"We and others have found that AD is associated with anxiety and depression in adulthood, but there were not as many studies focusing on mental health among children," Dr. Katrina Abuabara of the University of California, San Francisco told Reuters Health by email. "Yet, AD affects up to one in five kids worldwide, and mental health issues in kids are often underrecognized. Moreover, eczema is quite variable in both its severity and disease course, so we wanted to examine this issue in a way that allowed us to take that variability into consideration."
"I was somewhat surprised to see an increase in symptoms of depression even among very young children with severe AD," she said. "Moreover, we found a risk of more subtle internalizing behaviors even among those with mild and moderate AD."
As reported in JAMA Dermatology, Dr. Abuabara and colleagues studied data on UK children followed from birth for a mean of 10 years. The annual AD period prevalence was assessed at 11 points, from six months to 18 years of age.
Among the 11,181 children (51% male) included in the analysis, the period prevalence of depression symptoms ranged from 6% to 21.6%; for internalizing behaviors, from 10.4% to 16.0%.
Mild-to-moderate AD was not associated with depression symptoms. However, it was associated with internalizing behaviors as early as age four (mean increased odds of 29%-84% across childhood in adjusted models).
Severe AD was associated with depression symptoms (adjusted odds ratio, 2.38) and internalizing symptoms (aOR, 1.90). Sleep quality mediated some of this association, but not by factors such as differences in sleep duration, asthma/rhinitis, or levels of inflammatory markers (interleukin 6 and C-reactive protein).
The authors note, "Risk of internalizing symptoms was increased even for children with mild AD beginning early in childhood, highlighting the importance of behavioral and mental health awareness in this population."
Dr. Nanette Silverberg, Chief of Pediatric Dermatology for the Mount Sinai Health System in New York City, told Reuters Health by phone. "There is a subpopulation of AD patients in every age group, but particularly adolescents with moderate-to-severe disease, who have a need for mental health services."
"Some of the problem is really untreated disease," she noted. "Kids who have very significant disease experience a lot of problems with self-image development and with their ability to socialize, particularly in the teenage years. I think it is worthwhile to screen the more severe cases, and that can simply be by asking questions in the doctor's office or, depending on the severity, a referral may be necessary."
"Also, household features play into how AD patients behave and deal with their disease," she said. "Particularly for younger children, it's not just the child who may have to meet with a therapist, but it may also require some discussion with the family on how to deal with these issues."
"In my experience, appropriate therapeutics that enable a child get control of their disease - whether it's effective topical or biologic therapy - can help certain kids overcome some of the short-term sadness," she added. "In my practice, I have teenagers with severe AD who appear withdrawn. They're sitting in the corner, wearing a hoodie, and sometimes they're crying. With many of those kids, when they're treated and doing well, the hoodie comes down."
SOURCE: https://bit.ly/2VnVguX JAMA Dermatology, online September 1, 2021.
By Marilynn Larkin
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