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INVESTIGATIVE REPORT
Suicidal Ideation in Adult Patients with Atopic Dermatitis: A German
Cross-sectional Study
Jan DIERIS-HIRCHE 1 , Uwe GIELER 2 , Frank PETRAK 1,3 , Wolfgang MILCH 4,5 , Bert TE WILDT 1 , Barbara DIERIS 6 and Stephan
HERPERTZ 1
Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, 2 Department of
Dermatology and 5 Clinic for Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, 3 Center for Psychotherapy
Wiesbaden, Wiesbaden, 4 Practice for Psychotherapy, Wettenberg, and 6 Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine,
Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Witten/Herdecke, Germany
1
A cross-sectional study was performed to assess symp-
toms of suicidality, depression and anxiety in adult pa-
tients with atopic dermatitis. The study describes the
relationships between these psychiatric symptoms and
skin-specific factors, such as atopic dermatitis severity
and skin satisfaction. A sample of 181 German patients
with atopic dermatitis was compared with a control
group of 64 persons with healthy skin with a similar
age and sex distribution. Standardized questionnaires
were used to assess suicidality (Pöldinger’s Scale),
depression and anxiety (Hospital Anxiety and Depres-
sion Scale; HADS), quality of life (Dermatology Life
Quality Index; DLQI), atopic dermatitis severity (Pa-
tient-Oriented Scoring Atopic Dermatitis; PO-SCORAD)
and skin satisfaction (Skin Satisfaction Questionnaire;
SSQ). The prevalence of suicidal ideation among pa-
tients with atopic dermatitis was high (21.3%); 3.9%
scored above the cut-off that might be an indicator for
acute suicidality. Depression symptoms, high severi-
ty of atopic dermatitis, lower age, and little touching
within the family were identified as significant factors
to predict suicidality in atopic dermatitis. Psychiatric
screening in dermatological treatment of atopic der-
matitis is discussed.
Key words: atopic dermatitis; suicidal ideation; depression;
anxiety; skin satisfaction.
Accepted Jul 5, 2017; Epub ahead of print Jul 5, 2017
Acta Derm Venereol 2017; 97: 1189–1195.
Corr: Jan Dieris-Hirche, Department of Psychosomatic Medicine and
Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum,
Alexandrinenstr. 1-3, DE-44791 Bochum, Germany. E-mail: jan.dieris-
[email protected]
A
topic dermatitis (AD) is a chronic inflammatory skin
disease with a wide spectrum of symptoms, such as
skin irritation, lichenification, dry skin and distressing
pruritus. AD occurs mostly in childhood and remits in
adulthood. The prevalence of AD among children in
industrialized western countries is estimated to be ap-
proximately 10–30%, while the prevalence rate of AD
among adults is approximately 1.5–3% (1). Recent data
suggest a multifactorial aetiology of AD with a sum of
different pathomechanisms, e.g. defects in skin barrier,
altered immunological response and environmental fac-
tors (2–4). AD is accompanied by a high psychological
burden and causes a substantial reduction in quality of
life (5–7). Although a strong association between psycho-
pathological conditions and skin diseases is well known,
the extent of psychiatric comorbidities in AD has been
little investigated (8–10). While many European studies
have detected an increased risk of symptoms of depres-
sion and anxiety among patients with AD, there is a lack
of knowledge regarding suicidal ideation and suicidality
in AD (5). This is of considerable relevance because af-
fective disorders might be a strong risk factor for suicide
attempts (11–13). Very few recent European studies have
reported prevalence rates for suicidal ideation in AD (5, 8,
14–17). In addition, assessment is often limited to single
items from various depression scales, which might reduce
the validity of the research. There is consensus that the
treatment of many patients with skin diseases is insuf-
ficient unless their psychological problems are not also
recognized and treated (5).
The present article reports a cross-sectional investiga-
tion of suicidal id