychological distress is one of the common comorbidities linked to AD, and could negatively affect quality of life.8 The association between AD and mental health comorbidities in children and adolescents has been well established.9,10 Recent large population-based studies have demonstrated that AD in children and adolescents is associated with mental health disorders including attention deficit hyperactivity disorder, depression, anxiety, conduct disorder, and autism.11,12 Additionally, there is a dose-dependent relationship between AD severity and mental health problems.11,13 In a prospective cohort study in Germany, children with infant-onset eczema were at increased risk for mental health problems in their childhood.14 Suicidal ideation is also more prevalent in adolescents with AD compared with healthy individuals, and both are significantly associated in a multivariate model.15 In a few studies that use adult samples, it has been reported that patients with AD have higher levels of depression and anxiety than controls.16–18 However, these studies have some inherent limitations such as small sample sizes, lack of controlling for potential confounders, or not considering AD severity. A study using a large general population found, after multivariate analyses, that somatization considerably contributes to the association between depression/anxiety and eczema.19 However, the authors in that study did not separate eczema into atopic and nonatopic, and were unable to show solely the effects of AD. Despite mental health problems in a young person potentially leading to many adverse outcomes, including significant impairments in work, education, and social interaction,20 there are no studies investigating the associations between AD and psychological distress in a large population of young adults. Therefore, the aim of the present study was to perform a comprehensive evaluation using a substantial amount of conscription data to examine psychological distress in young adults with AD.
(Medicine 94(23):e949) Abbreviations: AD = atopic dermatitis, CI = confidence interval, KMPI = Korean Military Multiphasic Personality Inventory, OR = odds ratio.
Editor: Peter Mclaughlin. Received: February 25, 2015; revised: May 5, 2015; accepted: May 10, 2015. From the Department of Preventive Medicine and Public Health (SHK, JYJ); Department of Allergy and Clinical Immunology (HSP); Department of Psychiatry (CHH, SJS, KJC), Ajou University School of Medicine, Suwon; and Cheonan Soo Skin Clinic (JH), Cheonan, South Korea. Correspondence: Ki Jung Chang, Department of Psychiatry, Ajou University School of Medicine, San-5 Wonchon-dong, Youngtong-gu, Suwon, South Korea (e-mail: [email protected]). The authors have no funding or conflicts of interest to disclose. Copyright # 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. ISSN: 0025-7974 DOI: 10.1097/MD.0000000000000949
Medicine
Volume 94, Number 23, June 2015
A
METHODS Data Source In South Korea, it is mandatory for all men around 19 years of age to be examined for military conscription by the Military www.md-journal.com |
1
Medicine
Kim et al
Volume 94, Number 23, June 2015
TABLE 1. Characteristics of the Study Population Variable Age (years, mean SD) Level of education, years
Economic status
Family structure
Strata
Total Population (n ¼ 120,508), n (%)
AD Population (n ¼ 1,517), n (%)
Non-AD Population (n ¼ 118,991), n (%)
6 7–12 13 Very low Low Middle High Very high Nonparent Single parent Dual parent
20.0 1.2 564 (0.5) 36,384 (30.2) 83,560 (69.3) 11,915 (9.9) 29,029 (24.1) 63,868 (53.0) 11,295 (9.4) 4,401 (3.7) 1,125 (0.9) 15,758 (13.1) 103,625 (86.0)
19.8 1.0 11 (0.7) 565 (37.2) 941 (62.0) 168 (11.1) 125 (8.2) 935 (61.6) 163 (10.7) 126 (8.3) 21 (1.4) 184 (12.1) 1,312 (86.5)
20.0 1.2 553 (0.5) 35,819 (30.1) 82,619 (69.4) 11,747 (9.9) 28,904 (24.3) 62,933 (52.9) 11,132 (9.4) 4,275 (3.6) 1,104 (0.9) 15,574 (13.1) 102,313 (86.0)
P Value
