Children and adolescents with alopecia areata: psychiatric symptoms, psychosocial functioning, and stressful experiences in a case-control study with longitudinal follow-up during the COVID-19 pandemic

This study examined psychiatric symptoms and stressful experiences in children and adolescents with alopecia areata, taking the skin-mind connection as its starting point. It focused on stressful experiences reported before hair-loss onset, alongside psychiatric symptoms and quality of life. The COVID-19 pandemic offered an opportunity to follow how psychological and dermatological outcomes changed within the AA cohort during widespread stress. Before the pandemic, 36 children and adolescents with alopecia areata (AA) and 60 community controls completed standardized parent- and child-report measures and a study-specific assessment of stressful experiences. Participants with AA and their parents also underwent semi-structured clinical interviews covering psychiatric symptoms, disease history, and experiences preceding hair-loss onset. Approximately one year later, the AA cohort was reassessed during the pandemic, whereas controls were assessed only at baseline. Baseline case-control and within-cohort longitudinal comparisons were performed using nonparametric tests with Benjamini–Hochberg false-discovery-rate correction. Stressful experiences were more frequent in the AA group than in controls (94.4% vs. 33.3%, p < 0.001), and separation-related experiences were the most common category before hair-loss onset (47.2%). At baseline, parents of participants with AA reported higher depressive symptoms, total difficulties, emotional symptoms and hyperactivity/inattention, and poorer psychosocial health-related quality of life; all remained significant after false-discovery-rate correction (all q ≤ 0.024). No child-reported baseline difference remained significant. Within the AA cohort, child-reported depressive symptoms were higher at the pandemic follow-up than at baseline in the full available-case analysis (q = 0.022), although this did not remain significant when restricted to the validated age range of the child-report measure (q = 0.128); the increase in child-reported anxiety was not significant after correction (q = 0.063), and parent-reported outcomes did not change significantly. Substantial or complete regrowth occurred in 19 of 32 participants (59.4%). Alopecia areata in childhood may carry emotional and social difficulties beyond visible hair loss, and separation-related experiences were the most commonly reported stressful experiences before hair-loss onset. Their prominence, together with the finding that child-reported depressive symptoms increased while many participants showed dermatological improvement, suggests that the type and relational context of stress may deserve attention alongside its overall burden.