The Impact of Atopic Dermatitis Symptoms on Mental Health

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In this interview, Jessica Johnson, MPH, discusses the recent National Eczema Association study on the relationship between atopic dermatitis (AD) symptoms and mental health. Addressing correlations and considerations in managing patients with AD and mental health symptoms, Ms Johnson offers practical insights, stressing the importance of patient assessment and highlighting the significance of provider-patient relationships.

The Dermatologist: What is the correlation between AD symptoms and mental health?

Jessica Johnson: AD has a negative impact on patients’ and caregivers’ mental health, which can be exacerbated with increased disease severity. Itch has traditionally been characterized as the most troublesome symptom for patients with AD. Studies have shown that AD is also strongly associated with symptoms of psychological distress, including anxiety and depression, which both significantly contribute to the overall patient disease burden. Importantly, however, we found in our study that mental health impacts are not solely driven by changes in disease severity.

The Dermatologist: How does your study highlight patient and caregiver awareness of the impact of AD on mental health?

Jessica Johnson: We know that AD is associated with mental health symptoms; however, the actual patient-reported perception about the relationship between their mental health and their AD symptoms has previously not been well understood.

We wanted to find out what the AD community has experienced, specifically regarding their perceptions and awareness of how mental health relates to their AD symptoms. For us to be able to understand this awareness, or lack thereof, we surveyed 954 adult patients with AD and caregivers of pediatric patients with AD. We asked them questions about their or their child’s AD and mental health symptoms, including their perceptions of the connections between AD and mental health. We then asked about their experiences with referral and access to mental health services.

Seventy percent of survey respondents reported that either their or their child’s mental health was impacted by their eczema during the past year. More than one-third of survey respondents said that their or their child’s mood and emotions were affected a lot or extremely by their eczema in the past month. It was also interesting to find that both adults with eczema and caregivers of pediatric patients with eczema were very aware of their child’s mental health when they were experiencing a flare with their AD and right before they would experience a flare. Even after their flare, we had patients and caregivers both reporting apprehension about experiencing future flares resulting in ongoing detrimental mental health effects. These data confirm that many patients and caregivers are aware of the impact AD has on their mental health, and they may need or want additional support in this area.

The Dermatologist: What are the benefits of addressing mental health in the AD care setting, especially early in the disease?

Jessica Johnson: Our study highlighted the mental health impact that AD can have on patients despite the ever-growing pipeline of treatments and patient resources available to the community. We suggest that a collaborative approach to care, including addressing both the physical symptoms of AD and the patient’s overall mental health, can help people better manage their disease.

Addressing mental health issues for younger patients with AD may require additional attention. Children with AD often experience many different forms of stress that can impact their physical, cognitive, social, and emotional development, which can, in turn, have a negative impact on their families. The various types of stressors that a child with AD may face have the potential to put them at higher risk for developing poor mental health. This highlights the importance and potentially the benefit of addressing mental health early in their disease journey.

The Dermatologist: What tools can health care providers utilize to acknowledge and raise mental health considerations, despite AD clinical severity, to achieve a more holistic and integrative approach to treatment?

Jessica Johnson: There is a large opportunity right now for both patients and health care providers to acknowledge and raise mental health considerations as part of a more holistic and integrative approach to treatment. While many dermatologists are aware of the mental health issues that exist within dermatologic disease; currently there is not a standard of care for addressing them.

The opportunity remains to be able to improve both the assessment of and discussions around mental health within AD care settings. We saw in our study that both adult patients with AD and caregivers of pediatric patients with AD reported worsening of their mental health symptoms before and during flares. We also found that AD disease severity does not always predict current or ongoing mental health burden, and sometimes mental health symptom resolution may not necessarily parallel improvement in disease signs and/or symptoms.

Our findings suggest that patients may need additional mental health support at different points in their disease journey, regardless of their disease severity, warranting a more holistic clinical and patient-centered assessment of the overall disease burden for patients. Despite the strong association between AD and mental health conditions, there is still a significant proportion of patients who may need mental health support.

In terms of tools, providers may want to consider asking patients general questions about their mental health, or using various validated measures to improve the identification of patients who require additional support. It is also important to establish collaborations between mental health professionals and providers who treat AD to help increase accessibility to mental health resources and support for those patients who may not have otherwise been seen at all within the mental health system. For example, allergists and primary care physicians are nondermatological providers who frequently see patients with AD, usually patients with multiple atopic comorbidities. These patients may face a higher burden of mental health concerns and may benefit from a more standardized practice of diagnoses and discussions around the topic of mental health within both allergy and primary care settings.

The Dermatologist: What are the key takeaways or important points you would like practitioners to gain from your study on the relationship between AD symptoms and mental health?

Jessica Johnson: It is important to know that the discussion of mental health does not occur consistently during AD care. Both patients and health care providers have a big opportunity to acknowledge and raise mental health considerations, regardless of a patient’s AD clinical severity. It is also important for health care providers who treat patients with AD to understand patient and caregiver perspectives on this topic.

Previous research has shown us that patients report fear of stigmatization as a barrier to seeking mental health support, and while we recognize reducing mental health stigma is an ongoing process, providers may have the opportunity to improve patients’ mental health outcomes just through normalizing these discussions with their patients, as well as incorporating a more holistic, patient-centered care approach focused on increased shared decision-making. Addressing patient comfort with mental health conversations is a simple way for health care providers to introduce this topic as needed.

Reference:

Johnson JK, Loiselle A, Chatrath S, Smith Begolka W. Patient and caregiver perspectives on the relationship between atopic dermatitis symptoms and mental health. Dermatitis. Published online March 14, 2024. doi:10.1089/derm.2023.0365