Hidradenitis Suppurativa Linked to Higher Risk of New-Onset Depression and Anxiety, Regardless of Disease Severity

A new nationwide study out of Denmark has found that patients with hidradenitis suppurativa (HS) face a significantly elevated risk of developing new-onset depression and anxiety, regardless of how severe their disease is. The findings, published in JAMA Dermatology, underscore the need for proactive mental health screening and support for all individuals living with HS, not just those with the most visibly severe cases.

To quantify these risks, researchers conducted a population-based cohort study using Danish national registry data spanning 1997 to 2022. The analysis included over 10,000 patients with hospital-diagnosed HS and more than 40,000 age- and sex-matched controls without the condition. Investigators assessed the incidence of both first-time and recurrent diagnoses of depression and anxiety, adjusting for comorbidities and socioeconomic status.

The results were striking: patients with HS were 69% more likely to develop new-onset depression (hazard ratio [HR], 1.69; 95% CI, 1.57–1.81) and 48% more likely to develop new-onset anxiety (HR, 1.48; 95% CI, 1.38–1.56) compared to individuals without HS.

To evaluate the role of disease severity, researchers stratified patients based on treatment intensity—ranging from topical therapy to systemic nonbiologic and biologic agents—as well as the number of hospitalizations for HS-related surgical procedures. Surprisingly, the increased mental health risk persisted across all severity levels. For instance, patients receiving only topical treatment still had an elevated risk of depression or anxiety (HR, 1.62), and those treated with systemic therapies or biologics had similar hazard ratios (1.61 and 1.38, respectively). Likewise, the number of surgical hospitalizations did not consistently correlate with a higher or lower psychiatric risk.

Notably, while patients with HS had markedly higher baseline rates of prior depression and anxiety compared to controls (7.0% vs 0.3% for depression; 5.9% vs 0.5% for anxiety), the study found no statistically significant difference in the risk of recurrent episodes between the two groups once a history of mental illness was established.

These findings suggest that the very presence of HS, independent of its severity, confers an increased psychological vulnerability—perhaps due to the chronicity, stigma, and unpredictable flares that characterize the disease. The authors argue that mental health assessments should become a routine part of clinical care for patients with HS, and not be limited to those undergoing advanced or surgical treatments.