The association between hidradenitis suppurativa and psychiatric disease: a systematic review and meta-analysis.

Background: Hidradenitis suppurativa (HS) has been associated with increased risk of psychiatric disease (PD) in patients with HS compared with the general population. To our knowledge, no recent comprehensive examination of the prevalence and association between HS and PD has been undertaken.

Objectives: To investigate the association between HS and PD.

Methods: A systematic review and meta-analysis was performed using standard methodologies and was reported in accordance with the PRISMA guidelines. The medical databases PubMed, Embase, PsycINFO, Cochrane, Web of Science and the Directory of Open Access Journals were searched. Studies were included if addressing HS and any PD. Study quality was assessed through the Newcastle-Ottawa Scale (NOS). Certainty of evidence was assessed using the GRADE approach.

Results: A total of 83 studies were included in the narrative analysis of which 76 were included in the quantitative analysis. This study found that patients with HS had higher risk of depression, pooled prevalence 20.9% vs. 8.4%, odds ratio (OR) 2.06 [95% confidence interval (CI) 1.75-2.41], P < 0.001; anxiety, 19.3% vs. 8.1%, OR 1.91 (95% CI 1.64-2.22), P < 0.001; bipolar disorder, 1.0% vs. 0.06%, OR 3.68 (95% CI 1.11-12.20), P = 0.03; schizophrenia, 2.7% vs. 1.2%, OR 2.00 (95% CI 1.21-3.30), P = 0.007; substance use disorder 6.0% vs. 3.1%, OR 3.58 (95% CI 2.01-6.37), P < 0.001; alcohol abuse 4.0% vs. 1.8%, OR 1.88 (95% CI 0.98-3.58), P = 0.06, and completed suicide 0.7% vs. 0.4%, OR 1.56 (95% CI 1.14-2.14), P = 0.005 when compared with the general population. PD was more prevalent in female patients with HS (28.0%, 95% CI 22.5-34.3) compared with males (21.1%, 95% CI 15.6-27.9). Depression increased with increasing Hurley stage [stage I, 19.5% (95% CI 8.3-39.4); stage II, 20.9% (95% CI 11.5-34.9) and stage III, 35.3% (95% CI 16.1-60.8), P < 0.001]. North American studies had higher pooled prevalence of PD compared with European studies [35.4% (95% CI 13.6-65.6) vs. 21.2% (95% CI 11.9-34.7)]. Adults had higher pooled prevalence of depression compared with children [19.1% (95% CI 12.4-28.3) vs. 9.5% (95% CI 6.3-14.1)]. Half of included studies were assessed as high quality (NOS ≥ 7).

Conclusions: This study found a significantly higher risk of several PDs in patients with HS compared with the general population. Our findings reflect a need to raise awareness of psychiatric illnesses in patients with HS to improve patients' quality of life.