Psychological Burden of Atopic Dermatitis Appears Greatest in Children and Adolescents
Key Takeaways
- A systematic review and meta-analysis found that children and adolescents with atopic dermatitis (AD) had numerically higher risks of depression, anxiety, and suicidality than adults with AD.
- Across 28 observational studies, pediatric patients with AD had a pooled hazard ratio of 2.16 for depression in cohort studies compared with 1.32 in adults, although heterogeneity across studies was substantial.
- The authors caution that the high between-study heterogeneity limits confidence in age-specific risk estimates and underscores the need for standardized, prospective research.
Children and adolescents with atopic dermatitis (AD) may experience a greater psychological burden than adults with the disease, according to a systematic review and meta-analysis published in Frontiers in Public Health.¹ However, investigators cautioned that substantial heterogeneity among included studies limits the certainty of the findings.
The review included 28 observational studies, including cohort, cross-sectional, and case-control designs, identified through searches of PubMed, Embase, and the Cochrane Library through October 2025. The investigators pooled hazard ratios (HRs) from cohort and case-control studies and odds ratios (ORs) from cross-sectional studies using random-effects models. The review protocol was prospectively registered in PROSPERO (CRD420251244849).
Meta-analysis Identifies Age-Related Differences in Psychological Comorbidity
Across cohort studies, children and adolescents with AD had a pooled HR for depression of 2.16 (95% CI, 1.56-2.98) compared with 1.32 (95% CI, 1.23-1.41) among adults. Cross-sectional studies demonstrated a similar pattern, with pooled ORs for depression of 2.79 (95% CI, 1.52-5.12) in younger patients versus 1.61 (95% CI, 1.22-2.14) in adults. Similar age-related trends were observed for anxiety, and younger patients also demonstrated a higher risk of suicidality relative to adults.
The authors noted that heterogeneity was consistently very high across analyses (I² values exceeding 90% in most comparisons), suggesting considerable variability in study populations, methodologies, and outcome definitions. As a result, the pooled estimates should be interpreted cautiously.
Additional limitations included the observational nature of the included studies and methodological differences that may have contributed to between-study variability.
"The psychological burden of AD appears most pronounced in children and adolescents, but the very high heterogeneity across studies limits the certainty of this finding. Therefore, the results should be interpreted cautiously," the authors wrote.¹
References
- Wang H, Ma H, Wei D, Xi Y, Zhao J. Age differences in psychological comorbidity in atopic dermatitis: a systematic review and meta-analysis. Front Public Health. 2026;14:1818252. doi:10.3389/fpubh.2026.1818252