Association between hospital‐diagnosed atopic dermatitis and psychiatric disorders and medication use in childhood

Summary Background While adult atopic dermatitis (AD) is associated with anxiety and depression, and paediatric AD is linked to attention deficit hyperactivity disorder (ADHD), the relationship between AD in childhood and other psychiatric disorders is largely unknown. Objectives To determine the relationship between AD and diagnosis and treatment of psychiatric disorders in children. Methods All Danish children born between 1 January 1995 and 31 December 2012 with a hospital diagnosis of AD (n = 14 283) were matched 1 : 10 with children without a hospital diagnosis of AD. Endpoints were psychotropic medication use, hospital diagnoses of depression, anxiety, ADHD, or self‐harming behaviour, accidental/suicidal death, and consultation with a psychiatrist or psychologist. Results Significant associations were observed between hospital‐diagnosed AD and antidepressant [adjusted hazard ratio (aHR) 1·19, 95% confidence interval (CI) 1·04–1·36], anxiolytic (aHR 1·72, 95% CI 1·57–1·90), and centrally acting sympathomimetic (aHR 1·29, 95% CI 1·18–1·42) medication use. Consultation with a psychiatrist (aHR 1·33, 95% CI 1·16–1·52) or psychologist (aHR 1·25, 95% CI 1·11–1·41) was also associated with AD. No association with a hospital diagnosis of depression (aHR 0·58, 95% CI 0·21–1·56), anxiety (aHR 1·47, 95% CI 0·98–2·22) or self‐harming behaviour (aHR 0·88, 95% CI 0·27–2·88) was observed, but a diagnosis of ADHD (aHR 1·91, 95% CI 1·56–2·32) was significantly associated with AD. The absolute risks were generally low. Conclusions The increased risk of treatment, but not of a hospital diagnosis of psychiatric disorders in children with hospital‐diagnosed AD, suggests that psychiatric issues in children with AD could be of a transient, reversible or mild–moderate nature. What is already known about this topic? Children with atopic dermatitis have reduced quality of life, but apart from the well‐established association with attention deficit hyperactivity disorder (ADHD), little is known about psychiatric diagnoses and treatments in association with paediatric atopic dermatitis. What does this study add? Risk of psychotropic medication use, of consulting a psychiatrist or psychologist, and of being diagnosed with ADHD was higher in children with hospital‐diagnosed atopic dermatitis. However, children with hospital‐diagnosed atopic dermatitis did not have a higher risk of receiving a hospital diagnosis of depression, anxiety or self‐harming behaviour. Linked Comment: E.K