Mental Health Comorbidity in Patients With Atopic Dermatitis

To quantify the mental health burden associated with pediatric atopic dermatitis (AD) in the United States. Recent data suggest that children with AD might be at an increased risk of mental health disorders.Data were analyzed from the 2007 National Survey of Children’s Health, a survey reporting on the health status of 91 642 children aged 0 to 17 years. The analysis was limited to those children who had seen a health care provider in the past year (n = 79 667).Data were used from the 2007 National Survey of Children’s Health, which was designed to estimate the prevalence of various child health issues, including physical, emotional, and behavioral factors. The lifetime prevalence of provider-diagnosed mental health conditions was calculated for those with and without a history of AD, as determined by parental report. AD severity (mild, moderate, severe) was based on parent/guardian assessment of the skin disease. The mental health disorders assessed in the study were chosen based on previous associations with AD and included attention-deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD), depression, anxiety, and behavioral or conduct problems, such as oppositional defiant disorder, conduct disorder, autism, Asperger’s disorder, pervasive developmental disorder, or other autism spectrum disorders.Children with AD reported seeing mental health care providers more often (12.12%) and receiving more mental health therapy (11.31%) than their peers without AD (7.89% and 6.61%, respectively; P < .0001). The odds of developing a mental health disorder was higher among children with AD than control subjects and included ADHD (odds ratio [OR] 1.87; 95% confidence interval [CI], 1.54–2.27), depression (OR 1.81; 95% CI, 1.33–2.46), anxiety (OR 1.77, 95% CI, 1.36–2.29), conduct disorders (OR 1.87, 95% CI, 1.46–2.39), and autism (OR 3.04, 95% CI, 2.13–4.34). The prevalence of each mental health disorder also strongly correlated with disease severity in a dose-dependent manner.This study found strong associations between AD and several mental health disorders in the US pediatric population. The data showed that children with AD have an increased prevalence of ADHD, depression, anxiety, conduct disorder, and autism compared with their peers without AD. Children with more severe skin disease appear to be at greatest risk.This study is the first comprehensive evaluation of the mental health burden associated with pediatric AD in the United States. The results indicate that children with AD are at an increased risk for mental health disorders, and health care providers should be aware of this when evaluating these children. Prospective studies are needed to better define risks and to determine strategies that might modify the risk of developing mental health disorders in at-risk children.