Beyond Anxiety and Depression: Loneliness and Psychiatric Disorders in Adults with Atopic Dermatitis




atopic dermatitis, mental disorder, loneliness, disease severity, epidemiology


There is a lack of knowledge concerning loneliness and psychiatric disorders other than anxiety and depression in patients with atopic dermatitis. This cross-sectional study was conducted within the Lifelines Cohort Study, in the Netherlands, by sending an atopic dermatitis questionnaire to adult participants (n = 135,950) in 2020. Psychiatric disorders were measured with a self-reported question and validated instrument (Mini International Neuropsychiatric Interview; M.I.N.I.), and loneliness was assessed with the validated 6-item De Jong Gierveld Loneliness Scale. In total, 56,896 subjects (mean age 55.8 years, 39.7% males) were included. Atopic dermatitis showed positive associations with self-reported chronic fatigue syndrome, burnout, depression, social phobia, panic disorder, attention deficit hyperactivity disorder, and eating disorder in the participants’ lifetimes. Based on the M.I.N.I., atopic dermatitis was positively associated with panic disorder and at least 1 anxiety disorder. In addition, subjects with atopic dermatitis were more likely to experience loneliness compared with those without atopic dermatitis. These associations were observed only in the moderate-to-severe, but not mild, atopic dermatitis group. This study raises awareness that a significant proportion of adults with atopic dermatitis feel lonely and are affected by several psychiatric disorders, especially those severely affected by atopic dermatitis. Further studies are required to evaluate if interdisciplinary care, such as the collaboration between dermatologists and psychiatrists, could optimize medical care for this vulnerable patient group.


Download data is not yet available.


Zhang J, Loman L, Voorberg AN, Schuttelaar MLA. Prevalence of adult atopic dermatitis in the general population, with a focus on moderate-to-severe disease: results from the Lifelines Cohort Study. J Eur Acad Dermatol Venereol 2021; 35: e787-e790. DOI:

Simpson EL, Guttman-Yassky E, Margolis DJ, Feldman SR, Qureshi A, Hata T, et al. Association of inadequately controlled disease and disease severity with patient-reported disease burden in adults with atopic dermatitis. JAMA Dermatol 2018; 154: 903-912. DOI:

von Stülpnagel CC, Augustin M, Düpmann L, da Silva N, Sommer R. Mapping risk factors for cumulative life course impairment in patients with chronic skin diseases - a systematic review. J Eur Acad Dermatol Venereol 2021; 35: 2166-2184. DOI:

Patel KR, Immaneni S, Singam V, Rastogi S, Silverberg JI. Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol 2019; 80: 402-410. DOI:

Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, et al. Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study. J Allergy Clin Immunol Pr 2020; 8: 248-257. DOI:

Zhang J, Loman L, Oldhoff JM, Schuttelaar MLA. Moderate-to-severe atopic dermatitis and lifestyle factors in the Dutch general population. Clin Exp Dermatol 2022; 47: 1523-1535. DOI:

Kim DH, Han K, Kim SW. Relationship between allergic rhinitis and mental health in the general Korean adult population. Allergy Asthma Immunol Res 2016; 8: 49-54. DOI:

Scott KM, Von Korff M, Ormel J, Zhang M, Bruffaerts R, Alonso J, et al. Mental disorders among adults with asthma: results from the World Mental Health Survey. Gen Hosp Psychiatry 2007; 29: 123-133. DOI:

Christiansen J, Qualter P, Friis K, Pedersen SS, Lund R, Andersen CM, et al. Associations of loneliness and social isolation with physical and mental health among adolescents and young adults. Perspect Public Health 2021; 141: 226-236. DOI:

Hsieh M-T, Liang SH-Y, Yang Y-H, Kuo T-Y, Lin T-Y, Wang T-N, et al. Allergic rhinitis increases the risk of incident panic disorder among young individuals: a nationwide population-based cohort study in Taiwan. J Affect Disord 2019; 252: 60-67. DOI:

Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Ann Allergy, Asthma Immunol 2018; 121: 340-347. DOI:

Roosta N, Black DS, Peng D, Riley LW. Skin disease and stigma in emerging adulthood: impact on healthy development. J Cutan Med Surg 2010; 14: 285-290. DOI:

Scholtens S, Smidt N, Swertz MA, Bakker SJL, Dotinga A, Vonk JM, et al. Cohort Profile: LifeLines, a three-generation cohort study and biobank. Int J Epidemiol 2015; 44: 1172-1180. DOI:

Charman CR, Venn AJ, Ravenscroft JC, Williams HC. Translating patient-oriented eczema measure (POEM) scores into clinical practice by suggesting severity strata derived using anchor-based methods. Br J Dermatol 2013; 169: 1326-1332. DOI:

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59: 22-33. DOI:

de Jong Gierveld J, van Tilburg T. [A shortened scale for overall, emotional and social loneliness]. Tijdschr Gerontol Geriatr 2008; 39: 4-15.

Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy 2018; 73: 1284-1293. DOI:

Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol 2015; 135: 984-991. DOI:

Strom MA, Fishbein AB, Paller AS, Silverberg JI. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermatol 2016; 175: 920-929. DOI:

Kauppi S, Jokelainen J, Timonen M, Tasanen K, Huilaja L. Adult patients with atopic eczema have a high burden of psychiatric disease: a Finnish Nationwide Registry Study. Acta Derm Venereol 2019; 99: 647-651. DOI:

Schmitt J, Romanos M, Pfennig A, Leopold K, Meurer M. Psychiatric comorbidity in adult eczema. Br J Dermatol 2009; 161: 878-883. DOI:

Silverberg JI, Garg NK, Paller AS, Fishbein AB, Zee PC. Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study. J Invest Dermatol 2015; 135: 56-66. DOI:

Ahn H-J, Shin MK, Seo J-K, Jeong SJ, Cho AR, Choi S-H, et al. Cross-sectional study of psychiatric comorbidities in patients with atopic dermatitis and nonatopic eczema, urticaria, and psoriasis. Neuropsychiatr Dis Treat 2019; 15: 1469-1478. DOI:

Campagne DM. Stress and perceived social isolation (loneliness). Arch Gerontol Geriatr 2019; 82: 192-199. DOI:

Leistner C, Menke A. Hypothalamic-pituitary-adrenal axis and stress. Handb Clin Neurol 2020; 175: 55-64. DOI:

Buske-Kirschbaum A, Schmitt J, Plessow F, Romanos M, Weidinger S, Roessner V. Psychoendocrine and psychoneuroimmunological mechanisms in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder. Psychoneuroendocrinology 2013; 38: 12-23. DOI:

Chida Y, Steptoe A, Hirakawa N, Sudo N, Kubo C. The effects of psychological intervention on atopic dermatitis. A systematic review and meta-analysis. Int Arch Allergy Immunol 2007; 144: 1-9. DOI:

Norén P, Hagströmer L, Alimohammadi M, Melin L. The positive effects of habit reversal treatment of scratching in children with atopic dermatitis: a randomized controlled study. Br J Dermatol 2018; 178: 665-673. DOI:

Revankar RR, Revankar NR, Balogh EA, Patel HA, Kaplan SG, Feldman SR. Cognitive behavior therapy as dermatological treatment: a narrative review. Int J Women's Dermatology 2022; 8: e068. DOI:

Capec S, Petrek M, Capec G, Yaremkevych R, Andrashko Y. Psychologic interventions in patients with the chronic dermatologic itch in atopic dermatitis and psoriasis: A step forward with family constellations seminars. Front Med 2022; 9: 965133. DOI:

Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, et al. European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations. J Eur Acad Dermatol Venereol 2022; 36: 1904-1926. DOI:

Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet 2020; 396: 345-360. DOI:

Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Association of atopic dermatitis with allergic, autoimmune, and cardiovascular comorbidities in US adults. Ann Allergy Asthma Immunol 2018; 121: 604-612.e3 DOI:

Additional Files



How to Cite

Zhang, J., Loman, L., Oldhoff, J. M., & Schuttelaar, M. L. (2023). Beyond Anxiety and Depression: Loneliness and Psychiatric Disorders in Adults with Atopic Dermatitis. Acta Dermato-Venereologica, 103, adv9378.

Funding data

Most read articles by the same author(s)