The associated burden of mental health conditions in alopecia areata:a population-based study in UK primary care

Background: Alopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact. Objectives: To assess the co-occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment. Methods: In total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre-existing mental health conditions, rates of mental health-related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521). Results: Depression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new-onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA. Conclusions: People with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence-based mental health treatment programmes are needed for people with AA. What is already known about this topic? Alopecia areata is a common cause of nonscarring hair loss. Psychological comorbidity is common in people with alopecia areata, but limited information is available on the co-occurrence and impact of depression and anxiety in this group. What does this study add? Adults newly diagnosed with alopecia areata (5435 in UK primary care) have a higher background prevalence of depression and anxiety than population controls, and are also at 30–38% higher risk of being subsequently diagnosed with new-onset depression and anxiety. After alopecia areata diagnosis, people with the condition are more likely to be issued time off work certificates (56% higher) and to be recorded as unemployed (82% higher risk) than population controls.