Drivers of Depression and Anxiety in US Non-Segmental Vitiligo Patients

OBJECTIVES: Vitiligo is an autoimmune skin depigmentation disorder which can be detrimental to patients’ psychosocial health. This study evaluates factors that drive depression and anxiety in non-segmental vitiligo (NSV) patients, beyond clinical manifestations of the disease.

METHODS: Data were drawn from the Adelphi Vitiligo Disease Specific Programme^TM, a cross-sectional survey of physicians and their adult and adolescent NSV patients in the US conducted between October 2021 and April 2022. Physicians reported patient demographics, clinical characteristics, and treatment history. Patients provided information on feelings about their vitiligo and its impact on their lives, including the Hospital Anxiety and Depression Scale (HADS) and Vitiligo Noticeability Scale (VNS). Data were analysed using elastic net regressions, an extension of LASSO and ridge regression which uses regularization to model a large number of predictor variables.

RESULTS: Analysis included 112 patients (54.56% female; mean age = 35 [sd=33]) with NSV from the US with complete data for the 87 variables input into the elastic net models. The key drivers of worsening HADS depression were: VNS reported as a lot less noticeable by patient (β = 0.599), experiencing bullying in everyday life due to their vitiligo (β = 0.402), feeling isolated due to their vitiligo (β = 0.389), and vitiligo affecting their face (β = 0.315). Key drivers of the HADS anxiety domain were: VNS reported as a lot less noticeable (β = 1.305), experiencing bullying in everyday life due to vitiligo (β = 0.432), frustration with treatment options (β = 0.298), feeling isolated due to vitiligo (β = 0.260), and vitiligo affecting their face (β = 0.177).

CONCLUSIONS: Feelings of societal isolation and stigmatization due to NSV are expectedly strong indicators of depression and anxiety, more unexpectedly we also see improvement in vitiligo noticeability as an indicator. This highlights the pervasive effect NSV can have on patients despite clinical improvement.