01/21/11

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FROM THE JOURNAL OF INVESTIGATIVE DERMATOLOGY

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Vitals

Major Finding: The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne.

Data Source: The Youth 2004 study – a large cross-sectional questionnaire-based study.

Disclosures: Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Related News:

Acne Severity May Be Bigger Suicide Risk Than Isotretinoin

Isotretinoin -- Caught Between Help and Hype

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

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