Anxiety and depression predispose individuals to an autoimmune bullous diseases- bullous pemphigoid: A large-scale population-based cohort study

The association of bullous pemphigoid (BP) with anxiety and anxiety-depression comorbidity is yet to be established. We aimed to evaluate the bidirectional association of BP with anxiety, depression, and anxiety-depression comorbidity, and to delineate the epidemiological features of patients with BP and the aforementioned psychiatric comorbidities. A population-based cohort study was performed to assess the risk of anxiety, depression, and anxiety-depression comorbidity among patients with BP (n = 3924) relative to age-, sex- and ethnicity-matched control subjects (n = 19,280). A case-control design was additionally adopted to estimate the odds of BP in individuals with a preexisting diagnosis of these three psychiatric conditions. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were estimated by Cox regression and logistic regression, respectively. A history of anxiety (OR, 1.17; 95% CI, 1.04–1.31), depression (OR, 1.26; 95% CI, 1.15–1.38), and anxiety-depression comorbidity (OR, 1.19; 95% CI, 1.04–1.35) was associated with subsequent development of BP. In the cohort study design, patients with BP were found to be at an increased overall risk of depression (HR, 1.17; 95% CI, 1.01–1.35), while female BP patients had an increased risk of depression (HR, 1.19; 95% CI, 1.00–1.42) and anxiety (HR, 1.29; 95% CI, 1.00–1.67). Patients with comorbid BP and depression exhibited a 19% increased all-cause mortality rate (HR, 1.19; 95% CI, 1.08–1.31), whereas patients with BP and anxiety-depression comorbidity were less adherent to long-term topical corticosteroid treatment and less frequently managed by adjuvant agents. In conclusion, a history of anxiety, depression, and anxiety-depression comorbidity predisposes individuals to BP, whereas patients with BP are at an increased risk of depression. Clinicians managing patients with anxiety and depression should take the increased risk of BP into consideration, and patients with BP should be monitored for depression.