Digital Features for this article can be found at https://doi.org/10.6084/m9.figshare.15058539. |
Vitiligo has been associated with depression and anxiety; however, other psychosocial comorbidities have not been comprehensively investigated. |
A wide variety of psychosocial comorbidities are prevalent in patients with vitiligo; multidisciplinary treatment strategies and education about vitiligo are vital to addressing the burden of this disease. |
1 Introduction
2 Methods
2.1 Literature Search
2.2 Data Extraction and Analysis
3 Results
3.1 Literature Search
3.2 Study Characteristics
Characteristic | Number of studies, n (%) N = 168 |
---|---|
Year of publication | |
1979–1999 | 13 (7.7) |
2000–2009 | 33 (19.6) |
2010–2021 | 122 (72.6) |
Study type | |
Observational | 162 (96.4) |
Clinical trial | 6 (3.6) |
Geographic regiona | |
Africa | 4 (2.4) |
Europe | 48 (28.6) |
Eastern Asiab | 18 (10.7) |
Southern Asia | 26 (15.5) |
Middle East | 50 (29.8) |
North America | 20 (11.9) |
South America | 6 (3.6) |
Age group of patients with vitiligo, yearsc | |
Child only (< 12) | 1 (0.6) |
Adolescent only (12–17) | 1 (0.6) |
Adult only (≥ 18) | 87 (51.8) |
Child and adolescent (≤ 17) | 13 (7.7) |
Adolescent and adult (≥ 12) | 42 (25.0) |
All age groups (≥ 0) | 15 (8.9) |
Number of patients with vitiligod | |
≤ 25 | 15 (8.9) |
26–100 | 77 (45.8) |
101–200 | 38 (22.6) |
> 200 | 30 (17.9) |
3.3 Instruments Measuring QoL
3.4 Psychosocial Comorbidities
3.4.1 Prevalence of Psychosocial Comorbidities
Psychosocial comorbidity | Comorbidity screening tool | Number of patients with vitiligo | Prevalence, % | Country |
---|---|---|---|---|
Depression or depressive disorders | Any | 6–7104 | 0.1–62.3 | Egypt [154], Estonia [92], Georgia [159], Germany [104], India [22, 28, 43, 100, 113, 114, 137, 138, 143, 145, 146, 150, 177], Italy [142], Iran [30], Japan [163], Jordan [104], South Korea [71], Mexico [115], Nepal [32], Nigeria [44], Saudi Arabia [17, 46, 48, 50], Singapore [68, 69], Taiwan [23], Thailand [35], Turkey [34, 39, 57, 155, 158], UK [40, 160], USA [15, 131] |
Depression | BDI | 100–308 | 30.3–54.5 | |
CES-D | 54–222 | 16.2–27.8 | ||
HADS | 15–102 | 7.8–60.0 | ||
PHQ-9 | 6–104 | 37.5–50.0 | ||
Othera | 22–3962 | 2.7–62.3 | ||
Bipolar disorder | Diagnosed during screening | 53 | 7.6 | India [137] |
Diagnosis on file | 1432 | 0.1 | Taiwan [23] | |
Dysthymic disorder | Diagnosed during screening | 113 | 0.9–1.8 | |
SCID-I | 42–50 | 4.8–26.0 | ||
MDD | Othera | 42–7104 | 3.5–56.6 | |
Unspecified depressive disorder | K-SADS-PL | 30 | 23.4 | Turkey [34] |
Anxiety or anxiety-related disorders | Any | 15–1432 | 1.9–67.9 | |
Anxiety | BAI | 100–150 | 60.0–66.0 | |
HADS | 15–102 | 18.6–66.7 | ||
Othera | 30–1432 | 3.3–57 | ||
Agoraphobia | PAS | 100 | 2.0 | India [43] |
GAD | Othera | 30–42 | 4.8–10.0 | |
Panic disorder | Othera | 53–95 | 1.9–11.3 | |
Social phobia | Othera | 42–181 | 2.4–67.9 | |
Depression and anxiety | Any | 15–102 | 4.9–33.3 | |
HADS | 15–102 | 4.9–33.3 | ||
Othera | 30–100 | 5–10.0 | ||
Stigmatization | Othera | 7–326 | 17.3–100 | |
Adjustment disorders | Any | 22–326 | 4–93.9 | |
Adjustment disorder | Diagnosed during screening | 113 | 10.6–11.5 | |
Helplessness | VIS | 22 | 9.1 | Nepal [32] |
Hopelessness | BHS | 100 | 60.0 | Iran [30] |
Stress | Holmes and Rahe Social Readjustment Rating Scale | 30–32 | 65.6–93.9 | |
Freiburger Personality Inventory | 117 | 28.2 | Germany [141] | |
Unhappiness | Self-report | 22 | 68.2 | Nepal [32] |
Worry about others’ thoughts | VitiQoL | 22–29 | 31.8–40.9 | |
Worry about spread | VitiQoL | 22–29 | 68.2–75.9 | |
Othera | 22–326 | 4–88.0 | ||
Sleep disturbances | Othera | 30–116 | 4.6–89.0 | |
Behavioral impairment | Any | 22–1432 | 0.1–76 | |
ADHD | K-SADS-PL | 30 | 20.0 | Turkey [34] |
Binge-eating disorder | PRIME-MD PHQ | 95 | 7.4 | India [22] |
Obsessive disorders | Diagnosed during screening | 53–113 | 7.6–19.5 | |
Diagnosis on file | 1432 | 0.1 | Taiwan [23] | |
Not specified | 53 | 3.8 | India [138] | |
Social and situational avoidance/restriction | Participation Scale | 100–150 | 17.3–48.0 | |
Othera | 22–442 | 12.5–76 | ||
Self-consciousness | Any | 22–326 | 6.2–72.7 | |
Embarrassment | VitiQoL | 22–29 | 27.3–55.5 | |
Othera | 22–326 | 24–66.7 | ||
Low self-esteem | RSES | 145–222 | 6.2–6.8 | |
Othera | 22–117 | 30–72.7 | ||
Emotional impairment | Any | 22–1432 | 6–65.0 | |
VitiQoL | 22–29 | 18.2–55.2 | ||
Othera | 61–1432 | 6–65.0 | ||
Cognitive impairment | Any | 53–1432 | 0.3–50.8 | |
Schizophrenia | Diagnosed during screening | 53 | 3.8 | India [137] |
Diagnosis on file | 1432 | 0.3 | Taiwan [23] | |
Unspecified | Skindex-61 | 61 | 50.8 | India [145] |
Relationship difficulties and sexual dysfunction | Any | 22–326 | 2.0–81.8 | |
Relationships | Othera | 22–326 | 4.5–81.8 | |
Sexual | Othera | 32–167 | 2.0–48.2 | |
Alexithymia | TAS-20 | 30–181 | 23.8–46.7 | |
Anger | Any | 61–181 | 14–36.9 | |
IPQ | 100–164 | 29.0–34 | ||
Othera | 61–181 | 14–36.9 | ||
Suicidality | Any | 30–326 | 3–28.3 | |
Attempts | Diagnosed during screening | 30–108 | 3.3–3.7 | |
Ideation | Othera | 22–326 | 3–25.0 | |
Unspecified | Not specified | 53 | 28.3 | India [138] |
Somatoform disorder | Othera | 30–95 | 6.3–9.4 | |
Alcohol dependence or abuse | Othera | 42–95 | 2.4–7.6 |
3.4.2 Degree of Psychosocial Burden
Psychosocial comorbidity, % | Vitiligo vs acne | Vitiligo vs alopecia areata | Vitiligo vs atopic dermatitis | Vitiligo vs psoriasis | Vitiligo vs urticaria | Vitiligo vs eczema |
---|---|---|---|---|---|---|
Depression | 46.3 vs 18.9 [154] | 46.3 vs 55.3 [154] | 46.3 vs 35.5 [154] | 46.3 vs 42.3 [154] | 46.3 vs 35.5 [154] | 60.0 vs 56.6 [159] |
47.2 vs 19.6 [137] | 60.0 vs 50.0 [159] | 47.2 vs 34.8 [137] | 47.2 vs 43.6 [137] | |||
60.0 vs 54.1 [159] | 60.0 vs 69.4 [159] | |||||
10.0 vs 23.3 [150] | ||||||
4.4 vs 6.8 [113] | ||||||
Anxiety | 31.5 vs 55.3 [154] | 31.5 vs 19.7 [154] | 31.5 vs 43.6 [154] | 31.5 vs 24.3 [154] | 31.5 vs 43.6 [154] | 66.7 vs 73.3 [159] |
11.3 vs 24.7 [137] | 66.7 vs 64.3 [159] | 11.3 vs 13.5 [137] | 11.3 vs 11.5 [137] | |||
66.7 vs 78.4 [159] | 66.7 vs 83.3 [159] | 6.0 vs 30.0 [155] (p = 0.003) | ||||
3.3 vs 3.3 [150] | ||||||
Depression and anxiety | 33.3 vs 21.6 [159] | 33.3 vs 21.4 [159] | 33.3 vs 38.8 [159] | 33.3 vs 26.7 [159] | ||
Sleep disturbances | 4.6 vs 1.9 [154] | 4.6 vs 2.4 [154] | 4.6 vs 51.8 [154] | 4.6 vs 22.0 [154] | 4.6 vs 51.8 [154] | |
20.0 vs 56.7 [150] | ||||||
Suicide | ||||||
Ideation | 25.0 vs 11.7 [154] | 25.0 vs 38.5 [154] | 25.0 vs 19.1 [154] | 25.0 vs 10.0 [154] | 25.0 vs 19.1 [154] | |
10.0 vs 26.6 [150] | ||||||
Attempt | 3.7 vs 2.4 [154] | 3.7 vs 4.3 [154] | 3.7 vs 0 [154] | 3.7 vs 4.3 [154] | 3.7 vs 0 [154] | |
Sexual dysfunction | 48.2 vs 6.8 [154] | 48.2 vs 20.2 [154] | 48.2 vs 21.8 [154] | 48.2 vs 40.0 [154] | 48.2 vs 21.8 [154] | |
36.0 vs 58.0 [155] | ||||||
Somatoform disorder | 9.4 vs 8.3 [137] | 9.4 vs 5.6 [137] | 9.4 vs 9.0 [137] | |||
Adjustment disorder | 0 vs 10.3 [137] | 0 vs 4.5 [137] | 0 vs 7.7 [137] | |||
11.5 vs 14.6 [113] | ||||||
Obsessive-compulsive disorder | 18.5 vs 3.9 [154] 7.6 vs 11.3 [137] | 18.5 vs 2.9 [154] | 18.5 vs 2.7 [154] | 18.5 vs 2.7 [154] 7.6 vs 2.3 [137] | 18.5 vs 2.7 [154] 7.6 vs 2.6 [137] | |
Bipolar affective disorder | 7.6 vs 2.1 [137] | 7.6 vs 3.4 [137] | 7.6 vs 3.9 [137] | |||
Schizophrenia | 3.8 vs 3.1 [137] | 3.8 vs 5.6 [137] | 3.8 vs 2.6 [137] | |||
Alcohol dependence syndrome | 7.6 vs 2.1 [137] | 7.6 vs 11.2 [137] | 7.6 vs 5.1 [137] | |||
Dysthymia | 1.8 vs 1.0 [113] | 26.0 vs 46.0 [155] (p = 0.04) | ||||
Stigma | 17.3 vs 28.0 [136] | |||||
Stressa | 65.6 vs 68.9 [109] | |||||
Participation restriction | 17.3 vs 28.0 [130] | |||||
Unspecified psychiatric comorbidity | 79.2 vs 60.0 [173] | 79.2 vs 56.3 [173] | 79.2 vs 80.0 [173] 16.7 vs 53.3 [150] (p = 0.003) | 79.2 vs 70.6 [173] |