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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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References

  1. Gilhar A, Etzioni A, Paus R (2012) Alopecia areata. N Engl J Med 366:1515–1525. https://doi.org/10.1056/NEJMra1103442

    Article  CAS  PubMed  Google Scholar 

  2. Safavi K (1992) Prevalence of alopecia areata in the First National Health and Nutrition Examination Survey. Arch Dermatol 128:702. https://doi.org/10.1001/archderm.1992.01680150136027

    Article  CAS  PubMed  Google Scholar 

  3. Mirzoyev SA, Schrum AG, Davis MDP, Torgerson RR (2014) Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990–2009. J Invest Dermatol 134:1141–1142. https://doi.org/10.1038/jid.2013.464

    Article  CAS  PubMed  Google Scholar 

  4. Hordinsky MK (2013) Overview of alopecia areata. J Investig Dermatol Symp Proc 16:S13-15. https://doi.org/10.1038/jidsymp.2013.4

    Article  CAS  PubMed  Google Scholar 

  5. Thompson JM, Mirza MA, Park MK, Qureshi AA, Cho E (2017) The role of micronutrients in alopecia areata: a review. Am J Clin Dermatol 18:663–679. https://doi.org/10.1007/s40257-017-0285-x

    Article  PubMed  PubMed Central  Google Scholar 

  6. Barahmani N, Schabath MB, Duvic M, National Alopecia Areata Registry (2009) History of atopy or autoimmunity increases risk of alopecia areata. J Acad Dermatol. 61:581–591. https://doi.org/10.1016/j.jaad.2009.04.031

    Article  Google Scholar 

  7. Madani S, Schapiro J (2000) Alopecia areata update. J Am Acad Dermatol 42:549–566 (quiz 567–70)

    Article  CAS  Google Scholar 

  8. Mulinari-Brenner F (2018) Psychosomatic aspects of alopecia areata. Clin Dermatol 36:709–713. https://doi.org/10.1016/j.clindermatol.2018.08.011

    Article  PubMed  Google Scholar 

  9. Gupta MA, Gupta AK, Watteel GN (1997) Stress and alopecia areata: a psychodermatologic study. Acta Derm Venereol 77:296–298. https://doi.org/10.2340/0001555577296298

    Article  CAS  PubMed  Google Scholar 

  10. Liu LY, King BA, Craiglow BG (2016) Health-related quality of life (HRQoL) among patients with alopecia areata (AA): a systemic review. J Am Acad Dermatol 75:806–12.e3. https://doi.org/10.1016/j.jaad.2016.04.035

    Article  PubMed  Google Scholar 

  11. Li SJ, Huang KP, Joyce C, Mostaghimi A (2018) The impact of alopecia areata of sexual life. Int J Trichol 10:271–274. https://doi.org/10.4103/ijt.ijt_93_18

    Article  Google Scholar 

  12. Okhovat JP, Marks DH, Manatis-Lornell A, Hagigeorges D, Locascio JJ, Senna MM (2019) Association between alopecia areata, anxiety, and depression: a systematic review and meta-analysis. JAAD. https://doi.org/10.1016/j.jaad.2019.05.086 (Online ahead of print)

    Article  PubMed  Google Scholar 

  13. Díaz-Atienza F, Gurpegui M (2011) Environmental stress but not subjective distress in children or adolescents 43 with alopecia areata. J Psychosom Res 71:102–107. https://doi.org/10.1016/j.jpsychores.2011.01.007

    Article  PubMed  Google Scholar 

  14. Güleç AT, Tanriverdi N, Dürü C, Saray Y, Akçali C (2004) The role of psychological factors in alopecia areata 48 and the impact of the disease on the quality of life. Int J Dermatol 43:352–356. https://doi.org/10.1111/j.1365-4632.2004.02028.x

    Article  PubMed  Google Scholar 

  15. Karia SB, De Sousa A, Shah N, Sonavane S, Bharati A (2015) Psychiatric morbidity and quality of life in skin 66 diseases: a comparison of alopecia areata and psoriasis. Ind Psychiatry J 24:125–128. https://doi.org/10.4103/0972-6748.181724

    Article  PubMed  PubMed Central  Google Scholar 

  16. Singam V, Patel KR, Lee HH, Rastogi S, Silverberg JI (2019) Association of alopecia areata with hospitalization for mental health disorders in US adults. J Am Acad Dermatol 80:792–794. https://doi.org/10.1016/j.jaad.2018.07.044

    Article  PubMed  Google Scholar 

  17. Chu SY, Chen YJ, Tseng WC, Lin MW, Chen TJ, Hwang CY (2012) Psychiatric comorbidities in patients with alopecia areata in Taiwan: a case–control study. Br J Dermatol 166:525–531. https://doi.org/10.1111/j.1365-2133.2011.10714.x

    Article  PubMed  Google Scholar 

  18. Chen SJ, Chao YL, Chen CY, Chang CM, Wu ECH, Wu CS et al (2012) Prevalence of autoimmune diseases in in-patients with schizophrenia: nationwide population-based study. Br J Psychiatry 200:374–380. https://doi.org/10.1192/bjp.bp.111.092098

    Article  PubMed  Google Scholar 

  19. Dai YX, Yeh FY, Shen YJ, Tai YH, Chou YJ, Chang YT et al (2020) Cigarette smoking, alcohol consumption, and risk of alopecia areata: a population-based cohort study in Taiwan. Am J Clin Dermatol 21:901–911. https://doi.org/10.1007/s40257-020-00547-7

    Article  PubMed  Google Scholar 

  20. Lee NR, Kim BK, Yoon NY, Lee SY, Ahn SY, Lee WS (2014) Differences in comorbidity profiles between early-onset and late-onset alopecia areata patients: a retrospective study of 871 Korean patients. Ann Dermatol 26:722–726. https://doi.org/10.5021/ad.2014.26.6.722

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hennekens CH (2007) Increasing global burden of cardiovascular disease in general populations and patients with schizophrenia. J Clin Psychiatry 68(Suppl 4):4–7

    PubMed  Google Scholar 

  22. Ministry of Health (Il) [Internet], Annual report of healthcare‐providing companies for 2018. https://www.health.gov.il/PublicationsFiles/dochHashvaatui2018.pdf. Accessed 27 Mar 2020

  23. Tzur-Bitan D, Berzin D, Cohen AD (2020) Hidradenitis suppurativa and schizophrenia: a nationwide cohort study. JEADV. 34:574–579. https://doi.org/10.1111/jdv.15997

    Article  CAS  PubMed  Google Scholar 

  24. Tzur Bitan D, Berzin D, Cohen AD (2020) Hidradenitis suppurativa and bipolar disorders: a population-based study. Dermatology 236:298–304. https://doi.org/10.1159/000504535

    Article  PubMed  Google Scholar 

  25. Rennert G, Peterburg Y (2001) Prevalence of selected chronic diseases in Israel. Isr Med Assoc J 3:404–408

    CAS  PubMed  Google Scholar 

  26. World Health Organization (1978) International classification of diseases. Ninth revision. WHO, Geneva

    Google Scholar 

  27. Watad A, Bragazzi NL, Adawi M, Aljadeff G, Amital H, Comaneshter D et al (2017) Anxiety disorder among rheumatoid arthritis patients: insights from real-life data. J Affect Disord 213:30–34. https://doi.org/10.1016/j.jad.2017.02.007

    Article  PubMed  Google Scholar 

  28. Pearce N (2016) Analysis of matched case-control studies. BMJ. https://doi.org/10.1136/bmj.i969

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mansournia MA, Jewell NP, Greenland S (2018) Case–control matching: effects, misconceptions, and recommendations. Eur J Epidemiol 33:5–14. https://doi.org/10.1007/s10654-017-0325-0

    Article  PubMed  Google Scholar 

  30. Koo JY, Shellow WV, Hallman CP, Edwards JE (1994) Alopecia areata and increased prevalence of psychiatric disorders. Int J Dermatol 33:849–850. https://doi.org/10.1111/j.1365-4362.1994.tb01018.x

    Article  CAS  PubMed  Google Scholar 

  31. Villasante-Fricke AC, Miteva M (2015) Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol 8:397–403. https://doi.org/10.2147/CCID.S53985

    Article  PubMed  PubMed Central  Google Scholar 

  32. Miller R, Conic RZ, Bergfeld W, Mesinkovska NA (2015) Prevalence of comorbid conditions and sun-induced skin cancers in patients with alopecia areata. J Investig Dermatol Symp Proc 17:61–62. https://doi.org/10.1038/jidsymp.2015.44

    Article  PubMed  Google Scholar 

  33. Titeca G, Goudetsidis L, Francq F, Gieler U, Tomas-Aragones L, Lien L et al (2020) The psychosocial burden of alopecia areata and androgenetica: a cross-sectional multicentre study among dermatological out-patients in 13 European countries. JEADV 34:406–411. https://doi.org/10.1111/jdv.15927

    Article  CAS  PubMed  Google Scholar 

  34. Davis DS, Callender VS (2018) Review of quality of life studies in women with alopecia. Int J Womens Dermatol 4:18–22. https://doi.org/10.1016/j.ijwd.2017.11.007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Hunt N, McHale S (2005) The psychological impact of alopecia. BMJ 331:951–953. https://doi.org/10.1136/bmj.331.7522.951

    Article  PubMed  PubMed Central  Google Scholar 

  36. Peters EMJ, Muller Y, Snaga W, Filege H, Ribhauer A, Schmidt-Rose T et al (2017) Hair and stress: a pilot study of hair and cytokine balance alteration in healthy young women under major exam stress. PLoS ONE 12:e0175904. https://doi.org/10.1371/journal.pone.0175904

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Paus R, Theoharides TC, Arck PC (2006) Neuroimmunoendocrine circuitry of the “brain-skin connection.” Trends Immunol 27:32–39. https://doi.org/10.1016/j.it.2005.10.002

    Article  CAS  PubMed  Google Scholar 

  38. Vallerand IA, Lewinson RY, Parsons LM, Hardin J, Haber RM, Lowerison MW et al (2019) Assessment of a bidirectional association between major depressive disorder and alopecia areata. JAMA Dermatol 155:475–479. https://doi.org/10.1001/jamadermatol.2018.4398

    Article  PubMed  PubMed Central  Google Scholar 

  39. Eaton WW, Pedersen MG, Nielsen PR, Mortensen PB (2010) Autoimmune diseases, bipolar disorder, and non-affective psychosis. Bipolar Disord 12:638–646. https://doi.org/10.1111/j.1399-5618.2010.00853.x

    Article  PubMed  PubMed Central  Google Scholar 

  40. Saha S, Chant D, McGarth J (2007) A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry 64:1123–1131

    Article  Google Scholar 

  41. Druss BG, Bradford DW, Rosenheck RA, Radford MJ, Krumholz HM (2000) Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA 283:506–511

    Article  CAS  Google Scholar 

  42. Krieger I, Tzur Bitan D, Comaneshter D, Cohen A, Feingold D (2019) Increased risk of smoking-related illnesses in schizophrenia patients: a nationwide cohort study. Schizophr Res 212:121–125

    Article  Google Scholar 

  43. Lambert TJ, Velakoulis D, Pantelis C (2003) Medical comorbidity in schizophrenia. Med J Aust 178(suppl):S67–S70

    PubMed  Google Scholar 

  44. Ballenger JC (2000) Anxiety and depression: optimizing treatments. Prim Care Companion J Clin Psychiatry 2:71–79. https://doi.org/10.4088/pcc.v02n0301

    Article  PubMed  PubMed Central  Google Scholar 

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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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  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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