Childhood eczema takes a toll on children’s and parents’ mental health

Eczema severity in children is associated with depression, anxiety and stress in both children with eczema and their parents, a cross-sectional study in Hong Kong has shown.

Eczema is a common relapsing inflammatory skin disease affecting 30 percent of children in Hong Kong. There has been limited research focusing on how the severity of childhood eczema impacts both the affected children and their parents psychologically. [Asia Pac Allergy 2019;9:e26; J Dermatolog Treat 2015;26:83-89; Hong Kong Med J 2024;30:362-370]

In the current 2-year cross-sectional study, researchers recruited children with eczema (n=432; mean age, 9.61 years; female, 49.5 percent) and their parents (n=380; mean age, 41.1 years; female, 87.1 percent) at a paediatric dermatology clinic in a university-affiliated hospital in Hong Kong. Their mental health conditions were measured by the Chinese version of the 21-item Depression, Anxiety, and Stress Scales (DASS-21). [Hong Kong Med J 2024;30:362-370]

Most children (67.3 percent) in the study had moderate to severe eczema according to the Nottingham Eczema Severity Score (NESS). Eczema had a moderate to extremely large impact on health-related quality of life (HRQoL) in over half of the children.

Eczema severity and HRQoL were significantly associated with depression, anxiety, and stress levels in affected children and their parents, as measured by DASS-21 (children: r=0.28–0.72; p<0.001–0.007) (parents: r=0.20–0.52; p<0.001–0.034). Similarly, psychological symptoms in both children and their parents were negatively correlated with the children’s eczema severity and HRQoL impairment. “These strong correlations suggest that psychological symptoms, eczema severity, and impact on HRQoL have mutually detrimental effects,” pointed out the researchers.

Mothers, who serve as the primary caregivers for children with eczema, were more strongly affected, as their DASS depression, anxiety and stress scores were generally higher than those of fathers. Additionally, maternal depression showed a marginal association with higher anxiety in boys with eczema (r=0.311; p=0.045).

Of note, younger parents had higher risk of developing more anxiety and stress vs older parents (parental anxiety: adjusted odds ratio [aOR], -0.342; 95 percent confidence interval [CI], -0.613 to -0.70; p=0.014) (parental stress: aOR, -0.395; 95 percent CI, -0.724 to -0.066; p=0.019). Depression level of parents with primary to secondary education was 58 percent higher than their counterparts with tertiary education or above (aOR, -1.579; p=0.007). These findings indicated that higher parental education level and advanced parental age could be protective factors.

“Childhood eczema treatments mainly focus on pharmacological control of physical symptoms, but [we] often completely neglect the psychological symptoms in affected children and their parents,” commented the researchers. “We advocate a holistic and comprehensive approach for eczema management that considers children and their families. This approach should use a composite score to continuously evaluate disease severity in objective and subjective manners, as well as QoL impairment, psychological symptoms and miscellaneous disease surrogates in both affected children and their parents.”