J Clin Aesthet Dermatol. 2025;18(1):18-19.
Trending Psychiatric Comorbidities in Patients with Alopecia Areata in the United States from 2002 to 2019
Dear Editor:
Alopecia areata (AA) is an autoimmune nonscarring alopecia associated with psychiatric disease.1,2 Even as the prevalence of AA has increased throughout the past decade, new medications, such as Janus kinase (JAK) inhibitors, demonstrate promising treatment results.2,3 Additionally, throughout the 21st century, efforts have been made to decrease the stigma and encourage appropriate treatment of psychiatric disease.4 Given the changing contexts surrounding AA and psychiatric disease, this study examines the changes in prevalence of psychiatric disease over time in patients with AA compared to the general population.
A cross-sectional study was performed using Optum’s de-identified Clinformatics® Data Mart Database, a national claims database. Codes from the International Classification of Diseases, 9th Revision (ICD-9) and International Classification of Diseases, 10th Revision (ICD-10) for alopecia areata, major depressive disorder, generalized anxiety disorder, social anxiety disorder, dysthymic disorder, and obsessive-compulsive disorder were used to identify patient visits occurring from 2007 to 2021 with these diagnoses. For each year, a multivariable logistic regression was run to compare the prevalence of psychiatric disease in patients with AA to that of patients without AA, controlling for patient age, gender, race, geographical area, insurance, and income level.
Descriptive characteristics of the study population are listed in Table 1. The total number of patient visits with and without a diagnosis of AA was 379,217 and 168,367,402, respectively. Most patients were from the South Atlantic area of the United States, most were White, and most reported a household income of greater than $100,000 and a point-of-service insurance plan.
Figure 1 shows the prevalence of psychiatric comorbidities in AA and general population visits and the odds ratios from the logistic regression for each year. From 2007 to 2021, AA patients had significantly higher odds of having a psychiatric comorbidity than the general population. Odds ratios ranged from 1.28 in 2007 to 1.62 in 2014, decreasing to 1.53 in 2021, meaning that AA patients experienced anywhere from a 28 to 62-percent increased odds of having a psychiatric diagnosis during the studied time period. Additionally, the overall prevalence of psychiatric diseases increased from 2007 to 2021 for both study groups, even as the total number of patient visits increased with each year (from 7,083,639 in 2007 to 14,780,800 in 2021).
To the authors’ knowledge, this is among the first efforts to examine how prevalence of psychiatric comorbidities has changed over time in patients with AA compared to patients without AA. Our results show that the odds of having a psychiatric comorbidity remained anywhere from 28 to 62-percent higher in patients with AA compared to the general population during 2007 to 2021, in the context of increasing prevalence of psychiatric disease in both groups throughout this time. Several possible explanations exist for these findings. First, patients with AA might have continued to face similar detriments to quality of life due to their disease, despite recent advances in treatment options. The observed increase in psychiatric disease prevalence could be attributed to regular follow up that patients with stable psychiatric diagnoses maintain with their doctors as patients with newly diagnosed psychiatric diseases establish care over time. Alternatively, given recent societal efforts to increase public awareness of psychiatric disease, more people could be seeking medical treatment for psychiatric concerns.4,5 Finally, the overall prevalence of psychiatric disease may be increasing. For example, while the overall prevalence of major depressive episodes has not changed in recent decades, there has been a consistent increase in the reporting of poor mental health in general.5
Our study demonstrates that patients with AA continue to have significantly higher odds of having a psychiatric comorbidity compared to the general population. Further studies are needed to investigate the increasing prevalence in psychiatric comorbidities that we observed.
With regard,
Hannah Peterson, MD; Kathleen L. Miao, BS; Margaret Y. Huang, MD; and April W. Armstrong, MD, MPH
Keywords. Alopecia areata, psychiatric comorbidities, United States, dermatology, epidemiology
Affiliations. Dr. Peterson is with the Loma Linda University School of Medicine in Loma Linda, California. Ms. Miao and Dr. Huang are with the Keck School of Medicine at the University of Southern California in Los Angeles, California. Dr. Armstrong is with the David Geffen School of Medicine at the University of California, Los Angeles in Los Angeles, California.
Funding. No funding was provided for this article.
Disclosures. Dr. Armstrong has served as a research investigator, scientific advisor, or speaker to AbbVie, Amgen, Almirall, Arcutis, ASLAN, Beiersdorf, BI, BMS, EPI, Incyte, Leo, UCB, Janssen, Lilly, Novartis, Ortho, Sun, Dermavant, Dermira, Sanofi, Takeda, Regeneron, and Pfizer. Ms. Miao, Dr. Peterson, and Dr. Huang have no conflicts of interest relevant to the content of this article.
References
- Velez-Muniz RDC, Peralta-Pedrero ML, Jurado-Santa Cruz F, et al. Psychological profile and quality of life of patients with alopecia areata. Skin Appendage Disord. 2019;5(5):293–298.
- Mostaghimi A, Gao W, Ray M, et al. Trends in prevalence and incidence of alopecia areata, alopecia totalis, and alopecia universalis among adults and children in a US employer-sponsored insured population. JAMA Dermatol. 2023;159(4):411–418.
- Ramirez-Marin HA, Tosti A. Emerging drugs for the treatment of alopecia areata. Expert Opin Emerg Drugs. 2022;27(4):379–387.
- Jorm AF. Mental health literacy. Public knowledge and beliefs about mental disorders. Br J Psychiatry. 2000;177:396–401.
- Mojtabai R, Jorm AF. Trends in psychological distress, depressive episodes and mental health treatment-seeking in the United States: 2001-2012. J Affect Disord. 2015;174:556–561.