Eczema, also called , is an inflammatory skin disease that affects 18 million adults (and lots of children, as well) in the United States. Ask anyone who suffers from the itchy, chronic condition and they’ll tell you it can be unpleasant at best, and debilitating at worst.
Now, research published in JAMA Dermatology highlights just how much of a psychological burden people with eczema can carry. According to a review and meta-analysis of 15 previous studies and more than 300,000 atopic dermatitis patients, eczema sufferers were 44% more likely to have suicidal thoughts—and 36% more likely to attempt suicide—compared to their peers without the disease.
Only two of the studies in the review looked at the prevalence of completed suicides in eczema patients versus a control group, but their findings were contradictory: One found an increased risk among people with eczema, while the other found no significant difference in the two groups.
Previously, the evidence for a link between eczema and suicide has been inconclusive, according to the authors of the new review. What was clear, however, is that eczema can take a serious physical and mental toll.
“Because of the visibility of the disease, patients may experience shame, embarrassment, and stigmatization,” the researchers wrote in their paper. They can also suffer from persistent itching, burning, and dry skin, and may even develop painful blisters and sores.
Children with eczema perform worse in academics compared to those without, studies show, while adults with eczema fare worse at work. The disease has also been associated with depression and anxiety, as well as asthma, allergies, sleep disturbances, and other physical health problems.
But can eczema really be so bad that people actually try to take their own lives? It’s possible, say researchers. In fact, a woman in China killed herself—and her parents—last year, writing in a suicide note that her eczema made her feel she’d be “better dead than alive.”
Of course, the type and severity of eczema can vary: Some people have just small patches of dry skin, can control their symptoms with topical medications, and aren’t bothered regularly by flare-ups. Others can have persistent and hard-to-treat rashes covering much of their body.
One study included in the review compared suicidal ideations in eczema patients of varying severities, and it did find a big difference: Those with severe eczema had a much higher likelihood of suicidal thoughts (19.6%) compared to those with mild eczema (0.21%).
Itching and embarrassment may not be the only things driving a connection between these two health issues, either. Experts also believe that the inflammatory processes that fuel eczema’s dry, itchy patches may also affect the balance of mood-regulating neurotransmitters, like serotonin, in the brain. Studies have shown that people who attempt suicide have higher levels of pro-inflammatory proteins in their cerebrospinal fluid. Treatments that target those proteins have also been shown to decrease depression and anxiety in patients with eczema.
Most likely, the researchers say, eczema’s link to suicide has something to do with all three of these issues. “By addressing the physical burden, psychosocial burden, and chronic inflammatory state of [atopic dermatitis], we can work toward reducing suicidality in patients,” they wrote.
In the U.S., suicide is the second leading cause of death among adolescents and the tenth among all Americans, the authors wrote in their paper—with a death toll of almost 45,000 people a year. “It is important for dermatology providers to be aware of this increased risk in patients with atopic dermatitis, monitor for suicidality, and make appropriate referrals to mental health professionals,” they concluded.
If you or someone you know is thinking about suicide—whether eczema is involved or not—mental health professionals can help. Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255) to speak with someone right away.
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