The mental health associations of vitiligo: UK population-based cohort study

Abstract

Background Vitiligo is an acquired, autoimmune depigmenting skin disorder that may affect psychological well-being. Aims To determine the risk and impact of psychological comorbidity in people with new-onset vitiligo. Method We conducted a retrospective observational study, using UK general practice data (2004–2020). Adults diagnosed with vitiligo ( n = 7224) were matched 1:4 with controls ( n = 28 880). Associations within 2 years of diagnosis were assessed for psychological conditions: recurrent depressive disorder (RDD), depressive episodes, non-phobia-related anxiety disorder, social phobia, adjustment disorder, substance misuse, self-harm and suicide attempts. Healthcare utilisation, time off work and unemployment within 1 year were compared in those with and without a mental health condition at vitiligo diagnosis. Results At diagnosis, people with vitiligo had a similar prevalence of mental health conditions as controls, except for anxiety disorder (cases 7.9%, controls 7.0%; P = 0.014). Incident RDD and anxiety disorder were more common in people with vitiligo (RDD: adjusted hazard ratio (aHR) 1.25, 95% CI 1.01–1.55; anxiety disorder: aHR 1.23, 95% CI 1.00–1.51). Risk was highest in Black and minority ethnic individuals (RDD: aHR 1.72, 95% CI 1.06–2.79; depressive episodes: aHR 1.56, 95% CI 1.03–2.37). No association was found with other mental health conditions. People with vitiligo and psychological comorbidity had more primary care encounters, more time off workand higher unemployment. Conclusions People with vitiligo have a higher incidence of RDD and anxiety disorder than controls, and this risk increase may be greatest in Black and minority ethnic populations.