Anxiety and depression are often overlooked and underdiagnosed in both patients with atopic dermatitis (AD) and their family members and preschool caregivers. The clinical spectrum of AD often includes insomnia, anxiety, and psychosocial distress in patients. There is also a serious burden on the parents who are actively participating in the management of their child’s disease and are therefore also highly psychosocially affected.
The Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HAM-A), and a 7-item questionnaire were used for evaluation of the symptoms of depression and anxiety in 83 family members and caregivers of 35 patients with AD aged 1–6 years. The severity of AD was measured by the scoring atopic dermatitis (SCORAD) index.
A total of 61 (73.5%) participants presented with depression. The average score on the HAM-A scale was 12.9±4.8 (lowest score 6.7, highest score 20.0). The highest HAM-A and HAM-D score was not associated with highest SCORAD values in patients, but with the most persistent long-term clinical presentation of AD. The major concerns of caregivers and family members was the information given to them regarding the nature of the disease itself, because it is a long-term condition which requires complex and costly therapeutic regimens.
AD is a serious disease with high impact on the quality of life, not only of patients but of family members and caregivers as well. The chronicity and complexity of the disease often leads to overlooked anxiety and depression in family members and caregivers, and therefore addressing this might offer a wholesome view of the situation, tracking a widened approach to the management of AD, not only in the patients but in their families as well.
Although AD is not considered a lethal disease per se, the first information parents are given is that it is a genetically determined disease that, despite new promising medications, cannot be cured and is only managed. The pressure the parents perceive is even higher when faced with new medications, because even though they could have good results with the symptom control of AD, they tend to have side and adverse effects that could potentially outweigh the offered benefits.1 This typically starts a guilt, shame, and anxiety cycle, and the process of dealing with this information can result in a search for a ‘responsible person’ to advise them on the situation their child is facing.
The treatment choosing process develops in multiple ways as the care for the child demands physical, mental, and financial engagement from the parents, as well as a continuous dedication of time.2 Parents must control their child’s food consumption, clothes, and activities, though they must avoid micromanaging too much of their child’s lifestyle and habits. Knowing they must find the ‘perfect equilibrium’ between protecting their child and being an overbearing parent is an additional burden to parents.