J Eur Acad Dermatol Venereol. 2022 Aug 26. doi: 10.1111/jdv.18564. Online ahead of print.
BACKGROUND: Pediatric atopic dermatitis (AD) has been linked to neuropsychiatric comorbidities such as depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD). However, longitudinal data are limited and the effect of AD severity on neuropsychiatric outcomes requires further characterization.
OBJECTIVES: To determine the risk of several major neuropsychiatric conditions in children with AD METHODS: We analyzed UK health records data in a population-based cohort study. Each patient <18 years old with AD was matched to up to 5 unaffected patients on age, practice, and index date. Treatments served as proxies for AD severity, which was analyzed in a time-updated manner. Outcomes were incident anxiety, depression, bipolar disorder, schizophrenia, ADHD, autism, obsessive-compulsive disorder (OCD), suicidal ideation or attempt, and completed suicide.
RESULTS: 409,431 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) were compared to 1,809,029 children without AD. In Cox regression models adjusted for age, sex, socioeconomic status and other atopic comorbidities, no statistically significant relationships were observed between AD and incident anxiety (HR 1.01, 95% CI 0.99-1.03), ADHD (1.02, 0.97-1.06), autism (1.02, 0.98-1.06), bipolar disorder (1.08, 0.85-1.36), suicidal ideation/attempt (0.98, 0.95-1.01), or completed suicide (0.85, 0.64-1.14). Children with AD were less likely to develop depression (0.93, 0.91-0.95) or schizophrenia (0.72, 0.54-0.95) but more likely to develop OCD (1.26, 1.16-1.37). However, there was substantial variation by AD severity and age in both the direction and magnitude of effect for many of the neuropsychiatric conditions examined.
CONCLUSIONS: The was no substantial impact of AD on the overall risk of many neuropsychiatric conditions in children, but disease severity and age may be important modifying factors. Additional research is needed to further dissect the complex relationship between pediatric AD and neuropsychiatric comorbidities.