Abstract: Background: Atopic dermatitis (AD) has large mental health impacts for patients and caregivers, yet their preferences regarding how to relieve these impacts are poorly understood.
Objective: To understand patients' and caregivers' preferences for AD-related mental health care and support.
Methods: We surveyed 279 adult AD patients and 154 caregivers of children with AD across 26 countries regarding their AD-related mental health burden, preferred strategies for improving AD-related mental health, and experiences with mental health care in AD.
Results: Caregivers reported significantly worse overall mental health (P = 0.01) and anxiety (P = 0.03) than adult patients when controlling for AD severity. Among adult patients, 58% selected treating the AD, 51% managing itch, 44% wearing clothing to cover up skin, 43% avoiding social situations, and 41% spending time alone, as strategies they felt would improve their own AD-related mental health. Caregivers selected managing itch and treating the AD most frequently for both their own (76% and 75%, respectively) and their children's (75% and 61%) mental health. Adult patients were less satisfied with mental health care from mental health providers versus nonmental health providers (P < 0.001).
Conclusions: Effective AD management is the preferred method for improving mental health among patients as well as caregivers, who may experience the greatest mental health impacts. Self-care strategies should be considered in a shared decision-making approach.
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References
1.
NuttenS. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015; 66Suppl 1:8–16. doi:10.1159/000370220
2.
SilverbergJI. Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2019; 123(2):144–151. doi:10.1016/j.anai.2019.04.020
3.
XuX, van GalenLS, KohMJA, et al.Factors influencing quality of life in children with atopic dermatitis and their caregivers: a cross-sectional study. Sci Rep. 2019; 9(1):15990. doi:10.1038/s41598-019-51129-5
4.
PatelKR, ImmaneniS, SingamV, et al.Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol. 2019; 80(2):402–410. doi:10.1016/j.jaad.2018.08.063
5.
RønnstadATM, Halling-OvergaardAS, HamannCR, et al.Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: a systematic review and meta-analysis. J Am Acad Dermatol. 2018; 79(3):448–456.e30. doi:10.1016/j.jaad.2018.03.017
6.
LongQ, JinH, YouX, et al.Eczema is a shared risk factor for anxiety and depression: a meta-analysis and systematic review. PLoS ONE. 2022; 17(2):e0263334. doi:10.1371/journal.pone.0263334
7.
PompiliM, BonanniL, GualtieriF, et al.Suicidal risks with psoriasis and atopic dermatitis: systematic review and meta-analysis. J Psychosom Res. 2021; 141:110347. doi:10.1016/j.jpsychores.2020.110347
8.
KimRW, BartaK, BegolkaWS, et al.Qualitative analysis of the impact of atopic dermatitis on caregivers. Br J Dermatol. 2022; 187(6):1038–1041. doi: 10.1111/bjd.21828
9.
KimRW, BartaK, BegolkaWS, et al.The quantitative impact of atopic dermatitis on caregivers across multiple life domains. Br J Dermatol. 2022; 187(6):1041–1043. doi:10.1111/bjd.21855
10.
CapozzaK, GaddH, KelleyK, et al.Insights from caregivers on the impact of pediatric atopic dermatitis on families: “I'm tired, overwhelmed, and feel like I'm failing as a mother.”. Dermat Contact Atopic Occup Drug. 2020;31(3):223–227. doi:10.1097/DER.0000000000000582
11.
ArkwrightPD, KoplinJJ. Challenging best practice of atopic dermatitis. J Allergy Clin Immunol Pract. Published online March 23, 2023:S2213-S2198(23)00307-0. doi:10.1016/j.jaip.2023.03.023
12.
SunD, HeimallJ. Geographical distribution of allergy/immunology providers in the United States and association with median income. J Allergy Clin Immunol Pract. 2020; 8(8):2802–2804.e1. doi:10.1016/j.jaip.2020.04.018
13.
GlazerAM, RigelDS. Analysis of trends in geographic distribution of US Dermatology Workforce Density. JAMA Dermatol. 2017; 153(5):472–473. doi:10.1001/jamadermatol.2016.6032
14.
SoriaA, Du-ThanhA, SeneschalJ, et al.Development or exacerbation of head and neck dermatitis in patients treated for atopic dermatitis with dupilumab. JAMA Dermatol. 2019; 155(11):1312–1315. doi:10.1001/jamadermatol.2019.2613
15.
AchtenR, BakkerD, AriensL, et al.Long-term follow-up and treatment outcomes of conjunctivitis during dupilumab treatment in patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunol Pract. 2021; 9(3):1389–1392.e2. doi:10.1016/j.jaip.2020.09.042
16.
NogueiraM, TorresT. Janus kinase inhibitors for the treatment of atopic dermatitis: focus on Abrocitinib, Baricitinib, and Upadacitinib. Dermatol Pract Concept. 2021; 11(4):e2021145. doi:10.5826/dpc.1104a145
17.
BlackstoneB, PatelR, BewleyA. Assessing and improving psychological well-being in psoriasis: considerations for the clinician. Psoriasis Targets Ther. 2022; 12:25–33. doi:10.2147/PTT.S328447
18.
BlaissMS, StevenGC, BenderB, et al.Shared decision making for the allergist. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2019; 122(5):463–470. doi:10.1016/j.anai.2018.08.019
19.
SilverbergJI, PatelN, ImmaneniS, et al.Assessment of atopic dermatitis using self-report and caregiver report: a multicentre validation study. Br J Dermatol. 2015; 173(6):1400–1404. doi:10.1111/bjd.14031
20.
AhmadF, JhajjAK, StewartDE, et al.Single item measures of self-rated mental health: a scoping review. BMC Health Serv Res. 2014; 14(1):398. doi:10.1186/1472-6963-14-398
21.
KroenkeK, SpitzerRL, WilliamsJBW, et al.Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007; 146(5):317–325. doi:10.7326/0003-4819-146-5-200703060-00004
22.
KroenkeK, SpitzerRL, WilliamsJBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003; 41(11):1284–1292. doi:10.1097/01.MLR.0000093487.78664.3C
23.
MigliettaE, Belessiotis-RichardsC, RuggeriM, et al.Scales for assessing patient satisfaction with mental health care: a systematic review. J Psychiatr Res. 2018; 100:33–46. doi:10.1016/j.jpsychires.2018.02.014
ThayaparanAJ, MahdiE. The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool for use in various settings. Med Educ Online. 2013; 18:10.3402/meo.v18i0.21747. doi:10.3402/meo.v18i0.21747
26.
FaughtJ, BierlC, BartonB, et al.Stress in mothers of young children with eczema. Arch Dis Child. 2007; 92(8):683–686. doi:10.1136/adc.2006.112268
27.
BeckLA, ThaçiD, HamiltonJD, et al.Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med. 2014; 371(2):130–139. doi:10.1056/NEJMoa1314768
28.
SimpsonEL, PallerAS, SiegfriedEC, et al.Efficacy and safety of dupilumab in adolescents with uncontrolled moderate to severe atopic dermatitis: a phase 3 randomized clinical trial. JAMA Dermatol. 2020; 156(1):44–56. doi:10.1001/jamadermatol.2019.3336
29.
SimpsonEL, PappKA, BlauveltA, et al.Efficacy and safety of upadacitinib in patients with moderate to severe atopic dermatitis: analysis of follow-up data from the measure up 1 and measure up 2 randomized clinical trials. JAMA Dermatol. 2022; 158(4):404–413. doi:10.1001/jamadermatol.2022.0029
30.
SedehFB, HenningMAS, JemecGBE, et al.Comparative efficacy and safety of monoclonal antibodies and janus kinase inhibitors in moderate-to-severe atopic dermatitis: a systematic review and meta-analysis. Acta Derm Venereol. 2022; 102:adv00764. doi:10.2340/actadv.v102.2075
31.
SilverbergJI, AdamDN, ZirwasM, et al.Tralokinumab plus topical corticosteroids as needed provides progressive and sustained efficacy in adults with moderate-to-severe atopic dermatitis over a 32-week period: an ECZTRA 3 post hoc analysis. Am J Clin Dermatol. 2022; 23(4):547–559. doi:10.1007/s40257-022-00702-2
32.
ZimmermannM, RindD, ChapmanR, et al.Economic evaluation of dupilumab for moderate-to-severe atopic dermatitis: a cost-utility analysis. J Drugs Dermatol. 2018; 17(7):750–756.
33.
CapozzaK, FunkM, HeringM, et al.Patients' and caregivers' experiences with atopic dermatitis-related burden, medical care, and treatments in 8 countries. J Allergy Clin Immunol Pract. 2023; 11(1):264–273.e1. doi:10.1016/j.jaip.2022.10.032
34.
ChongAC, DiwakarL, KaplanCM, et al.Provision of food allergy care in the United Kingdom and United States: current issues and future directions. J Allergy Clin Immunol Pract. Published online March 27, 2023:S2213–2198(23)00316-1. doi:10.1016/j.jaip.2023.03.029
35.
EedyD. Dermatology: a specialty in crisis. Clin Med. 2015; 15(6):509–510. doi:10.7861/clinmedicine.15-6-509
36.
KatohN, OhyaY, IkedaM, et al.Japanese guidelines for atopic dermatitis 2020. Allergol Int. 2020; 69(3):356–369. doi:10.1016/j.alit.2020.02.006
37.
WerfelT, HeratizadehA, NiebuhrM, et al.Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber. J Allergy Clin Immunol. 2015; 136(1):96–103.e9. doi:10.1016/j.jaci.2015.04.015
38.
ChongAC, ChwaWJ, OngPY. Aeroallergens in atopic dermatitis and chronic urticaria. Curr Allergy Asthma Rep. 2022; 22(7):67–75. doi:10.1007/s11882-022-01033-2
39.
MonningerM, AggensteinerPM, PollokTM, et al.The importance of high quality real-life social interactions during the COVID-19 pandemic. Sci Rep. 2023; 13(1):3675. doi:10.1038/s41598-023-30803-9
