Prevalence of Anxiety and Depression Symptoms in Patients Diagnosed with Atopic Dermatitis in Mexico: A Cross-Sectional Study

Original Manuscript

Ann Depress Anxiety. 2023; 10(1): 1116.

Prevalence of Anxiety and Depression Symptoms in Patients Diagnosed with Atopic Dermatitis in Mexico: A Cross-Sectional Study

Macias-Weinmann A*; Chávez-Ruiz AK; González-Díaz SN; Canseco-Villareal JI; Noyola-Pérez A

Regional Center of Allergy and Clinical Immunology, Hospital Universitario “Dr. José Eleuterio González”, México

Corresponding author: Macias-Weinmann A Regional Center of Allergy and Clinical Immunology at the Hospital Universitario “Dr. José Eleuterio González”, Madero y Gonzalitos S/N, Mitras Centro, 64460, Monterrey, Nuevo León, Mexico. Tel: +52 (81)8346-2515 Email: [email protected]

Received: February 28, 2023 Accepted: March 31, 2023 Published: April 07, 2023


Introduction: Atopic Dermatitis (AD) is one of the most common inflammatory skin diseases affecting individuals of all ages. It is proposed that intense pruritus, sleep cycle disturbances, stigmatization, and social isolation due to the visual nature of the disease, along with the poor quality of life and the presence of neuroinflammation, contribute to the development of anxiety and depression. According to recent systematic reviews and meta-analyses evaluating the relationship between AD, anxiety, and depression, there is a higher likelihood of developing depression during the disease, predominantly in children and both disorders in adults. However, no Mexican studies have determined the prevalence of anxiety and depression symptoms in children, adolescents, and adults diagnosed with AD.

Objective: To determine the prevalence of anxiety and depression symptoms in patients diagnosed with AD.

Material and Methods: This is an observational, cross-sectional, and comparative study. We included forty-eight patients who met the inclusion criteria and applied two self-administered screening questionnaires for anxiety and depression symptoms.

Results: A prevalence rate of depression symptoms of 4.5% and 16.7% were found in children and adolescents, respectively, and 27.3% and 16.6% for anxiety symptoms, respectively. On the other hand, in the group of adults, the presence of clinically significant symptoms of anxiety and depression was present at 40% and 45%, respectively.

Conclusion: It is crucial that allergists evaluate the psycho-emotional sphere in patients with AD with the available screening tools with the aim to identify and refer in a timely manner.

Keywords: Atopic dermatitis; Anxiety; Depression; Allergic disorder; Mental health

Abbreviations: AD: Atopic Dermatitis; DALYs: Disability-Adjusted Life Years (DALYs); SCAS: Spence Children’s Anxiety Scale; CDI: Kovacs Depression Inventory; BDI II: Beck Depression Inventory-Second Edition; BAI: Beck Anxiety Inventory, DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; DSM-V: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; SCORAD: SCORing Atopic Dermatitis


Atopic Dermatitis (AD) is a prevalent and complex inflammatory skin disease that affects individuals of all ages, with a reported prevalence of up to 20% of children and 10% of adults in high-income countries [1,2]. The disease is characterized by eczematous lesions, intense pruritus, and a chronic or relapsing course [3,4]. Furthermore, AD imposes the highest disability-adjusted life years (DALYs) burden compared to other dermatoses and is associated with numerous atopic and non-atopic comorbidities, such as asthma and allergic rhinitis, food allergy, and mental health disorders [2,5].

Anxiety and depression are leading causes of global disability and have been associated with AD. Recent systematic reviews and meta-analyses have examined the correlation between anxiety, depression, and AD and have found that patients with AD have a greater likelihood of presenting with depression predominantly in childhood and both disorders in adulthood. Furthermore, research has consistently discovered a positive association between anxiety in adults and children with AD, with higher mean scores for anxiety assessment tools [6]. However, no Mexican studies have established the prevalence of anxiety and depression symptoms in children, adolescents, and adults diagnosed with AD.

The effect of AD on patients' lives is substantial, as it restricts interpersonal relationships, negatively influences self-worth, and results in rejection and stigmatization. Therefore, the aim of this research is to determine the prevalence of anxiety and depression symptoms in Mexican patients diagnosed with AD and establish the correlation between the results obtained from the anxiety and depression scales and the different variables examined in the population. Our findings will assist in identifying the percentage of individuals in the Mexican population who may be at risk of developing mental health disorders because of their illness and in supporting the development of targeted interventions to improve the mental health of individuals with AD. Incorporating patient burden and comorbidities into the evaluation and management of patients with AD is critical to improving therapeutic decision-making and achieving superior patient outcomes.

Material and Methods

We conducted an observational, cross-sectional, and comparative study at the Regional Center of Allergy and Clinical Immunology at the Hospital Universitario "Dr. José Eleuterio González" in Monterrey, Nuevo León, Mexico, from November 5, 2021, to November 1, 2022. The study protocol was approved by the Research Ethics Committee and Ethics Committee of the Hospital Universitario "Dr. José Eleuterio González".

We included all patients over seven years old of both genders who were diagnosed with AD. Participants were verbally informed about the study's objective, and their queries were addressed to ensure their understanding. They were also given written assent and consent as appropriate. The study used two self-applicable physical screening questionnaires for anxiety and depression symptoms. Children and adolescents aged 7-17 years were administered the Spence Children's Anxiety Scale (SCAS) and the Kovacs Depression Inventory (CDI), while adults aged ≥8 years were given the Beck Depression Inventory-Second Edition (BDI-II) and the Beck Anxiety Inventory (BAI). The questionnaires took approximately 15 minutes to complete.

During the single study visit, we collected sociodemographic variables such as age, gender, and education and clinical variables such as the presence of concomitant atopic diseases, duration of symptoms, and severity of atopic dermatitis.

Overview of Assessment Tools used for Anxiety and Depression

Our study utilized various validated tools to assess anxiety and depression symptoms in both adults and children. The Beck Anxiety Inventory (BAI) is a popular tool used to measure anxiety symptoms in individuals and evaluate their severity based on various behavioral and symptomatic factors. It consists of four main factors, namely subjective, neurophysiological, autonomic, and panic, and has been validated across different settings and populations. The inventory includes 21 items evaluated on a 4-point scale, and a global score range of 0 to 63 points. A score of 16 points or more is considered clinically significant for anxiety, with scores ranging from 0-5 indicating minimal anxiety, 6-15 indicating mild anxiety, 16-30 indicating moderate anxiety, and 31-63 indicating severe anxiety [7]. The Beck Depression Inventory-Second Edition (BDI-II) is a commonly used tool to diagnose depression symptoms in adults. It evaluates the presence of depression symptoms, including both DSM-IV and DSM-V criteria and cognitive symptoms, through 21 items rated on a scale of 0 to 3. The BDI-II has strong psychometric properties and provides cutoff points for different levels of depression severity: 0-13 for minimum range, 14-19 for mild depression, 20-28 for moderate depression, and 29-63 for severe depression [8].

For assessing the severity of depressive symptoms in children and adolescents aged 7-17 years, we used the Kovacs Children's Depression Inventory (CDI). The CDI consists of 27 items scored on a 3-option scale, with a total score range of 0 to 54 points. The cutoff point that defines the presence of depressive symptoms is 19. This scale covers both expressions of classic depressive symptoms (such as crying, sadness, hopelessness, reduced motivation, difficulty sleeping, and feeling worthless) and manifestations of depression in two contexts: school and family (such as having no friends, feeling like a burden, worse and performance in school). [9]

The SCAS consists of 44 items scored on a 4-option scale that evaluates anxiety symptoms in children and adolescents. The evaluation is based on whether the level of anxiety is higher than that of other children and adolescents in their age and gender group and the severity of these symptoms. The scores are added and compared with the appropriate age and gender T-score. A T-score of less than 60 is classified as "normal and a T-score of 60 or higher suggests the presence of elevated anxiety that may require further investigation and confirmation through clinical evaluation [10].

Statistical Plan Analysis

Descriptive statistics reported frequencies and percentages for categorical variables. Measures of central tendency and dispersion (mean/median; standard deviation/interquartile range) were reported for quantitative variables after assessing the distribution of the variables using the Kolmogorov-Smirnov test. Categorical variables were compared using Pearson's chi-square test. For quantitative variables, independent groups were compared using the t-test or Mann-Whitney U- test. P<0.05 and a confidence interval of 95% were considered statistically significant. The statistical package SPSS version 25 was used. A minimum sample of 48 participants was required and calculated with a finite population sample formula.


Patient Characteristics

We recruited 48 patients with AD, including 22 children, six adolescents, and 20 adults. The mean age of the participants was 17.1±9.8 years, with the third grade being the predominant level of education in children and the second grade of high school in adolescents. On the other hand, most adults (65%) had completed their undergraduate degree (Table 1). Only four patients had a medical record of anxiety/depression, one adolescent and three adults.