Mental Health Support Is Lacking for Many Patients With Atopic Dermatitis

More than 40% of patients with atopic dermatitis (AD) report never discussing their mental health with their primary eczema provider, according to a study published in Skin Health and Disease.

The results are from a cross‐sectional survey that was distributed by the National Eczema Association to primary caregivers of pediatric (age range, 8-17 years) and adult patients with self‐reported AD. The online survey was administered from October to November 2022, and all respondents were residents of the United States.

The survey assessed caregiver and patient experience regarding mental health discussions with their regular eczema provider and captured data on sociodemographic factors, mental health evaluation, and referral to mental health services. Multivariate and logistic regression models were used for statistical analysis.

The analysis was based on 954 respondents (completion rate, 96.3%), of whom 83.3% were adult patients, 16.7% were caregivers of pediatric patients, 68.1% were women, 67.0% were White, 89.6% were from an urban area, and 64.6% saw an allergist or dermatologist as their primary eczema provider.

Among the respondents, 41.9% never spoke about mental health with their primary eczema provider, 50.5% were never asked about their mental health, and 64.1% did not receive a referral for mental health services from their provider. Of 343 respondents who did receive a referral, 56.6% used the recommended mental health services.

Significant factors among respondents who spoke with provider about their mental health 7 to 12 months after AD diagnosis included male sex (adjusted odds ratio [aOR], 2.00; 95% CI, 1.08-3.69; P =.0269), less than a high-school education level (aOR, 4.89; 95% CI, 2.10-11.36; P =.0002) to some college (aOR, 2.71; 95% CI, 1.36-5.40; P =.0047), and a purchased health insurance policy (aOR, 4.43; 95% CI, 1.79-10.98; P =.0013).

Significant factors among respondents who never spoke about mental health with their provider included low annual income (≤$49,000; aOR, 1.98; 95% CI, 1.16-3.39; P =.0127), age (35-64 years; aOR, 2.48; 95% CI, 1.18-5.23; P =.0171), and lack of a provider (aOR, 2.59; 95% CI, 1.12-6.0). Patients with a nonspecialist vs specialist primary eczema provider were more likely to be asked about their mental health (aOR, 2.58; 95% CI, 1.78-3.74; P <.0001).

Respondents were more likely to receive a referral for mental health services if they were men (aOR 2.58; 95% CI, 1.90-3.49; P <.0001), of Hispanic ethnicity (aOR, 2.75; 95% CI, 1.99-3.81; P <.0001), from a small/rural town (aOR, 2.19; 95% CI, 1.84-2.60; P <.0001), and had less than a high-school education level (aOR, 4.74; 95% CI, 3.11-7.24; P <.0001) to some college (aOR, 2.48; 95% CI, 1.79-3.42; P <.0001).

The survey also evaluated the relationship between patient preference and mental health evaluations. Respondents who preferred but were less likely to be asked about their mental health included those aged 18 to 34 years (aOR, 5.52; 95% CI, 1.88-16.24; P =.0019) and Asian or Asian American patients (aOR, 3.19, 95% CI, 1.65-6.16; P =.0005).

Study limitations include the use of a retrospective, self‐reported survey among patients without confirmed AD diagnosis, the assessment of pediatric patients via caregiver proxy, and the lack of insight from providers on their mental health screening and referral behaviors.

“Screening for mental health symptoms with a validated approach and/or questionnaire prior to a medical encounter may help identify AD patients that need and desire additional support,” researchers concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Dermatology Advisor