Alopecia Areata as a Proximal Risk Factor for the Development of Comorbid Depression: A Population-based Study


  • Dana Tzur Bitan Department of Behavioral Sciences, Ariel University, IL-40700 Ariel, Israel
  • Daniella Berzin
  • Khalaf Kridin
  • Yaron Sela
  • Arnon Cohen



alopecia areata, depression, comorbidity, temporal precedence


Alopecia areata and depression tend to co-occur; however, their temporal association has not been comprehensively investigated. The aim of this study was to examine the temporal association between alopecia areata and depression. The study included only cases with a comorbid presentation of alopecia areata and depression (n = 1,936), extracted from the databases of the Clalit Health Services, Israel. Survival analyses were used to assess the cumulative probability of receiving alopecia areata as comorbid diagnosis in the years following depression, and vice versa, compared with the opposite trajectory. The results indicate that patients with alopecia areata had greater odds of subsequent depression within 2 years from alopecia areata diagnosis, and showed a steeper increase in cumulative probability of depression as time progressed (log-rank =336.38, p < 0.001), compared with the opposite trajectory. All patients with alopecia areata had comorbid depression within 10 years of alopecia areata, compared with 70% of depression patients receiving diagnoses of comorbid alopecia areata within the same time-frame. 


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Strazulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, Shapiro J. Alopecia areata: disease characteristics, clinical evaluation, and new perspectives on pathogenesis. J Am Acad Dermatol 2018; 78: 1-12. DOI:

Mulinari-Brenner F. Psychosomatic aspects of alopecia areata. Clin Dermatol 2018; 36: 709-713. DOI:

Pratt CH, King Jr. LE, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primers 2017; 3: 1-17. DOI:

Tucker P. Bald is beautiful?: the psychosocial impact of alopecia areata. J Health Psycho 2009; 14: 142-151. DOI:

Okhovat JP, Marks DH, Manatis-Lornell A, Hagigeorges D, Locascio JJ, Senna MM. Association between alopecia areata, anxiety, and depression: a systematic review and meta-analysis. J Am Aacad Dermatol 2019 Jun 1 [Epub ahead of print]. DOI:

McCarter T. Depression overview. Am Health Drug Benefits 2008; 1: 44-51.

Katz SJ, Conway CC, Hammen CL, Brennan PA, Najman JM. Childhood social withdrawal, interpersonal impairment, and young adult depression: a mediational model. J Abnorm Child Psychol 2011; 39: 1227-1238. DOI:

WHO The global burden of disease: 2004 update. Geneva: World Health Organization; 2008.

Baghestani S, Zare S, Seddigh SH. Severity of depression and anxiety in patients with alopecia areata in Bandar Abbas, Iran. Dermatol Reports 2015: 7; 6063. DOI:

Velez-Muniz RDC, Peralta-Pedrero ML, Jurado-Santa Cruz F, Morales-Sanchez MA. Psychological profile and quality of life of patients with alopecia areata. Skin Appendage Disord 2019; 5: 293-298. DOI:

Hunt N. The psychological impact of alopecia. BMJ 2005; 331: 951-953. DOI:

Gupta MA, Gupta AK, Watteel GN. Stress and alopecia areata: a psychodermatologic study. Acta Derm Venereol 1997; 77: 296-298.

Manolache L, Benea V. Stress in patients with alopecia areata and vitiligo. J Eur Acad Dermatol Venereol 2007; 21: 921-928. DOI:

Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: a multifactorial autoimmune condition. J Autoimmun 2019; 98: 74-85. DOI:

Thom E. Stress and the hair growth cycle: cortisol-induced hair growth disruption. J Drugs Dermatol 2016; 15: 1001-1004.

Chu SY, Chen YJ, Tseng WC, Lin MW, Chen TJ, Hwang CY. Psychiatric comorbidities in patients with alopecia areata in Taiwan: a case-control study. Br J Dermatol 2012; 166: 525-531. DOI:

Vallerand IA, Lewinson RT, Parsons LM, Hardin J, Haber RM, Lowerison MW, et al. Assessment of a bidirectional association between major depressive disorder and alopecia areata. JAMA Dermatol 2019; 155: 475-479. DOI:

Ministry of Health (Il). Annual report of healthcare-providing companies for 2018. [accessed 2020 March 27]. Available from:

Rennert G, Peterburg Y. Prevalence of selected chronic diseases in Israel. Isr Med Assoc J 2001; 3: 404-408.

Tzur Bitan D, Berzin D, Cohen AD. Hidradenitis suppurativa and schizophrenia: a nationwide cohort study. J Eur Acad Dermatol Venereol 2020; 34: 574-579. DOI:

Tzur Bitan D, Berzin D, Cohen A. Hidradenitis suppurativa and bipolar disorders: a population-based study. Dermatology 2020; 236: 298-304. DOI:

Tzur Bitan D, Berzin D, Cohen A. The association of chronic spontaneous urticaria (CSU) with anxiety and depression: a nationwide cohort study. Arch Dermatol Res 2020; 313: 33-39. DOI:

World Health Organization (WHO). International classification of diseases, Ninth revision. Geneva: WHO; 1978.

Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH. Bidirectional association between alopecia areata and major depressive disorder among probands and unaffected siblings: a nationwide population-based study. J Am Acad Dermatol 2020; 82: 1131-1137. DOI:

Hunt N, McHale SUE. Reported experiences of persons with alopecia areata. J Loss Trauma 2004; 10: 33-50. DOI:

Sinclair RD. Alopeica areata and suicide of children. Med J Aust 2014; 200: 145. DOI:

Rencz F, Gulácsi L, Péntek M, Wikonkál N, Baji P, Brodszky V. Alopecia areata and health-related quality of life: a systematic review and meta-analysis. Br J Dermatol 2016; 175: 561-571. DOI:

Bain KA, McDonald E, Moffat F, Tutino M, Castelino M, Barton A, et al. Alopecia areata is characterized by dysregulation in systemic type 17 and type 2 cytokines, which may contribute to disease-associated psychological morbidity. Br J Dermatol 2020; 182: 130-137. DOI:

Keller M. Depression: a long-term illness. B J Psychiatry 1994; 165: 9-15. DOI:

Rodgers AR. Why finding a treatment for alopecia is important: a multifaceted perspective. J Investig Dermatol Symp Proc 2018; 19: S51-S53. DOI:



How to Cite

Tzur Bitan, D., Berzin, D., Kridin, K., Sela, Y., & Cohen, A. (2022). Alopecia Areata as a Proximal Risk Factor for the Development of Comorbid Depression: A Population-based Study. Acta Dermato-Venereologica, 102, adv00669.

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