The prevalence of psychological co-morbidity in people with vitiligo: a systematic review and meta-analysis O. Osinubi, M.J. Grainge, L. Hong, A. Ahmed, J.M. Batchelor, D. Grindlay, A.R. Thompson S. Ratib Centre of Evidence Based Dermatology, University of Nottingham Journal reference

S Ratib

Introduction What’s already known? Vitiligo is a chronic disorder that causes skin depigmentation Global prevalence: 0.2 to 1.8%. Occurs in both genders, all ages and all ethnicities Aetiology not fully understood Currently no cure People with vitiligo are likely to suffer depression Assessment of psychological state during clinical evaluation of vitiligo is recommended by UK Guidelines The prevalence of psychological co-morbidity in people with vitiligo has not been synthesised

Objective To synthesise all available evidence from observational studies on the prevalence of psychological symptoms or disorders in people living with vitiligo

Methods (1) Protocol registration carried out in March 2016 (PROSPERO) Use of MOOSE guidelines Comprehensive literature search in December 2016: MEDLINE, Embase, PsychINFO, CINAHL; Grey Literature Eligibility criteria: Observational studies, any psychological outcome, prevalence or incidence, vitiligo either clinically diagnosed or self reported, all languages

Methods (2) Independent searching & data extraction & evaluation Modified Newcastle-Ottawa tool Meta Analysis: DerSimonian and Lard random- effects models Narrative synthesis

Results (1) Included studies: 29, n=2530 patients Type of studies: 26 cross-sectional; 3 case-control Geography: Asia (13), Europe (7), Americas (3), Africa (3), Middle East (3) Setting: Hospital (24), Clinic (4), Unknown (1)

Results (2) Outcomes: Depression (25), Anxiety (13), Others (10) Outcomes tools: 19 different tools used (Hospital Anxiety & Depression scale, and Centre for Epidemiology Studies Depression Scale were the most common) Quality of studies: Poor (14%), Fair (45%), Good (41%)

Results from meta-analysis (3) Prevalence of outcomes: Depression 1 in 4 or 1 in 5 prevalence depending on the use of questionnaires or clinical diagnosis, respectively Lower in vitiligo vs. psoriasis (statistically significant difference) Anxiety Depends on tool: Questionnaires (range 33% to 46%); Clinical diagnosis (15%) Lower in vitiligo vs. psoriasis

Results from meta-analysis (3) Prevalence of outcomes: Other outcomes seen: substance abuse, suicidal attempts, panic disorder, social phobia, dysthymic disorder, adjustment disorder, alcohol addiction, asthenia, interpersonal conflict, obsessive compulsive disorder, specific phobia and agoraphobia High level of heterogeneity seen Inadequate comparators used

Conclusions What does this study add? People living with vitiligo experience a range of psychological disorders Assessment of psychological state in people with vitiligo is essential The prevalence of anxiety varied by screening tool, suggesting the need for dermatologic specific validated screening tools Population-based studies are required to provide more generalizable results

O Osinubi MJ Grainge JM Batchelor AR Thompson A Ahmed S Ratib D Grindlay

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