Cross-sectional study of psychiatric comorbidities in patients with atopic dermatitis and nonatopic eczema, urticaria, and psoriasis

Figures & data

Table 1 Prevalence rate of mental illnesses in AD and non-AD patients by age

Mental illness		Frequency (prevalence rate [%])
		Total all patients	Infant	Early childhood	Late childhood	Total childhood	Adolescent	Adult	Elderly
Total number of patients	AD	42,641	6,219	6,132	4,217	10,349	8,339	14,874	2,860
	Non-AD	139,486	25,252	19,095	10,460	29,555	21,187	53,004	10,488
Attention-deficit/hyperactivity disorder	AD	240 (0.56)	–	45 (0.73)	74 (1.75)	119 (1.15)	97 (1.16)	24 (0.16)	–
	Non-AD	655 (0.47)	12 (0.05)	171 (0.90)	182 (1.74)	353 (1.19)	209 (0.99)	78 (0.15)	3 (0.03)
Autism spectrum disorder	AD	88 (0.21)	10 (0.16)	19 (0.31)	16 (0.38)	35 (0.34)	24 (0.29)	19 (0.13)	–
	Non-AD	212 (0.15)	36 (0.14)	59 (0.31)	22 (0.21)	81 (0.27)	49 (0.23)	45 (0.08)	1 (0.01)
Conduct disorder	AD	17 (0.04)	1 (0.02)	1 (0.02)	2 (0.05)	3 (0.03)	10 (0.12)	3 (0.02)	–
	Non-AD	25 (0.018)	–	6 (0.03)	2 (0.02)	8 (0.03)	13 (0.06)	2 (0.00)	2 (0.02)
Depression	AD	1,052 (2.47)	–	8 (0.13)	22 (0.52)	30 (0.29)	105 (1.26)	543 (3.65)	374 (13.08)
	Non-AD	4,728 (3.39)	2 (0.01)	37 (0.19)	79 (0.76)	116 (0.39)	364 (1.72)	2,499 (4.71)	1,747 (16.66)
Anxiety	AD	1,448 (3.40)	5 (0.08)	19 (0.31)	24 (0.57)	43 (0.42)	109 (1.31)	758 (5.10)	533 (18.64)
	Non-AD	6,510 (4.67)	43 (0.17)	80 (0.42)	78 (0.75)	158 (0.53)	420 (1.98)	3,482 (6.57)	2,407 (22.95)
Suicidal ideation	AD	176 (0.41)	–	2 (0.03)	2 (0.05)	4 (0.04)	14 (0.17)	80 (0.54)	61 (2.13)
	Non-AD	832 (0.60)	–	12 (0.06)	3 (0.03)	15 (0.05)	35 (0.17)	388 (0.73)	292 (2.78)
Schizophrenia	AD	130 (0.30)	–	2 (0.03)	–	2 (0.02)	11 (0.13)	101 (0.68)	16 (0.56)
	Non-AD	489 (0.35)	–	7 (0.04)	16 (0.15)	23 (0.08)	44 (0.21)	341 (0.64)	81 (0.77)
Sleep disorder	AD	938 (2.20)	3 (0.05)	3 (0.05)	6 (0.14)	9 (0.09)	24 (0.29)	507 (3.41)	395 (13.81)
	Non-AD	4,523 (3.24)	58 (0.23)	27 (0.14)	23 (0.22)	50 (0.17)	111 (0.52)	2,504 (4.72)	1,800 (17.16)
Allergic conjunctivitis	AD	6,195 (14.53)	602 (9.68)	1,363 (22.23)	915 (21.70)	2,278 (22.01)	1,192 (14.29)	1,814 (12.20)	309 (10.80)
	Non-AD	25,958 (18.61)	3,923 (15.61)	5,572 (29.18)	2,835 (27.10)	8,407 (28.45)	3,831 (18.08)	8,484 (16.00)	1,313 (12.52)
Allergic rhinitis	AD	20,863 (48.93)	4,308 (69.27)	4,307 (70.24)	2,437 (57.79)	6,744 (65.17)	3,580 (42.93)	5,162 (34.70)	1,069 (37.38)
	Non-AD	80,866 (57.97)	20,539 (81.34)	15,107 (79.11)	6,748 (64.51)	21,855 (73.95)	10,544 (49.77)	22,854 (43.12)	5,074 (48.38)
Asthma	AD	6,823 (16.00)	2,540 (40.84)	1,856 (30.27)	621 (14.73)	2,477 (23.93)	522 (6.26)	902 (6.06)	382 (13.36)
	Non-AD	29,504 (21.15)	12,347 (48.90)	7,323 (38.35)	1,965 (18.79)	9,288 (31.43)	1,743 (8.23)	4,257 (8.03)	1,869 (17.82)
Previous AD history	AD	33,559 (78.70)	2,615 (42.05)	5,262 (85.81)	3,964 (94.00)	9,226 (89.15)	7,797 (93.50)	11,993 (80.63)	1,928 (67.41)
	Non-AD	–	–	–	–	–	–	–	–

Table 2 Multiple logistic regression analysis of mental illnesses and atopic dermatitis (AD) in total patients

Mental illness	AD
	Odds (95% CI)^†	P-value
Attention-deficit/hyperactivity disorder^a	1.48 (1.27~1.72)	<0.0001
Autism spectrum disorder^a	1.54 (1.19~1.99)	0.0010
Conduct disorder^a	2.88 (1.52~5.45)	0.0011
Depression	0.94 (0.88~1.01)	0.0991
Anxiety	0.91 (0.85~0.97)	0.0036
Suicidal ideation	0.90 (0.76~1.06)	0.2143
Schizophrenia	1.08 (0.88~1.31)	0.4777
Sleep disorder	0.85 (0.79~0.92)	<0.0001

Notes: *Adjusted by age, gender, economic status, severity of atopic dermatitis, AD history, concomittent allergic disease. †Odds ratio calculated vs non-AD controls. ^aMeans are significantly different.

Table 3 Multiple logistic regression analysis of mental illnesses in atopic dermatitis (AD) compared to non-AD eczema, urticaria, and psoriasis

Mental illness	Skin disease	Odds (95% CI)^†	P-value
Attention-deficit/hyperactivity disorder	AD	1.25 (1.06~1.48)	0.0091
	Urticaria	0.68 (0.58~0.80)	<0.0001
	Psoriasis	0.97 (0.64~1.49)	0.9023
Autism spectrum disorder	AD	1.24 (0.94~1.64)	0.1312
	Urticaria	0.61 (0.46~0.81)	0.0007
	Psoriasis	0.63 (0.26~1.57)	0.3226
Conduct disorder	AD	2.74 (1.30~5.78)	0.0084
	Urticaria	0.75 (0.32~1.75)	0.4980
	Psoriasis	3.30 (0.91~11.99)	0.0696
Depression	AD	0.96 (0.89~1.04)	0.3401
	Urticaria	1.01 (0.94~1.07)	0.8664
	Psoriasis	1.38 (1.23~1.56)	<0.0001
Anxiety	AD	0.96 (0.89~1.03)	0.2056
	Urticaria	1.10 (1.04~1.16)	0.0012
	Psoriasis	1.16 (1.03~1.30)	0.0109
Suicidal ideation	AD	1.03 (0.86~1.24)	0.7521
	Urticaria	1.33 (1.15~1.53)	0.0001
	Psoriasis	1.01 (0.74~1.39)	0.9421
Schizophrenia	AD	1.02 (0.82~1.26)	0.8959
	Urticaria	0.83 (0.69~1.00)	0.0522
	Psoriasis	1.35 (0.96~1.89)	0.0843
Sleep disorder	AD	0.93 (0.86~1.02)	0.1134
	Urticaria	1.18 (1.11~1.26)	<0.0001
	Psoriasis	1.29 (1.14~1.47)	<0.0001

Notes: Adjusted by age, gender, economic status, severity of atopic dermatitis, AD history, concomittent allergic disease. †Odds ratio calculated vs control group with non-AD eczema.

Table 4 Risk of mental illnesses according to atopic dermatitis (AD) severity

Mental illness	AD severity	Odds (95% CI)^†	P-value
Attention-deficit/hyperactivity disorder	Mild	1.14 (0.84~1.56)	0.3909
	Moderate	1.23 (0.66~2.28)	0.5108
	Severe^a	3.22 (2.36~4.40)	<0.0001
Autism spectrum disorder	Mild	1.07 (0.66~1.74)	0.7872
	Moderate	0.96 (0.33~2.84)	0.9438
	Severe^a	2.54 (1.54~4.21)	0.0003
Conduct disorder	Mild	0.82 (0.23~2.89)	0.7527
	Moderate	<0.001 (<0.001~ >999.999)	0.9809
	Severe	4.32 (1.23~15.10)	0.0221
Depression	Mild	0.92 (0.82~1.03)	0.1515
	Moderate^a	1.75 (1.42~2.16)	<0.0001
	Severe^a	3.15 (2.83~3.51)	<0.0001
Anxiety	Mild	0.93 (0.84~1.02)	0.1190
	Moderate^a	1.59 (1.32~1.91)	<0.0001
	Severe^a	2.64 (2.41~2.88)	<0.0001
Suicidal ideation	Mild	0.98 (0.75~1.28)	0.8558
	Moderate	1.22 (0.70~2.14)	0.4877
	Severe^a	2.68 (2.08~3.46)	<0.0001
Schizophrenia	Mild	0.81 (0.59~1.12)	0.2081
	Moderate	0.73 (0.33~1.62)	0.4367
	Severe^a	3.26 (2.40~4.43)	<0.0001
Sleep disorder	Mild^a	0.88 (0.78~0.98)	0.0237
	Moderate^a	1.31 (1.03~1.67)	0.0267
	Severe^a	2.56 (2.30~2.85)	<0.0001

Notes: *Adjusted by age, gender, economic status, AD history, concomittent allergic disease. †Odds ratio calculated vs non-AD controls. ^aMeans are significantly different.

Table 5 Risk of mental illnesses according to atopic dermatitis (AD) history in AD patients

Mental illness	Past AD history
	Odds (95% CI)^†	P-value
Attention-deficit/hyperactivity disorder^a	3.56 (2.21~5.73)	<0.0001
Autism spectrum disorder	1.55 (0.87~2.74)	0.1351
Conduct disorder	2.06 (0.46~9.22)	0.3437
Depression^a	1.23 (1.06~1.44)	0.0072
Anxiety	1.12 (0.99~1.28)	0.0797
Suicidal ideation	0.82 (0.59~1.14)	0.2293
Schizophrenia	0.74 (0.50~1.08)	0.1195
Sleep disorder	1.07 (0.91~1.25)	0.4133

Notes: ^aAdjusted by age, gender, economic status, severity of atopic dermatitis, concomittent allergic diseases: Means are significantly different. _†Odds ratio calculated vs control group with no history of atopic dermatitis.

Table 6 Risk of mental illnesses according to concomitant atopic disease in atopic dermatitis (AD) patients

Mental illness	Allergic conjunctivitis		Allergic rhinitis		Asthma
	Odds (95% CI)	P-value	Odds (95% CI)	P-value	Odds (95% CI)	P-value
Attention-deficit/hyperactivity disorder	1.53 (1.13~2.07)	0.0063	1.21 (0.91~1.60)	0.2009	0.44 (0.30~0.65)	<0.0001
Autism spectrum disorder	1.14 (0.66~1.99)	0.6383	0.75 (0.47~1.20)	0.2280	0.54 (0.30~1.00)	0.0502
Conduct disorder	3.02 (1.07~8.49)	0.0363	0.38 (0.13~1.12)	0.0796	1.13 (0.32~4.01)	0.8546
Depression	1.00 (0.83~1.20)	0.9943	0.92 (0.80~1.05)	0.2272	0.67 (0.55~0.83)	0.0002
Anxiety	1.12 (0.95~1.31)	0.1729	1.15 (1.02~1.30)	0.0187	0.97 (0.82~1.14)	0.6732
Suicidal ideation	0.70 (0.43~1.15)	0.1571	1.10 (0.80~1.52)	0.5497	1.03 (0.66~1.59)	0.9124
Schizophrenia	0.74 (0.42~1.31)	0.3031	0.63 (0.43~0.93)	0.0188	0.50 (0.26~0.95)	0.0355
Sleep disorder	1.10 (0.91~1.34)	0.3331	1.31 (1.14~1.52)	0.0002	0.92 (0.75~1.13)	0.4021

Notes: Adjusted by age, gender, economic status, severity of atopic dermatitis, AD history, †Odds ratio calculated vs. control group with non-AD eczema.