Association of atopic dermatitis with depressive symptoms and suicidal behaviors among adolescents in Korea: the 2013 Korean Youth Risk Behavior Survey

BACKGROUND: Atopic dermatitis (AD) is a chronic skin disease which has been known to negatively influence the mental health of patients. However, only a few studies have explored the prevalence of psychiatric problems among AD patients, particularly among adolescents. In this study, we aimed to assess the association of AD with depressive symptoms and suicidal behaviors among adolescents by analyzing data from the 2013 Korean Youth Risk Behavior Survey, a nationwide web-based survey. METHODS: Data from 72,435 adolescent middle and high school students in Korea were analyzed. Students self-reported AD diagnosed by a doctor and yes-or-no answers to questions about depressive symptoms and suicide ideation, suicide planning, and suicide attempts were analyzed. Relationships between AD and depressive symptoms or suicidal behaviors were tested by logistic regression models after controlling for potential confounding factors. RESULTS: The proportion of adolescents who had AD was 6.8%. The proportion of adolescents reporting depressive feelings was 31.0%, suicide ideation was 16.3%, suicide planning was 5.8%, and suicide attempts was 4.2%. Compared to adolescents without AD, adolescents with AD were significantly more likely to experience depressive feelings (odds ratio [OR]: 1.27, 95% confidence interval [Cl]: 1.19-1.36), suicide ideation (OR: 1.34, 95% Cl: 1.24-1.45), suicide planning (OR: 1.46, 95% Cl: 1.32-1.65), and suicide attempts (OR: 1.51, 95% Cl: 1.33-1.72). In the multivariate model, the relationships between AD and suicide ideation (OR: 1.26, 95% Cl:1.16-1.36), suicide planning (OR: 1.28, 95% Cl:1.14-1.44), and suicide attempt (OR: 1.29, 95% Cl:1.13-1.49) were statistically significant. CONCLUSION: Adolescents who have AD are associated with a higher prevalence of depression symptoms and suicidal behaviors. Adolescent AD patients may need interventions from clinicians and caregivers that use a holistic approach to prevent psychological comorbidities, although further research is needed to clarify this relationship

Functional Symptoms in Pediatric Dermatology: The Canary in the Coal Mine

The skin is a window into the state of health revealing genetic predispositions, hormonal balance, nutritional status, and internal wellness. It exposes stress burden, emotional well-being, and psychological health. In this way the skin can operate as the metaphorical canary in the coal mine announcing the body’s hidden alarm signals. Psychocutaneous disorders draw attention to the intimate connections between the mind and the skin. During development, the brain and skin are born from the same embryonic tissue and throughout life they continue to be connected through elegant interactions involving neuropeptides, hormones, and inflammatory mediators, the so-called molecules of emotion. Disfiguring skin disease such as vitiligo, acne vulgaris, and ichthyosis have large emotional and psychological interactions. Perhaps surprisingly, the extent of the psychological fallout that results from these conditions is not necessarily related to the objective nature of the disease. Instead it is highly correlated with its subjective severity, which is dependent on self-perception and is highly personal. Recurrent skin disease often results in anxiety, depression, social isolation, body dysmorphic disorder, and dramatic reductions in quality of life rivaling those associated with debilitating systemic illnesses. Crosstalk between the mind and skin also exists wherein physical or psychological stressors can both initiate and worsen skin disease that has clear organic underpinnings such as acne vulgaris, psoriasis, atopic dermatitis, alopecia areata, and cutaneous warts. Primary psychiatric disorders may result in skin and hair conditions such as trichotillomania, psychogenic excoriation, dermatitis artefacta, and delusions of parasitosis. Although mind–skin interactions can cause obstinate symptoms and skin disease, these same connections can also be harnessed for therapeutic benefit