HS Tied to Higher Risk for Depression and Anxiety

TOPLINE:

Patients with hidradenitis suppurativa (HS) showed a 69% higher risk for new-onset depression and a 48% higher risk for new-onset anxiety than individuals without HS, irrespective of disease severity.

METHODOLOGY:

• To address whether HS severity is an independent risk factor for new-onset depression and anxiety, researchers conducted a study from 1997 to 2022 that included 10,206 Danish patients (mean age, 38 years) with hospital-diagnosed HS, matched for age and sex 1:4 with 40,125 individuals without HS (mean age, 37.9 years) from national registries.
• Primary outcomes were a first diagnosis of depression or anxiety.
• Researchers also assessed recurrent depression and anxiety in participants with prior diagnoses using a separate analytic subset and a 3-year washout period and disease severity by treatments received and number of hospitalizations for HS-related surgical procedures.
• Of the patients with HS, 25.9% received no treatment, 12.0% received only topical therapy, 55.5% received systemic nonbiologic treatment, and 6.5% received biologic therapy.
• In terms of surgical severity, 58.1% of patients had no hospitalizations for HS-related surgery, 18.8% were hospitalized once for surgery, 7.6% were hospitalized twice, and 15.5% had three or more hospitalizations.

TAKEAWAY:

• During follow-up, the incidence rate of new-onset depression or anxiety was 3.11 per 100 person-years among patients with HS vs 1.77 per 100 person-years in the control group; patients with HS had a significantly higher risk for new-onset depression (hazard ratio [HR], 1.69; P < .001) and new-onset anxiety (HR, 1.48; P < .001).
• The risk of new-onset depression or anxiety remained elevated across all treatment groups, with HRs of 1.62 (P < .001) for topical therapy, 1.61 (P < .001) for systemic nonbiologics, and 1.38 (P < .05) for biologics.
• No consistent trend in risk was observed across levels of surgical severity; adjusted HR of 1.44 (95% CI, 1.36-1.53) for zero hospitalizations for an HS-related surgical procedure, 1.66 (95% CI, 1.53-2.17) for one, 1.59 (95% CI, 1.33-1.90) for two, and 1.60 (95% CI, 1.40-1.85) for three or more hospitalizations (P < .001 for all).
• Despite a higher baseline prevalence of prior depression (7.0% vs 0.3%; P < .001) and anxiety (5.9% vs 0.5%; P < .001) among patients with HS than those in the control group, the risk for recurrence was not significantly elevated when compared with the control group.

IN PRACTICE:

“This finding emphasizes that depression and anxiety may occur independent of disease severity, and clinicians should be aware of mental disorders across all severity stages and approach these patients in a multidisciplinary setting,” the study authors wrote. They called for research “to identify other factors that may be associated with the risk of the development of depression and anxiety for this group of patients.”

SOURCE:

This study was led by Nikolaj Holgersen, MD, Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital, Copenhagen, Denmark, and was published online on July 30 in JAMA Dermatology.

LIMITATIONS:

This study relied on hospital diagnoses and contacts for HS, potentially excluding milder cases managed in primary care settings. Using treatment categories as severity proxies could have introduced misclassification bias, and the inclusion of only Danish patients limited generalizability to other populations.

DISCLOSURES:

The authors did not report funding information. Several authors reported receiving personal fees, grants, advisory fees, and speaker fees from AbbVie, Almirall, Leo Pharma, Novartis, Sanofi, UCB, Pfizer, Sanofi, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation. Two authors are employees of Leo Pharma.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.