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The association of chronic spontaneous urticaria (CSU) with anxiety and depression: a nationwide cohort study

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Abstract

Chronic spontaneous urticaria (CSU) is a dermatological disease associated with significant impairment of overall quality of life as well as psychological distress. Previous studies have demonstrated significant comorbidity between CSU and a wide range of mental illnesses. In this study we aimed to focus on the association between CSU and anxiety and depression, using an optimized matched controlled design. A nationwide matched control study was conducted using the Clalit Health Services (CHS) database. The study included 12,539 CSU patients and 60,510 age and sex matched controls. Three multiple logistic regression models were conducted to assess the association between CSU and anxiety and depression, while adjusting for age, sex, socioeconomic status (SES), diabetes, obesity, hypertension, and smoking status. A higher frequency of anxiety and depression was found in CSU patients compared to that in controls (anxiety frequency of 9.6% vs. 5.7%, p < 0.001; depression frequency of 11% vs 7.9%, p < 0.001, respectively) after adjustment for demographic and clinical factors. The association of CSU with anxiety was the strongest in the 18–29 age group, and in the high SES group, while the association of CSU with depression was the highest in the 50–69 age group, and in the low SES group. Chronic spontaneous urticaria is associated with anxiety and depression. In light of the clinical implications of a comorbid mental disorder, dermatologists should consider employing mental health screening procedures, especially for patients from specific risk groups.

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Data sharing

The datasets generated during and/or analyzed during the current study are not publicly available due to the CHS ethical standards but are available from the corresponding author on reasonable request.

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Funding

The authors received no funding for the reported study.

Author information

Authors and Affiliations

  1. Department of Behavioral Sciences, Ariel University, 40700, Ariel, Israel

    Dana Tzur Bitan

  2. Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Dana Tzur Bitan

  3. School of Medicine, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Daniella Berzin

  4. Clalit Health Services, Tel Aviv, Israel

    Arnon Cohen

  5. Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Arnon Cohen

Authors
  1. Dana Tzur Bitan
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  2. Daniella Berzin
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  3. Arnon Cohen
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Corresponding author

Correspondence to Dana Tzur Bitan.

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Conflict of interest

AD Cohen received research grants from Janssen, Novartis, AbbVie, Janssen and Sanofi, and served as a consultant, advisor or speaker to AbbVie, Amgen, Boehringer Ingelheim, Dexcel pharma, Janssen, Kamedis, Lilly, Neopharm, Novartis, Perrigo, Pfizer, Rafa, Samsung Bioepis, Sanofi, Sirbal and Taro. All other authors have no conflict of interest to declare.

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All procedures performed in this study were in accordance with the ethical standards of the institutional national research committee and with the Declaration of Helsinki.

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Tzur Bitan, D., Berzin, D. & Cohen, A. The association of chronic spontaneous urticaria (CSU) with anxiety and depression: a nationwide cohort study. Arch Dermatol Res 313, 33–39 (2021). https://doi.org/10.1007/s00403-020-02064-3

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  • DOI: https://doi.org/10.1007/s00403-020-02064-3

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