Suicidal ideation in patients with atopic dermatitis: A case‐control study on 23,191 adults

results. The high prevalence of SI in patients with AD was reported in other studies, such as in a meta-analysis, 2 where mean rates of SI were 1.8 times (16.8%/9.1%) higher than controls. Also, previous studies observed an association of SI in AD with severity, 5 obesity, 6 pruritus, 1 and sleep disorders. 5 All these aspects are interconnected. 7,8 For example, severe pruritus, the main sleep disruptor in AD, contributes to the development of depression and anxiety, both risk factors for SI. 9 Moreover, stigma related to AD 6 is a key psychosocial factor in the increased risk of SI, interacting with different aspects, such as severity, pain, sleep disturbances and depression. Beyond the current high prevalence of SI, we found that many adult patients with early AD onset recalled experiencing SI during adolescence. Suicide is a major cause of mortality among adolescents worldwide. Large-scale studies showed up to a 44% increased risk of suicidal thoughts and a 36% higher risk of attempts 3 compared to adolescents without AD, highlighting AD as a serious public health concern requiring integrated care. Key strengths of our study include the large, population-based sample 10,11 and the stratification by age of onset. Limitations include the assessment of SI without a validated psychiatric tool, a possible recall bias in reporting adolescent SI, the cross-sectional design, which does not allow causal inference and the lack of psychiatric comorbidity data, which could confound the associations. Our findings highlight that SI is not only common in adults with AD but often begins in adolescence, underscoring the need for suicide risk screening and mental health support in dermatological care, especially for early-onset cases.