Depression and Anxiety in Patients with Bullous Pemphigoid: A Systematic Review and Narrative Synthesis

Background: Bullous pemphigoid (BP) is a chronic autoimmune blistering disorder associated with significant morbidity and mortality. BP has previously been linked to several neurological disorders; however, its relationship with depression and anxiety remains poorly understood. Objectives: This systematic review aimed to evaluate the prevalence, severity, and impact of depression and anxiety in patients with BP. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Embase, and PsycINFO up to August 2024. Studies involving adults (≥16 years) with BP reporting depression and/or anxiety outcomes were included. Experimental and observational peer-reviewed studies were considered. Two reviewers independently screened and extracted data on mental health prevalence, effect estimates, and study quality, assessed via the Newcastle-Ottawa Scale. Results: This review identified a high prevalence of mental health issues in patients with BP, with depression a seemingly more consistent and pronounced issue versus anxiety. Despite this, current UK guidance provides no provision for screening and treatment of mental health issues in patients with BP. Comorbid depression was linked to increased mortality and poorer treatment adherence, suggesting a bidirectional relationship. Conclusions: Integrating validated mental health screening tools such as PHQ-9 and GAD-7 in BP care is critical. A holistic approach addressing both dermatological and psychiatric aspects may improve outcomes and quality of life for BP patients.