Depression and anxiety are more common in people with common skin diseases like atopic eczema than people without skin disease. Possible explanations include poor lifestyle choices (i.e., increased alcohol consumption, a lack of exercise) and poor sleep quality because of skin disease.
Ethnicity may also play a role. Atopic eczema looks different in people with darker skin, potentially affecting how readily it is diagnosed and subsequently treated with consequent impacts on quality of life. Different cultures have different beliefs about skin diseases, some of which are negative and may impact the mental health of people affected. People from minority ethnic groups are also disproportionately affected by socioeconomic deprivation, racism, and discrimination, all of which can lead to health inequalities, and are also known to have a negative impact on mental health. It is therefore possible that the risk of people with atopic eczema getting depression or anxiety varies depending on individual’s ethnicity.
Our study will follow large numbers of people with and without atopic eczema of different ethnicities over time to see whether they develop depression or anxiety. We will investigate whether people in all other ethnic groups are more likely to be depressed or anxious compared to people in the white ethnic group, and whether this depends on how severe skin disease is in different ethnic groups. Our study will allow us to highlight whether people with eczema from particular ethnic groups may benefit from targeted prevention strategies (e.g., screening for mental health conditions).
Our aim is to investigate whether the link between atopic eczema and new depression/anxiety varies by ethnicity.
We will include adults (18years+) with atopic eczema and match (without replacement) each adult on age, sex, and general practice with up to five adults without atopic eczema during the study period (1 April 2006 – 31 January 2020). Follow-up for adults with atopic eczema will start at the latest of: study start (April 1, 2006, the date ethnicity records became more complete following introduction of remuneration for capturing ethnicity data through the Quality and Outcomes Framework); date individuals met atopic eczema definitions; one year after registration with practice; date their practice met CPRD quality control standards; or 18th birthday. Follow-up for matched individuals will begin on the same date as their matched counterparts with atopic eczema.
We will pool individuals from Black, South Asian, Mixed and Other ethnic groups into a minority ethnic group (we acknowledge the limitations associated with the term ‘minority ethnic’ but have chosen this as a convenient label for this group). We will use Cox regression, stratified by matched set, to estimate hazard ratios and 95% confidence intervals for the association between atopic eczema and new depression/anxiety in the white ethnic and minority ethnic groups. We will use directed acyclic graphs to inform covariate selection (including deprivation, comorbidities, body mass index, smoking status, harmful alcohol use, problems with sleep, high-dose oral glucocorticoid use) in our analyses. We will initially construct models implicitly adjusted for matching variables, including an interaction term between the atopic eczema and ethnicity, followed by sequential models further adjusting for potential explanatory variables. We will also describe ethnic differences in atopic eczema severity and investigate whether the relationship between atopic eczema severity and depression/anxiety differs between the white ethnic group, and the minority ethnic group.
Our primary outcomes are: 1) depression and 2) anxiety.
Kathryn Mansfield - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Elizabeth Adesanya - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Alasdair Henderson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Amy Mulick - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Caroline Morton - Collaborator - University of Oxford
Joseph Hayes - Collaborator - University College London ( UCL )
Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sinead Langan - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;Patient Level Carstairs Index;Practice Level Carstairs Index (Excluding Northern Ireland)