The link between atopic dermatitis and mental health outcomes across childhood: A longitudinal cohort study

Abstract

Importance Research has highlighted associations between atopic dermatitis (AD) and mental health conditions in adults. However, literature on the development of mental health comorbidities in children is limited despite the large burden of pediatric AD worldwide. Objective To examine the relationship between AD and internalizing behaviors and symptoms of depression at multiple time points across childhood and adolescence, and to explore potential mediating factors including asthma/rhinitis, sleep, and inflammation. Design Longitudinal cohort study Setting Population-based birth cohort in the United Kingdom Participants Children followed from birth for a mean duration of 10.0 years (SD 2.9 years) from The Avon Longitudinal Study of Parents and Children Exposure AD annual period prevalence and disease severity assessed at 11 time points between ages 6 months and 18 years, measured by standardized questions about flexural dermatitis Main outcomes and measures Symptoms of depression, measured using child-reported responses to the Short Moods and Feelings Questionnaire at five time points between ages 10 and 18 years; and Internalizing behaviors, measured by maternal report of the Emotional Symptoms subscore of the Strength and Difficulties Questionnaire collected at seven time points between ages 4 and 16 years. Results Among 11,181 children, the annual period prevalence of internalizing behaviors and symptoms of depression ranged from 10.3% to 16.0% and 6.0% to 22.1%, respectively. Although mild/moderate AD was not associated with symptoms of depression, it was associated with internalizing behaviors as early as age 4 (average of 29-84% increased odds across childhood in adjusted models). Severe AD was associated with symptoms of depression (aOR 2.38, 95% CI 1.21-4.72) and internalizing symptoms (aOR 1.90, 95% CI 1.14-3.16). Sleep quality mediated some of this association, but it was not explained by differences in sleep duration, asthma/rhinitis, nor inflammatory markers (IL-6 and CRP). Conclusion and relevance Within a population-based birth cohort in the United Kingdom, severe AD was associated with symptoms of depression and internalizing behaviors throughout childhood and adolescence. Risk of internalizing symptoms was increased even for children with mild AD beginning early in childhood, highlighting the importance of behavioral/mental health awareness in providers treating this population.