The Association of Hidradenitis Suppurativa and Psychiatric Disease: A Systematic Review and Meta-analysis

Br J Dermatol. 2025 Apr 19:ljaf151. doi: 10.1093/bjd/ljaf151. Online ahead of print.

ABSTRACT

BACKGROUND: Hidradenitis suppurativa (HS) has been associated with increased risk of psychiatric disease (PD) compared to the general population. However, to our knowledge, no recent comprehensive examination of the prevalence and association between HS and PD has been made.

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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The medical databases PubMed, EMBASE, PsychINFO, 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 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. 8.35%, OR 2.06 [1.75-2.41], p<0.0001; anxiety, 19.3% vs. 8.14%, OR 1.91 [1.64-2.22], p<0.0001; bipolar disorder, 1.04% vs. 0.06%, OR 3.68 [1.11-12.2], p=0.0332; schizophrenia, 2.68% vs. 1.23%, OR 2.00 [1.21-3.30], p=0.007; substance use disorder 6.02% vs. 3.12%, OR 3.58 [2.01-6.37], p<0.0001; alcohol abuse, 3.97% vs. 1.84%, OR 1.88 [0.98-3.58], p=0.0571, and completed suicide 0.67% vs. 0.44%, OR 1.56 [1.14-2.14], p=0.0054 when compared to general population. PD was more prevalent in females with HS (28%) compared to males (21%). Depression increased with increasing Hurley Stage (I=19.5%, II=20.9%, and II=35.3%, p<0.0001). North American studies had higher pooled prevalence of PD compared to European studies (35.4% vs. 21.2%). Adults had higher pooled prevalence of depression compared to children (19.1% vs. 9.51%). 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 to the general population. Our findings reflect a need to raise awareness of psychiatric illnesses in patients with HS to improve patients’ quality of life.

PMID:40251988 | DOI:10.1093/bjd/ljaf151