The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care

Abby E. Macbeth; Susan Holmes; Matthew Harries; Wing Sin Chiu; Christos Tziotzios; Simon de Lusignan; Andrew G. Messenger; Andrew R. Thompson

doi:10.1111/bjd.21055

The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care

Abby E. Macbeth, Susan Holmes, Matthew Harries, Wing Sin Chiu, Christos Tziotzios, Simon de Lusignan, Andrew G. Messenger, Andrew R. Thompson^*

^*Corresponding author for this work

Dermatology

Research output: Contribution to journal › Article › peer-review

39 Citations (Scopus)

Abstract

Background: Alopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact. Objectives: To assess the co-occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment. Methods: In total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre-existing mental health conditions, rates of mental health-related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521). Results: Depression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new-onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA. Conclusions: People with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence-based mental health treatment programmes are needed for people with AA. What is already known about this topic? Alopecia areata is a common cause of nonscarring hair loss. Psychological comorbidity is common in people with alopecia areata, but limited information is available on the co-occurrence and impact of depression and anxiety in this group. What does this study add? Adults newly diagnosed with alopecia areata (5435 in UK primary care) have a higher background prevalence of depression and anxiety than population controls, and are also at 30–38% higher risk of being subsequently diagnosed with new-onset depression and anxiety. After alopecia areata diagnosis, people with the condition are more likely to be issued time off work certificates (56% higher) and to be recorded as unemployed (82% higher risk) than population controls.

Original language	English
Pages (from-to)	73-81
Number of pages	9
Journal	British Journal of Dermatology
Volume	187
Issue number	1
DOIs	https://doi.org/10.1111/bjd.21055
Publication status	Published - Jul 2022

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10.1111/bjd.21055

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@article{b42574c2be3840d1a5f98707bd7bb775,

title = "The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care",

abstract = "Background: Alopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact. Objectives: To assess the co-occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment. Methods: In total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre-existing mental health conditions, rates of mental health-related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521). Results: Depression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new-onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA. Conclusions: People with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence-based mental health treatment programmes are needed for people with AA. What is already known about this topic? Alopecia areata is a common cause of nonscarring hair loss. Psychological comorbidity is common in people with alopecia areata, but limited information is available on the co-occurrence and impact of depression and anxiety in this group. What does this study add? Adults newly diagnosed with alopecia areata (5435 in UK primary care) have a higher background prevalence of depression and anxiety than population controls, and are also at 30–38% higher risk of being subsequently diagnosed with new-onset depression and anxiety. After alopecia areata diagnosis, people with the condition are more likely to be issued time off work certificates (56% higher) and to be recorded as unemployed (82% higher risk) than population controls.",

author = "Macbeth, {Abby E.} and Susan Holmes and Matthew Harries and Chiu, {Wing Sin} and Christos Tziotzios and {de Lusignan}, Simon and Messenger, {Andrew G.} and Thompson, {Andrew R.}",

note = "Funding Information: sources This research was sponsored by Pfizer. Project management, medical writing and statistical support were provided by Momentum Data, UK, and were funded by Pfizer UK. M.H. is supported by the Manchester NIHR Biomedical Research Centre.We thank the patients and practices who are members of the Oxford RCGP RSC network, who allow their data to be shared for surveillance, research, quality improvement and education. We acknowledge the collaboration of the primary care computerized medical record system providers EMIS, TPP, InPractice Systems, Microtest and Apollo Medical in facilitating the RCGP RSC data; data access support from the RCGP RSC team of the University of Oxford and University of Surrey; and project management, medical writing and statistical input from Anita Lynam, Louise Jordan and Anna-Louise Dennis of Momentum Data, and project management support from Filipa Ferreira of the University of Oxford and University of Surrey. Publisher Copyright: {\textcopyright} 2022 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.",

year = "2022",

month = jul,

doi = "10.1111/bjd.21055",

language = "English",

volume = "187",

pages = "73--81",

journal = "British Journal of Dermatology",

issn = "0007-0963",

publisher = "John Wiley & Sons, Ltd (10.1111)",

number = "1",

}

TY - JOUR

T1 - The associated burden of mental health conditions in alopecia areata

T2 - a population-based study in UK primary care

AU - Macbeth, Abby E.

AU - Holmes, Susan

AU - Harries, Matthew

AU - Chiu, Wing Sin

AU - Tziotzios, Christos

AU - de Lusignan, Simon

AU - Messenger, Andrew G.

AU - Thompson, Andrew R.

N1 - Funding Information: sources This research was sponsored by Pfizer. Project management, medical writing and statistical support were provided by Momentum Data, UK, and were funded by Pfizer UK. M.H. is supported by the Manchester NIHR Biomedical Research Centre.We thank the patients and practices who are members of the Oxford RCGP RSC network, who allow their data to be shared for surveillance, research, quality improvement and education. We acknowledge the collaboration of the primary care computerized medical record system providers EMIS, TPP, InPractice Systems, Microtest and Apollo Medical in facilitating the RCGP RSC data; data access support from the RCGP RSC team of the University of Oxford and University of Surrey; and project management, medical writing and statistical input from Anita Lynam, Louise Jordan and Anna-Louise Dennis of Momentum Data, and project management support from Filipa Ferreira of the University of Oxford and University of Surrey. Publisher Copyright: © 2022 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

PY - 2022/7

Y1 - 2022/7

N2 - Background: Alopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact. Objectives: To assess the co-occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment. Methods: In total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre-existing mental health conditions, rates of mental health-related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521). Results: Depression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new-onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA. Conclusions: People with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence-based mental health treatment programmes are needed for people with AA. What is already known about this topic? Alopecia areata is a common cause of nonscarring hair loss. Psychological comorbidity is common in people with alopecia areata, but limited information is available on the co-occurrence and impact of depression and anxiety in this group. What does this study add? Adults newly diagnosed with alopecia areata (5435 in UK primary care) have a higher background prevalence of depression and anxiety than population controls, and are also at 30–38% higher risk of being subsequently diagnosed with new-onset depression and anxiety. After alopecia areata diagnosis, people with the condition are more likely to be issued time off work certificates (56% higher) and to be recorded as unemployed (82% higher risk) than population controls.

AB - Background: Alopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact. Objectives: To assess the co-occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment. Methods: In total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre-existing mental health conditions, rates of mental health-related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521). Results: Depression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new-onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA. Conclusions: People with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence-based mental health treatment programmes are needed for people with AA. What is already known about this topic? Alopecia areata is a common cause of nonscarring hair loss. Psychological comorbidity is common in people with alopecia areata, but limited information is available on the co-occurrence and impact of depression and anxiety in this group. What does this study add? Adults newly diagnosed with alopecia areata (5435 in UK primary care) have a higher background prevalence of depression and anxiety than population controls, and are also at 30–38% higher risk of being subsequently diagnosed with new-onset depression and anxiety. After alopecia areata diagnosis, people with the condition are more likely to be issued time off work certificates (56% higher) and to be recorded as unemployed (82% higher risk) than population controls.

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U2 - 10.1111/bjd.21055

DO - 10.1111/bjd.21055

M3 - Article

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AN - SCOPUS:85129844629

SN - 0007-0963

VL - 187

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EP - 81

JO - British Journal of Dermatology

JF - British Journal of Dermatology

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The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care

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