Mental health impairment among children with atopic dermatitis: A United States population-based cross-sectional study of the 2013-2017 National Health Interview Survey - 29/02/20

Doi : 10.1016/j.jaad.2019.10.019

Joy Wan, MD, MSCE ^a,^⁎ , Junko Takeshita, MD, PhD, MSCE ^a,^b, Daniel B. Shin, PhD ^a, Joel M. Gelfand, MD, MSCE ^a,^b
^a Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
^b Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

^∗Correspondence to: Joy Wan, MD, MSCE, 3400 Civic Center Blvd, PCAM South Tower, 7th Floor, Office 773, Philadelphia, PA 19104.3400 Civic Center BlvdOffice 773PCAM South Tower7th FloorPhiladelphiaPA19104

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 29 February 2020

Abstract

Background

Atopic dermatitis (AD) is associated with mental health disorders, but its impact on global mental health symptoms is less clear.

Objective

To determine the association between pediatric AD and mental health impairment.

Methods

In a cross-sectional study using 2013-2017 United States National Health Interview Survey data, children with and without AD were assessed for mental disorder with impairment (MDI) using a validated behavioral screening questionnaire. Mental health services utilization was also reported.

Results

The prevalence of any MDI was 26.7% (95% confidence interval [CI], 25.1-28.3) among children with AD and 17.7% (95% CI, 17.2-18.2) among those without AD, with severe MDI being present in 10.9% (95% CI 9.9-12.1) and 6.2% (95% CI 5.9-6.5), respectively. Adjusted for sociodemographic factors, AD was associated with higher odds of MDI (odds ratio, 1.52; 95% CI, 1.39-1.67), including impairments in conduct, emotions, peer relationships, and attention. Among children with AD, 19.9% (95% CI, 16.6-23.8) and 53.5% (95% CI, 48.5-58.5) of those with mild or severe MDI, respectively, had seen a mental health professional in the last year.

Limitations

Misclassification bias may arise from self-reported data.

Conclusion

AD is associated with clinically significant mental health symptoms, but many affected children may not seek or receive care for their symptoms.

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Key words : anxiety, attention, atopic dermatitis, conduct, depression, eczema, emotion, health care utilization, mental health, psychiatry, psychology, relationships

Abbreviations used : AD, ADHD, aOR, CI, MDI, NHIS, SDQ, US

Esquema

	Funding sources: The study was supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases grant P30-AR-069589. Dr Takeshita is also supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases K23-AR-068433.
	Conflicts of interest: Dr Wan receives research fellowship funding from Pfizer Inc (to the Trustees of the University of Pennsylvania) and has received payment for consulting work with Health Union, LLC. Dr Takeshita receives a research grant from Pfizer Inc (to the Trustees of the University of Pennsylvania) for work that is unrelated to this study and has received payment for continuing medical education work related to psoriasis that was supported indirectly by Eli Lilly and Novartis. Dr Gelfand served as a consultant for BMS, Boehringer Ingelheim, Janssen Biologics, Novartis Corp, UCB (DSMB), Sanofi, and Pfizer Inc., receiving honoraria; and receives research grants (to the Trustees of the University of Pennsylvania) from AbbVie, Boehringer Ingelheim, Janssen, Novartis Corp, Celgene, Ortho Dermatologics, and Pfizer Inc, and received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly, Ortho Dermatologics, and Novartis. Dr Gelfand is a co-patent holder of resiquimod for treatment of cutaneous T-cell lymphoma and a Deputy Editor for the Journal of Investigative Dermatology, receiving honoraria from the Society for Investigative Dermatology. Dr Shin reports no conflicts of interest.
	Disclaimer: The analyses, interpretations, and conclusions in this paper are credited to the authors and not to the National Center for Health Statistics in the Centers for Disease Control and Prevention, which is responsible only for the initial data.
	IRB approval status: The study was granted exemption status by the University of Pennsylvania Institutional Review Board.
	Reprints not available from the authors.