1. 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

2. S Ratib

3. 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

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

5. 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

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

7. 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)

8. 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%)

9. 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

10. 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

11. 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

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

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