Abstract
Background:
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with physical and psychological burden. Prior research has shown increased rates of depression and anxiety among individuals with HS; however, sex-based disparities in the prevalence of these mental health conditions in patients with HS remain underexplored.
Objective:
To evaluate sex-based differences in the prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and the prescribing of antidepressants and anxiolytics among patients with HS.
Methods:
Using the TriNetX database, we identified patients over the age of 18 who had a recorded diagnosis of HS. Propensity score matching based on demographics was applied to compare prevalence rates of MDD, GAD, and antidepressant and anxiolytic prescriptions between patients with HS and matched controls without HS, as well as between men and women with HS.
Results:
Women with HS had significantly higher odds of MDD (OR: 1.40), GAD (OR: 1.22), and prescriptions for antidepressants (OR: 1.28) and anxiolytics (OR: 1.40) compared with women without HS. Men with HS demonstrated higher rates of MDD (OR: 1.33), GAD (OR: 1.13), and prescriptions for antidepressants (OR: 1.28) and anxiolytics (OR: 1.42) compared to men without HS. When comparing women with HS to men with HS, women had significantly higher odds of MDD (OR: 1.88), GAD (OR: 1.94), and prescriptions for antidepressants (OR: 1.72) and anxiolytics (OR: 1.39).
Conclusion:
A higher prevalence of psychiatric conditions was found in patients with HS compared to patients without HS, as well as in women with HS compared to men with HS. Recognizing these disparities is important, as they highlight the distinct psychological burdens experienced by women and men with HS that may influence disease management, treatment engagement, and overall quality of life.
Introduction
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent painful nodules, abscesses, and sinus tract formation, which can often lead to significant physical discomfort, scarring, and impaired quality of life. 1 The chronic pain, disfigurement, and stigma associated with HS can cause substantial psychological distress, with prior studies reporting an increased prevalence of mental health disorders, such as depression and anxiety. 2
HS predominantly affects younger adults, with a disproportionate impact on women and Black Americans. 3 The prevalence of HS in women is more than twice that in men. However, a retrospective analysis found that women have an earlier age of disease onset, while men are more than twice as likely to present with severe disease (Hurley-III). 4 HS affects women more often in the inframammary and groin regions, whereas men are typically more affected in the gluteal region and also tend to have more severe acne. 5
This study aimed to compare the prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and antidepressant and anxiolytic prescriptions between men and women with HS.
Understanding these prevalence patterns is essential for clinical practice. Significant sex-based disparities in depression, anxiety, and related conditions may reflect underlying biological, hormonal, or psychosocial influences on mental health and further emphasize the need for targeted mental health screenings, as well as integrated dermatologic and psychiatric care.
Methods
The TriNetX database is a de-identified, nationwide, population-level claims dataset comprising over two hundred million patients. Through this platform, we identified individuals >18 who had a recorded diagnosis of HS (ICD-10 L73.2). Each group was then matched to a respective control group with no diagnosis of HS. Men with HS were matched to men without HS, and women with HS were matched to women without HS. Age and demographic characteristics were used for propensity score matching.
The primary analyses assessed included MDD, GAD, and the prescription of antidepressants and anxiolytics. Propensity score matching was performed separately for each comparative analysis. Sex-stratified comparisons of patients with HS versus controls were conducted independently for men and women. All analyses were derived from the same underlying HS population; differences in sample size reflect analysis-specific matching requirements rather than redefinition of the HS cohort.
In this study, we identified 194,979 women and 56,515 men diagnosed with HS. In our control group, we identified 8,761,514 women and 6,333,596 men without HS.
Results
Demographic data for the matched study populations are summarized in Table 1. The matched cohort included 244,216 patients, with 189,661 women and 54,555 men in both the HS and control groups. The mean age at index was 36.5 years (SD ± 14.8) and was slightly higher in men (39.5) than women (35.4). Across groups, half of the patients were White (50.4%), followed by Black or African American individuals (33.1%). Hispanic or Latino ethnicity accounted for 9.8% of the sample. Other races, which included Asian, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander, were each represented by less than 3% of the total sample.
Baseline Characteristics of Matched Women and Men with and without HS
Table 2 presents a comparison of psychiatric conditions and medication use between women with HS and matched controls without HS and between men with HS and matched controls without HS. Compared to women without HS, women with HS had a significantly higher prevalence of MDD (27.1% vs. 20.1%; OR: 1.40, 95% CI: 1.38–1.42) and GAD (10.7% vs. 8.9%; OR: 1.22, 95% CI: 1.20–1.25). Women with HS were also significantly more likely to be prescribed antidepressants (34.4% vs. 29.1%; OR: 1.28, 95% CI: 1.26–1.30) and anxiolytics (26.3% vs. 20.4%; OR: 1.40, 95% CI: 1.37–1.41). Compared to men without HS, men with HS had significantly higher odds of MDD (17.1% vs. 13.5%; OR: 1.33, 95% CI: 1.29–1.38) and GAD (6.0% vs. 5.3%; OR: 1.13, 95% CI: 1.07–1.19). Additionally, men with HS were significantly more likely to be prescribed antidepressants (24.6% vs. 20.2%; OR: 1.28, 95% CI: 1.25–1.32) and anxiolytics (21.6% vs. 16.3%; OR: 1.42, 95% CI: 1.38–1.46). This pattern was also observed descriptively in our control population, where women had higher prevalence of MDD (20.1% vs. 13.5%), GAD (8.9% vs 5.3%), antidepressant use (29.1% vs. 20.2%), and anxiolytic use (20.4% vs. 16.3%) compared to men.
Prevalence of MDD, GAD, and Antidepressant and Anxiolytic Prescriptions among Women with HS Compared to Women without HS and among Men with HS Compared to Men without HS
Statistically significant.
Table 3 compares women and men with HS. Women with HS had significantly higher odds of MDD (28.2% vs. 17.3%; OR: 1.88, 95% CI: 1.82–1.93) and GAD (10.9% vs. 5.9%; OR: 1.94, 95% CI: 1.85–2.02) compared to men with HS. Women were also significantly more likely to be prescribed antidepressants (36.3% vs. 24.9%; OR: 1.72, 95% CI: 1.68–1.77) and anxiolytics (27.9% vs. 21.8%; OR: 1.39, 95% CI: 1.35–1.42).
Prevalence of MDD, GAD, and Antidepressant and Anxiolytic Prescriptions between Matched Women with HS Versus Men with HS
Statistically significant.
Discussion
The findings of this study highlight significant sex differences in the prevalence of psychiatric comorbidities among patients diagnosed with HS. Women with HS had a higher prevalence of depression, anxiety, antidepressant use, and anxiolytic use compared to men with HS.
Additionally, when compared to matched controls without HS, both women and men with HS had significantly higher odds of depression, anxiety, and psychotropic medication prescriptions, reinforcing the psychiatric burden associated with HS.
The increased prevalence of mental health conditions in women compared to men with HS is consistent with broader trends in psychiatric disorders, where women generally report higher rates of medication use, 6 anxiety, 7 and depression. 8 Moreover, the magnitude of these sex-based differences was greater among patients with HS than in controls, suggesting that HS may amplify existing disparities in psychiatric burden beyond baseline trends.
These findings highlight important sex-based considerations in the mental health management of patients with HS. They do not suggest that mental health screening should be performed less frequently or less rigorously in men. Rather, the data support routine screening for all patients with HS, with attention to differences in documented psychiatric burden between women and men. Among women with HS, the higher prevalence of depression, anxiety, and psychotropic medication use may reflect a greater burden of psychiatric conditions and point to a need for early identification, timely referral to mental health care, and close longitudinal follow-up to support sustained engagement with care. 9 In contrast, the lower documented prevalence among men despite more severe disease may indicate potential underrecognition and sociocultural barriers to seeking care. 10 These findings highlight the importance of targeted efforts to improve education on psychiatric symptom recognition, encourage treatment initiation, and support continued engagement with mental health care.
While this study provides novel insights into the relationship between biological sex and the prevalence of mental health disorders and medication use in patients with HS, certain limitations should be acknowledged. First, the study’s retrospective design may introduce selection bias, which could impact the validity of the findings. Additionally, missing data from clinical records or follow-up assessments could also introduce bias. Relatedly, because patients with HS may have more frequent disease-related clinical encounters, there may be greater opportunity for recognition and diagnosis of psychiatric conditions, which are frequently underrecognized in routine clinical care of the general population. Lastly, differences in racial composition reflect the demographic distribution of participating health care systems within TriNetX and may not fully represent population-level disease prevalence.
Conclusion
In conclusion, this study reports sex differences in the prevalence of depression and anxiety among patients diagnosed with HS. Among individuals with HS, women were more likely than men to be diagnosed with MDD and GAD. Women were also more likely to receive prescriptions for antidepressants and anxiolytics. Understanding sex disparities is important as they highlight the distinct psychological burdens associated with HS, which can impact disease management, treatment outcomes, and quality of life. While this study does not establish sex-specific screening thresholds or frequencies, the observed differences in psychiatric burden highlight the importance of routine screening for all patients with HS and may help inform clinician awareness, follow-up practices, and referral decisions.
Footnotes
Author Disclosure Statement
S.G.K. has received research funding from the National Institutes of Health and the National Science Foundation. In the past 36 months, she has served as a consultant for Lilly, Sage Therapeutics, Biogen, Reunion Neuroscience, Relmada, Gerbera, Arrivo Bioventures, and Intracellular Therapies.
Funding Information
No funding was received for this article.