Jon Anders Halvorsen

The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants––3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67–3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68–2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33–2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.

Genital Ulcers as Initial Manifestation of Epstein-Barr Virus Infection: Two New Cases and a Review of the Literature

Genital ulceration is an uncommon manifestation of primary Epstein-Barr virus (EBV) infection. We present here two cases of genital ulcers probably caused by EBV. The first case is a 12-year-old girl with a genital ulcer appearing before specific EBV serology could identify a primary infection. However, serology was positive 13 days after the ulcer appeared. Polymerase chain reaction for EBV was positive in the biopsy from the ulcer as well. The second case is an 18-year-old female in whom the specific EBV serology was positive 8 days after appearance of the ulcer. The ulcers in both cases healed after 21 days. We reviewed the literature and a total of 26 cases of EBV-associated genital ulcers in females are now published. Median age of the 26 cases is 14.5 years of whom only 6 reports previous sexual contact. Mean healing time for the ulcers is 18 days. Our two cases correspond well with clinical reports of 24 EBV-associated genital ulcers in the literature.

Is the association between acne and mental distress influenced by diet? Results from a cross-sectional population study among 3775 late adolescents in Oslo, Norway

BackgroundSeveral studies with conflicting findings have investigated the association between acne and mental health problems. Acne usually starts in adolescents, as does an increase in the prevalence of depression and anxiety. Recently, there has been more focus on the link between diet and acne and diet and mental health problems. The objective of this study is to investigate the association between acne and mental distress and to explore a possible influence of dietary factors on the relation.MethodsA population-based cross-sectional study in Oslo of 18 or 19 year old adolescents. The participation rate was 80%. Acne was self-reported. To measure mental distress, the Hopkins Symptom Checklist 10 was used. Diet and lifestyle variables were also collected by questionnaire and socio-demographic variables were obtained from Statistics Norway.ResultsThe prevalence of acne was 14.4% among the males and 12.8% among the females. The mean score of mental distress increased when the severity of acne increased. In the crude analyses, the significant associations with acne among the males were: mental distress OR = 1.63, frequent consumption of chocolate/sweets OR = 1.40, frequent consumption of potato chips OR = 1.54. The significant crude associations with acne among the females were: mental distress OR = 2.16, infrequent consumption of raw vegetables OR = 1.41, non-Western background OR = 1.77 and low family income OR = 2.14. No crude associations with acne were identified in either gender for the consumption of sugary soft drinks, fatty fish, cigarette smoking or alcohol. In adjusted models which included diet and socio-demographic variables, the association between acne and mental distress was unchanged for both males (OR = 1.68) and females (OR = 2.04), and between acne and infrequent consumption of raw vegetables among the females (OR = 1.38).ConclusionAmong late adolescents in Oslo, self-reported acne is significantly associated with mental distress and, among girls, with infrequent consumption of raw vegetables. Our finding does not support the hypothesis that dietary factors alter the relationship between acne and mental distress.

Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study.

There are few studies on psychosocial problems in adolescents with eczema. We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning with eczema. A total of 4,744 adolescents (18-19 years) were invited for the study, of whom 3,775 (80%) participated. The overall prevalence of current eczema was 9.7%. Among those with current eczema, 15.5% reported suicidal ideation compared with 9.1% among those without eczema, significantly associated in a multivariate model (odds ratio 1.87, 95% confidence interval 1.31-2.68). In a subgroup analyses, the prevalence of suicidal ideation in those with both eczema and itch was 23.8%, and was significantly associated, compared with those without eczema (3.57, 2.46-5.67). Eczema was associated with mental health problems assessed by the Strength and Difficulties Questionnaire (1.72, 1.21-2.45) and the Hopkins Symptom Checklist 10 (1.63, 1.23-2.16). Five questions assessed social function: feeling attached to family and friends; thriving at school; experiencing bullying; and romantic relationships. Boys with current eczema were less likely to have had romantic relationships (1.93, 1.21-3.08). Eczema in late adolescence is associated with suicidal ideation and mental health problems but rarely with social problems. Our findings point to the importance of addressing mental health issues in adolescents with eczema.

Itch and mental distress: a cross-sectional study among late adolescents.

Itch is known to be associated with psychological factors in adults, but has not been explored among adolescents. A cross-sectional, questionnaire-based population study involving adolescents born mostly in 1986 was carried out in 2004. A total of 4744 individuals were invited and the participation rate was 80%. The Hopkins Symptom Checklist-10 was used to measure mental distress. The prevalence of itch was 8.8%. Itch was associated with mental distress, gender, socio-demographic factors, asthma, rhinoconjunctivitis and eczema. In a logistic regression model adjusting for possible confounders (including eczema), an association between itch and mental distress was found (odds ratio=3.1). In a subgroup analysis of those without eczema, the association was stronger. When the severity of itch increased, in both genders mental distress also increased. Mental distress and eczema are the variables in the study that contributes most to the distribution of itch at population level among adolescents in Oslo, Norway.

Itch and pain in adolescents are associated with suicidal ideation: a population-based cross-sectional study.

The association between itch and suicidal ideation has not been explored previously in the general population. The aim of the present study is to analyse the association between itch and suicidal ideation in adolescents, and to compare the findings with an expected association between pain and suicidal ideation in the same sample. A total of 4,744 adolescents were invited to join the questionnaire-based study. The participation rate was 80%. The prevalence of suicidal ideation among those who reported no itch was 8.4% vs 21.1% among those who reported severe itch. Significant association between itch and suicidal ideation was found in a multivariate model (odds ratio 3.0, 95% confidence interval (CI) 2.1-4.2) and between pain and suicidal ideation (odds ratio 3.8, 95% CI 2.6-5.7). The findings were similar and statistically significant in girls and boys separately. Itch and pain are approximately equally strongly associated with suicidal ideation in a large general population of adolescents.

The burden of common skin diseases assessed with the EQ5D: a European multicentre study in 13 countries

Generic instruments measuring health‐related quality of life (HRQoL), like EQ5D™, enable comparison of skin diseases with healthy populations and nondermatological medical conditions, as well as calculation of utility data.

Acne and dairy products in adolescence: results from a Norwegian longitudinal study

Acne is a very common skin condition, and it is of great interest to elucidate lifestyle factors that may contribute to its occurrence. In the last decade, the acne‐diet connection has been brought back to credibility.

European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo

The term prurigo has been used for many decades in dermatology without clear definition, and currently used terminology of prurigo is inconsistent and confusing. Especially, itch‐related prurigo remains unexplored regarding the epidemiology, clinical profile, natural course, underlying causes, available treatments and economic burden, although burdensome and difficult to treat.

Parental divorce in late adolescence does not seem to increase mental health problems: a population study from Norway

BackgroundFormer studies have shown increased mental health problems in adolescents after parental divorce all over the Western world. We wanted to see if that still is the case in Norway today when divorce turns to be more and more common.MethodsIn a prospective study design, two samples were constituted, adolescents at a baseline survey in 2001/02 (n = 2422) and those at follow-up in 2003/04 (n = 1861), when the adolescents were 15/16 and 18/19 years-old, respectively. They answered self-administered questionnaires in both surveys of Young-HUBRO in Oslo. Early parental divorce was defined as that which occured before age 15/16 years, and late divorce occured between age 15/16 and 18/19. Internalized and externalized mental health problems were measured by the Hopkin’s Symptom Check List (HSCL-10) and the Strengths and Difficulties Questionnaire (SDQ).ResultsAfter linear regression models were adjusted for gender, ethnicity, family economy, social support, and mental health problem symptoms measured at baseline before parental divorce occured, late parental divorce did not lead to significant increase in mental health problems among adolescents in the city of Oslo. Early parental divorce was associated with internal mental health problems among young adolescents when adjusted only for the first four possible confounders.ConclusionsIt seems that parental divorce in late adolescence does not lead to mental health problems in Norway any more, as has been shown before, while such problems may prevail among young adolescents. This does not mean that parental divorce create less problems in late adolescence than before but these youths might have developed adjustment abilities against health effects as divorce have turned to be more common.