Anxiety Prevalent in Dermatology Outpatients

Dermatology outpatients are at a higher risk for, and have a higher prevalence of, anxiety disorders when compared to members of the general population.

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A recent systematic review and meta-analysis¹ revealed the prevalence of anxiety disorders among dermatology outpatients, as researchers sought to determine variations across types of anxiety and dermatologic conditions. Furthermore, they noted that in the literature, there are no systematic reviews that examine anxiety disorder prevalence across the entire population of adult dermatology outpatients.

Researchers utilized covidence systematic review software to screen and extract previous research before 2 reviewers screened titles, abstracts, and completed a review of each full text. They also completed data extraction and assessed text quality using the Joanna Briggs Institute Checklist for Prevalence Studies (JIB), a risk of bias assessment.

Texts included in the review were required to report the prevalence of an anxiety disorder or provide data supporting the ability to calculate prevalence. Authors of each paper were contacted, and researchers required a response within a 2-week period in order to include texts for review.

Researchers also utilized several other factors, including proportion of variance, potential sources of heterogeneity, and the impact of publication bias.

As a result, they identified a total of 5,423 studies, 32 of which met their criteria for dermatology outpatient inclusion. All 32 studies, amassing several regions and continents, had sufficient and qualifying JIB score results. Of the studies, 19 were of a cross-sectional nature, 10 were prevalence studies, and 3 were identified as case-control studies. In total, 12,812 participants were represented. However, only 29 studies were included in the meta-analysis due to a limited number of papers meeting the necessary criteria.

Results were investigated among general dermatology outpatients, patients with psoriasis, and patients with other unspecified dermatologic diagnoses. Papers involved in the review included prevalence of overall anxiety symptoms/diagnosis, obsessive-compulsive disorder, general anxiety disorder, panic disorder, social anxiety/phobia, agoraphobia, illness anxiety disorder, somatisation, and post-traumatic stress disorder.

The meta-analysis found that the prevalence of anxiety or anxiety symptoms ranged from 2.9% to 67.8% between all studies with an average prevalence of 26.7%.

Researchers noted that psoriasis was the only dermatologic condition for which there was an adequate sample size to examine specific anxiety disorder prevalence. Psoriasis outpatients had an average anxiety disorder prevalence of 33.9%, while general dermatology outpatients had a prevalence of 27.0%, and other specific dermatology outpatients had a prevalence of 15.1%.

The review and meta-analysis also analyzed the prevalence by grouped countries represented in the included papers, and researchers found there to be no significant difference in the prevalence estimates of anxiety disorders when comparing developed and developing countries.

Study limitations, according to researchers, included weaknesses or omissions in research methodology or papers included in the study as well as a limited number of existing studies properly addressing the intended subject matter.

“This is the first systematic review to assess the prevalence of all types of anxiety in the dermatology outpatient setting. While there was substantial variability in the prevalence of anxiety across studies, the meta-analysis revealed an average rate of anxiety in dermatology outpatients of 26.7%,” study authors wrote. “This falls within the range of prevalence reported in some previous studies of single dermatological conditions (psoriasis; primary hyperhidrosis) although not all (rosacea), which reported a lower prevalence than the present study.”

Reference

1. Storer B, Kershaw KA, Braund TA, Chakouch C, et al. The prevalence of anxiety disorders in dermatology outpatients: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. http://dx.doi.org/10.1111/jdv.19151