TOPLINE:

Adults with alopecia areata (AA) faced a significantly higher risk for psychiatric disorders, with women showing greater vulnerability to depression, anxiety, and eating disorders. The post-COVID-19 pandemic period saw up to a 70% increase in mental health conditions, particularly suicide and eating disorders.

METHODOLOGY:

• This retrospective cohort study included 57,389 patients with AA in one group and 57,389 matched control individuals in another from the TriNetX Global Health Research Network database between January 2015 and April 2025.
• Patients included required at least one diagnosis of AA and at least 6 months of continuous electronic health record activity before the index date (the first qualifying diagnosis of AA). The matched control individuals were selected if they had attended at least one routine general examination with no history of AA or other autoimmune hair loss disorders before the index date.
• Researchers employed 1:1 propensity score matching between two groups to assess the incidence, prevalence, or risks for psychiatric disorders, including depression, anxiety, stress-related disorders, eating disorders, self-harm, suicidal ideation or attempts, substance use disorders, somatoform disorders, and severe illnesses.
• Follow-up started 1 day after the first diagnosis of AA for patients or first general examination for control individuals until the earliest of the first documented outcome, death, loss to follow-up, or the study's administrative end date.

TAKEAWAY:

• Patients with AA showed a significantly higher cumulative incidence of any psychiatric disorder than control individuals (17.3% vs 3.9%; risk ratio [RR], 4.49), with a large difference seen in incidences of depression (6.4% vs 1.3%; RR, 5.14) and anxiety (10.6% vs 2.8%; RR, 3.83).
• The risk for somatoform disorders (RR, 6.07), suicidal ideation and attempts (RR, 5.62), and substance use disorders (RR, 6.13) was also higher among patients with AA than among healthy control individuals. Patients with AA showed higher risks for bipolar and manic episodes (RR, 5.17), psychotic disorders (RR, 6.38), eating disorders (RR, 4.29), personality disorders (RR, 5.53), and sleep disorders (RR, 3.80).
• Women with AA experienced a higher psychiatric burden than men, particularly in terms of depression (7.6% vs 3.5%; RR, 2.21; hazard ratio [HR], 2.06), anxiety (11.9% vs 6.5%; RR, 1.83; HR, 1.72), and eating disorders (0.42% vs 0.06%; RR, 6.85; HR, 6.11).
• The post-COVID-19 pandemic period saw a raised prevalence of all psychiatric outcomes, with a more than 50% increase seen in anxiety, insomnia or parasomnia, and self-harm and a nearly 70% increase seen in eating disorders and suicide.

IN PRACTICE:

"AA is linked to a significantly increased risk of developing psychiatric disorders, with women experiencing a greater overall burden. The impact of AA on mental health worsened after the COVID-19 pandemic, affecting multiple outcomes," the authors wrote. They highlighted the importance of "routine, structured mental health screening and timely referral in dermatology clinics, especially for high-risk groups and during stressful periods."

SOURCE:

This study was led by Katarzyna Łuczak, Faculty of Medicine, Wrocław University of Science and Technology, Wrocław, Poland. It was published online on October 31, 2025, in Dermatology and Therapy.

LIMITATIONS:

Researchers noted potential misclassification risks due to the reliance on coded diagnoses for AA and psychiatric conditions. This study lacked data on disease severity, socioeconomic factors, healthcare utilisation patterns, and family psychiatric history. Surveillance bias may have occurred as increased clinical contact could have led to a higher detection of psychiatric conditions. For rare outcomes such as self-harm and psychosis, low event counts and wide CIs reduced the precision of estimates. The study's generalisability may have been limited by the potential underrepresentation of uninsured or marginalised populations.

DISCLOSURES:

No funding or sponsorship was received for this study. One author reported receiving travel support from TriNetX. Two authors reported serving as editorial board members of Dermatology and Therapy.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.