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Vitiligo and depression: a systematic review and meta‐analysis of observational studies
Author(s) -
Lai Y.C.,
Yew Y.W.,
Kennedy C.,
Schwartz R.A.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.15199
Subject(s) - vitiligo , medicine , depression (economics) , odds ratio , meta analysis , confidence interval , cochrane library , publication bias , observational study , funnel plot , relative risk , psychosocial , cohort study , psychiatry , dermatology , economics , macroeconomics
Summary Vitiligo is a common depigmenting disorder with profound psychosocial impacts. Previous observational studies have suggested a link between vitiligo and psychiatric morbidity, such as depression. However, variability in study design makes it difficult to quantify accurately the relationship between vitiligo and depression. We aimed to investigate the underlying prevalence and risk of depression among patients with vitiligo. A comprehensive search of MEDLINE , Embase and the Cochrane Library was conducted. Cross‐sectional, case–control or cohort studies that assessed the prevalence of depression among patients with vitiligo or the relationship between vitiligo and depression were included. DerSimonian and Laird random‐effects models were utilized to calculate the pooled prevalence and relative risks. Publication bias was evaluated by funnel plots and Egger's tests. Twenty‐five studies with 2708 cases of vitiligo were included. Based on diagnostic codes, the pooled prevalence of depression among patients with vitiligo was 0·253 [95% confidence interval ( CI ) 0·16–0·34; P < 0·001)]. Using self‐reported questionnaires, the pooled prevalence of depressive symptoms was 0·336 (95% CI 0·25–0·42; P < 0·001). The pooled odds ratio of depression among patients with vitiligo was 5·05 vs. controls (95% CI 2·21–11·51; P < 0·001). Moderate‐to‐high heterogeneity was observed between the studies. Patients with vitiligo were significantly more likely to suffer from depression. Clinical depression or depressive symptoms can be prevalent, with the actual prevalence differing depending on screening instruments or, possibly, geographical regions. Clinicians should actively evaluate patients with vitiligo for signs/symptoms of depression and provide appropriate referrals to manage their psychiatric symptoms accordingly.