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The association between alopecia areata and anxiety, depression, schizophrenia, and bipolar disorder: a population-based study

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Abstract

Although Alopecia areata (AA) has been found to be associated with psychological distress, the scope and nature of this association has not been fully delineated. The current study sought to examine the association of AA with anxiety, depression, schizophrenia, and bipolar disorder, utilizing a large-scale matched controlled cohort design. Patients suffering from AA (n = 41,055) were matched to control cases (n = 41,055) by age, sex, and socioeconomic status (SES). The prevalence of the four major mental disorders was assessed while stratifying the sample by age and sex, and after adjusting for marital status, smoking, BMI, hypertension, and diabetes. Data were accessed via the Clalit Health Services (CHS) database, a comprehensive health registry utilized by the largest managed healthcare company in Israel. Anxiety was independently and positively associated with AA (OR 1.22, 95% CI 1.13–1.31, p < 0.001), across all age groups above 30, with similar rates in males and females. Depression was also independently and positively associated with AA (OR 1.09, 95% CI 1.01–1.17, p < 0.005), particularly in the 30–49 age group, with a higher association among females. A negative association was found between AA and schizophrenia (OR 0. 71, 95% CI 0.61–0.83, p < 0.001). No association was found between AA and bipolar disease. Patients with AA are at risk for anxiety and depression, with female patients, and patients in the 30–49 age group being particularly vulnerable to develop a co-occurring mental disorder. Medical treatment should therefore include psychiatric evaluation and appropriate care.

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Funding

This study was supported by unrestricted grant of Pfizer Pharmaceuticals Israel (Grant No: 55988381).

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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. Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany

    Khalaf Kridin

  5. Clalit Health Services, Tel Aviv, Israel

    Arnon Cohen

  6. 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

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  1. Dana Tzur Bitan
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  2. Daniella Berzin
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  3. Khalaf Kridin
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  4. Arnon Cohen
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Contributions

DTB analyzed and interpreted the data, and thoroughly revised the manuscript. DB performed the literature review and drafted the first versions of the manuscript. KK reviewed and critically revised the manuscript. ADC initiated and designed the study and critically revised the manuscript.

Corresponding author

Correspondence to Dana Tzur Bitan.

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Conflict of interest

Dr. Dana Tzur Bitan received a research grant from Pfizer. Prof. Arnon Cohen received research grants from Janssen, Novartis, AbbVie, Janssen and Sanofi. Prof. Arnon Cohen 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.

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Tzur Bitan, D., Berzin, D., Kridin, K. et al. The association between alopecia areata and anxiety, depression, schizophrenia, and bipolar disorder: a population-based study. Arch Dermatol Res 314, 463–468 (2022). https://doi.org/10.1007/s00403-021-02247-6

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  • DOI: https://doi.org/10.1007/s00403-021-02247-6

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