Association Between Atopic Dermatitis and Suicidality: A Systematic Review and Meta-analysis.

Importance: Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with numerous psychiatric comorbidities. However, the association between AD and suicidality has not been well established. Objective: To synthesize the available literature to evaluate the association between AD and suicidality. Data Source: The protocol was prospectively registered in the PROSPERO database (CRD42018105291). Study Selection: Per PRISMA guidelines, PubMed, Embase, PsycINFO, and Cochrane databases were systematically searched for relevant articles published from 1946 to May 25, 2018. The search criteria for PubMed were as follows: (dermatitis, atopic [MeSH] OR eczema [MeSH]) AND (suicidal ideation [MeSH] OR suicide, attempted [MeSH] OR suicide [MeSH] OR suicidality OR suicidal behavior). The search criteria for Embase, PsycINFO, and Cochrane were as follows: (atopic dermatitis OR eczema) AND (suicidal ideation OR suicide attempt OR suicide OR suicidality OR suicidal behavior). Data Extraction and Synthesis: This systematic review and meta-analysis performed in an academic medical setting included observational studies that evaluated suicidal ideation, suicide attempts, and completed suicide among patients with AD. Main Outcome and Measure: The quality of included studies was assessed using the Newcastle-Ottawa Scale for observational studies. Results: The analysis identified 15 studies with a total of 4 770 767 participants, of whom 310 681 were patients with AD (52.7% female) and 4 460 086 served as controls (50.9% female). In the meta-analyses, patients with AD were 44% more likely to exhibit suicidal ideation (pooled odds ratio, 1.44; 95% CI, 1.25-1.65) and 36% more likely to attempt suicide (pooled odds ratio, 1.36; 95% CI, 1.09-1.70) compared with patients without AD. Studies investigating completed suicides in patients with AD had inconsistent results. Conclusions and Relevance: Results of this study suggest that patients with AD are at significantly increased risk of suicidal ideation and suicide attempts. It is important for dermatology providers to be aware of this risk, screen for suicidality in patients with AD, and make mental health referrals when necessary.