TABLE 2.
Results for depression.
| References | Country | Year | N | % male | Age (M, SD) | % AA, AT, AU | Controls | Measures | Conclusions | Quality score (%) |
| Pediatric and adult samples | ||||||||||
| Ataseven et al. (32) | Turkey | NR | 43 | 72.1 | 23.42 (11.41) | NR | 30 healthy controls | HAM-D; CDI | More symptoms of depression in AA compared to controls | 301 |
| Chu et al. (37) | Taiwan | 2000–2009 | 5,117 | 49.2 | NR | NR | 20,468 healthy controls | ICD-9 codes | 2.9% AA has depression diagnosis, more often than controls | 801 |
| Ghajarzadeh et al. (78) | Iran | January 2009–January 2010 | 100 | 69 | 23.02 (33.4) | NR | 100 psoriasis, 100 vitiligo | BDI | No difference AA and psoriasis/vitiligo | 551 |
| Gutierrez et al. (79) | USA | 2006–2016 | 2,298,432 visits to dermatologist | 35 | 37.8 (18.04) | NR | No | ICD-9 and ICD-10 codes | 4.3% of the visits was related to depression | 58.332 |
| Jagtiani et al. (80) | India | NR | 38 | 65.8 | 25.79 (8.82) | NR | 80 AV, 56 psoriasis | BDI | AA not significantly different from patients with acne vulgaris or psoriasis | 551 |
| Kökcam et al. (33) | Turkey | NR | 17 | NR | 26.47 (12.2) | NR | 11 vitiligo, 20 healthy controls | SCL-90-R; ZSDS | AA more symptoms of depression than healthy controls, no difference with vitiligo | 201 |
| Laitinen et al. (81) | Finland | 1987–2016 | 176 | 25 | 29.7 (NR) | NR | No | ICD-9 and ICD-10 codes | 3.98% was diagnosed with depression | 54.172 |
| Layegh et al. (82) | Iran | October 2005–May 2006 | 73 | NR | NR | NR | 78 AV, 62 psoriasis, 87 vitiligo | BDI | 31.51% minor depression, 23.29% mild depression, 24.66% moderate depression, 20.55% severe depression | 551 |
| Liu et al. (83) | USA | NR | 91 children, 292 adults | Child: 34.4%, adult: 27.9% | Child: 10 (2.92), adult: 41 (15.3) | NR | No | PHQ-9 | On average mild symptoms of depression in children and adults | 20.832 |
| Marahatta et al. (38) | Nepal | August 2015–July 2016 | 75 | 53.3 | 29.40 (9.90) | NR | No | BDI | 66.7% depressive complaints. No relation to disease severity. | 45.832 |
| Singam et al. (34) | USA | 2002–2012 | 5,605 hospitalized patients | 38.3 | 42.2 (NR) | NR | Hospitalized patients without AA (N unknown) | ICD-9 codes | AA more mood disorders than controls | 451 |
| Talaei et al. (35) | Iran | April–July 2005 | 24 | 33.33 | 25.38 (8.32) | NR | 24 healthy controls | SCL-90-R | No difference AA and controls | 701 |
| Vallerand et al. (84) | GB | NR | 6,861 | 43.9 | 32.20 (13.50) | NR | 6,137,342 healthy controls | Read codes | AA higher chance of depression than controls | 601 |
| Vélez-Muñiz et al. (36) | Mexico | March 2017–February 2018 | 32 children, 94 adults | 41 | NR | 92.9% patchy AA, 3.2% AT, 1.6% ophiasis, 1.6% AU | No | DSRS-C; HADS | Children: 6.3% symptoms of depression. Adults: 19.1% subclinical depression or anxiety, 34.1% no symptoms of anxiety or depression. | 502 |
| Pediatric samples | ||||||||||
| Altunisik et al. (39) | Turkey | NR | 27 | 29.6 | 11.9 (3.3) | 85.19% AA, 14.81% AU | 30 dermatology patients | K-SADS-PL; CDI | No difference AA and controls. 14.8% symptoms of depression. | 651 |
| Andreoli et al. (40) | Italy | 1997–2000 | 176 | NR | NR | NR | No | Diagnosis by psychologist | 10% dysthymia | 252 |
| Bilgiç et al. (41) | Turkey | NR | 74 | 55.41 | 12.1 (2.8) | NR | 65 healthy controls | CDI | AA more symptoms of depression than controls | 651 |
| Conic et al. (85) | USA | 2019 | 3,510 | 44.7 | 26.2% <10 years, 73.8% 10–18 years | NR | 8,310,710 patients without AA | Diagnoses in patient file | AA diagnosed with depression (2.6%) more often than controls (0.6%) | 101 |
| Díaz-Atienza and Gurpegui (42) | Spain | NR | 31 | 52 | 12.2 (3.8) | 51.61% AA, 48.39% AU/AT | 23 epilepsy, 25 siblings | CDI | No differences AA and epilepsy or siblings | 651 |
| Erdoğan and Gür (43) | Turkey | October 2018–December 2019 | 31 | 54.83 | 12.54 (3.56) | 100% AA | 29 vitiligo, 30 healthy controls | RCADS-C; RCADS-P | AA more depression than healthy controls, no difference vitiligo | 601 |
| Ghanizadeh (44) | Iran | August 2004–November 2006 | 14 | NR | 11.66 (6.08) | NR | No | K-SADS-PL | 50% has diagnosis of depression | 502 |
| Liakopoulou et al. (45) | Greece | NR | 33 | 30.3 | 10.5 (0.3) | NR | 30 patients from pediatrician | CDI | No difference AA and controls | 401 |
| Reeve et al. (46) | USA | NR | 12 | NR | 11.5 (2.9) | NR | No | DICA-R; CDS | No heightened group average | 37.52 |
| Adult samples | ||||||||||
| Aghaei et al. (47) | Iran | NR | 40 | 44.8 | 35.2 (9.2) | NR | 40 healthy controls | BDI | AA more symptoms of depression than controls | 351 |
| Alfani et al. (48) | Italy | November 2009–October 2010 | 73 | 45.2 | 25.2 (9.2) | 61.7% AA, 26.0% AT, 12.3% AU |
73 healthy controls | MMPI-2 | AA patients score above cut-off for depre ssion more often than controls | 351 |
| Altinöz et al. (49) | Turkey | September 2011–October 2012 | 30 | 50 | 33.3 (8.9) | NR | 30 urticaria, 39 healthy controls | HADS | AA more symptoms of depression than healthy controls. No difference with urticaria. | 401 |
| Annagur et al. (50) | Turkey | NR | 73 | 65.75 | 27.66 (7.79) | 100% AA | 78 healthy controls | SCL-90 | AA more symptoms of depression than controls | 351 |
| Atış et al. (19) | Turkey | NR | 39 | 59 | 33.5 (11.6) | NR | 46 vitiligo, 46 healthy controls | HADS | No differences between AA, vitiligo and healthy controls | 201 |
| Baghestani et al. (51) |
Iran | NR | 68 | 72 | 35.4 (7.6) | 100% AA | 68 healthy controls | HAM-D | AA more symptoms of depression than controls (OR = 4.48) | 601 |
| Bain et al. (52) | UK | NR | 39 | 23.07 | 43.15 (12.43) | NR | 23 PsA; 26 healthy controls | HADS* | Depressive symptoms in 18%. Less severe symptoms with higher SALT scores. | 301 |
| Balieva et al. (53) | 13 European countries | November 2011–February 2013 | 33 | 33.3 | 42.8 (14.1) | NR | 1,359 healthy controls | EQ-5D-3L | AA 4 times higher chance of anxiety/depression than controls | 651 |
| Bashir et al. (54) | Pakistan | January–March 2007 | 3 | NR | NR | NR | No | GHQ-12; interview | 1 person was diagnosed with depression | 41.672 |
| Bukharia and Jain (55) | India | NR | 100 | 48 | 54% 15–30 years, 46% 31–50 years | NR | 100 TE, 100 healthy controls | HAM-D | 23.68% AA and 33.33% TE with symptoms of depression | 452 |
| Cakirca et al. (56) | Turkey | March–December 2017 | 33 | 75.8 | 26.33 (6.08) | NR | 33 healthy controls | HADS | AA more depressive symptoms than controls | 301 |
| Colon et al. (57) | USA | April 1985–October 1987 | 31 | 29 | 35.70 (10.23) | 74% AA, 23% AT, 42% AU3 | No | DIS | Lifetime prevalence depression 39%, dysthymia 16% | 33.332 |
| Conic et al. (58) | USA | 2005–2014 | 584 | 31.5 | 35.54 (19.28) | 94.7% AA, 2.05% AT, 3.25% AU |
172 SD | Diagnoses in patient file | No difference with control group | 351 |
| Cordan Yazici et al. (59) | Turkey | NR | 43 | 60.5 | 33.80 (10.02) | 95.35% AA, 4.65% AT | 53 healthy controls | HADS | No difference with controls | 251 |
| Dai et al. (90) | Taiwan | NR | 2,123 | 44.8 | 31.39 (9.02) | NR | 2,298 siblings, 9,192 healthy controls | ICD-9 codes | 7.87% of AA with MDD diagnoses, 8.22 times higher chance than healthy control. A total of 2.55 higher chance than siblings. | 851 |
| Devar (60) | India | NR | 30 | 100 | NR | NR | 30 TV, 30 healthy controls | BDI | AA more symptoms of depression than healthy controls, no difference with TV | 501 |
| Endo et al. (61) | Japan | June 2009–August 2010 | 122 | 33.1 | 38.3 (16.5) | NR | No | CES-D | AA more symptoms of depression than norm group | 56.254 |
| Gallo et al. (77) | Italy | NR | 16 | 37.5 | 45.95 (13.25) | NR | No | BSI | AA more symptoms of depression than norm group | 39.295 |
| Güleç et al. (62) | Turkey | March 2001–January 2002 | 52 | 65.38 | 31.53 (12.61) | 94.23% AA, 3.65% AU, 1.92% AT | 52 healthy controls | BDI | No differences between AA and controls | 251 |
| Gupta and Gupta (16) | USA | NR | 45 | 24.44 | 44.7 (11.6) | NR | 72 AV, 146 AD, 217 psoriasis | CRSD | AA less depressive symptoms than AV and psoriasis, no difference with AD | 151 |
| Karia et al. (17) | India | NR | 50 | 66.00 | 27.76 (NR) | NR | 50 psoriasis, 50 healthy controls | DSM-IV-TR diagnosis | 18% AA depression diagnoses. More often than healthy controls, less often than psoriasis. | 601 |
| Kim et al. (13) | South Korea | 2002–2013 | 7,706 | 51.9 | 54.6% 20–39, 39.4% 40–59, 6.1% 60+ | NR | 30,824 people without AA | ICD-10 codes | AA higher chance of depression than controls | 651 |
| Kose et al. (63) | Turkey | NR | 18 | 100 | 21.3 (NR) | NR | No | BDI | On average subclinical depressive symptoms | 50.006 |
| Macbeth et al. (64) | UK | January 2009–December 2018 | 5,435 | 45.9 | 38.93 (14.35) | NR | 21,470 healthy controls | Diagnoses in patient file |
AA higher chance of depression than controls | 801 |
| Mirza et al. (87) | USA | 2002–2012 | 138 | 0 | NR | NR | No | Diagnoses in patient file |
21.74% has depression diagnosis | 58.332 |
| Pascual-Sánchez et al. (88) | Spain | NR | 16 | 0 | 45.1 (NR) | 100% AU | No | BDI | On average subclinical depressive symptoms | 29.176 |
| Rajoo et al. (65) | Australia | NR | 83 | NR | 40.95 (13.24) | NR | No | DASS-21 | 47.0% reported extreme depressive symptoms | 54.172 |
| Ruiz-Doblado et al. (66) | Spain | NR | 32 | 15 | NR | NR | No | SCAN | 7.4% depression diagnosis, 7.4% previously diagnosed, but currently free of symptoms | 37.52 |
| Şahiner et al. (68) | Turkey | August 2009–July 2010 | 41 | 49 | 32.9 (10.5) | NR | 30 psoriasis, 50 healthy controls | BDI | AA more depressive symptoms than healthy controls, no difference with psoriasis | 201 |
| Sayar et al. (69) | Turkey | NR | 31 | 100 | 23.8 (2.5) | NR | 40 healthy controls | BDI | AA more symptoms of depression than controls | 551 |
| Sellami et al. (70) | Tunisia | March–July 2010 | 50 | 48 | 32.92 (11.81) | NR | 50 healthy controls | HADS | AA more symptoms of depression than controls | 451 |
| Senna et al. (71) | USA | January 2011–December 2018 | 68,121 | 39 | 40.3 (17.8) | 98.1% AA, 1.3% AT, 0.6% AU |
No | ICD-9 and ICD-10 codes | 9.5% had depression diagnosis | 45.832 |
| Sorour et al. (14) | Egypt | NR | 208 | 58.65 | NR | NR | 1,042 dermatology patients | DSM-5 interview | 19.71% of AA had diagnosis of depression. 24.33% in psoriasis, 55.34% acne vulgaris, 31.47% vitiligo, 43.64% urticarial, and 43.63% in atopic dermatitis | 551 |
| Tan et al. (72) | China | December 2012–August 2013 |
168 | 50 | 34.5 (11.5) | 88.1% AA, 11.9% AT/AU | 100 healthy controls |
SCL-90-R | AA more symptoms of depression than controls | 41.674 |
| Titeca et al. (22) | 13 European countries | 37 | NR | NR | NR | NR | 1,359 healthy controls, 20 AGA | HADS | AA more symptoms of depression than healthy controls | 701 |
| Tzur Bitan et al. (15) |
Israel | 2018 | 41,055 | 62.9 | 39.97 (13.61) | NR | 41,055 healthy controls | ICD-9 codes | AA diagnosed with depression more often than controls | 801 |
| Willemsen et al. (73) |
Belgium | September 2006–August 2009 | 21 | 24 | 41.95 (13.79) | 33% patchy AA, 14% ophiasis, 29% AT, 24% AU | No | SCL-90 | AA more symptoms of depression than norm group | 54.176 |
| Willemsen et al. (74) |
Belgium | April 1999–April 2004 | 28 | 35.71 | 33.4 (NR) | 21.43% AA, 21.43% ophiasis, 28.57% AU, 3.57% AT | No | SCL-90 | AA more symptoms of depression than norm group | 50.006 |
| Yoon et al. (75) | South Korea | January 2015–February 2016 | 1,203 | 52.12 | 39.45 (12.21) | NR | No | BDI | 40.9% depressive symptoms. Women more often than men, more symptoms with more severe AA. | 41.672 |
| Yu et al. (76) | China | October 2013–December 2014 | 130 | 41.5 | 31.78 (10.34) | NR | 212 AGA | ZSDS | No differences between AA and AGA | 701 |
*This questionnaire was not administered to the control group.
AD, atopic dermatitis; AGA, alopecia androgenetica; AV, acne vulgaris; PsA, psoriatic arthritis; SD, seborrheic dermatitis; TE, telogen effluvium; TV, tinea versicolor.
1As measured by the NIH Quality Assessment of Case-Control studies.
2As measured by the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
3Some patients had multiple episodes, with different forms of alopecia. Hence, the total is higher than 100%.
4As measured by the QAVALS (26).
5As measured by the NIH Quality Assessment of Controlled Intervention Studies.
6As measured by the NIH Quality Assessment Tool for Before-After (Pre-Post) Studies with no Control Group.