Mental health consequences of hidradenitis suppurativa: population-level evidence of elevated risk for recurrent major depressive disorder

Summary: Abstract Body: Hidradenitis suppurativa (HS) is a chronic inflammatory condition that exerts a substantial psychological toll. HS has been found to be associated with increased risk of anxiety and depression at small sample sizes. Our study provides a novel evaluation of these associations at a population-level. Our retrospective cohort study used TriNetX data between November 2004 and November 2024 to evaluate whether HS patients who had been diagnosed subsequently with major depressive disorder (MDD) (single episode) had a higher risk of developing MDD (recurrent) compared to matched controls without HS and with MDD (single episode). Propensity matching was performed to control for sex, patient current age, age at MDD diagnosis, ethnicity, and race. Risk ratios were calculated and evaluated for statistical significance. HS propensity matched cohorts with initial diagnosis of MDD (single episode) each contained 49,205 patients (mean age 45±15 years) and were 79% female, 27% Black, 9% Hispanic, 56% White, and 1% Asian. HS patients diagnosed with MDD (single episode) were 33% more likely to be diagnosed with recurrent MDD compared to controls without HS (RR=1.328, 95% CI=(1.284, 1.372)), 25% more likely to have anxiety, (RR=1.245, 95% CI=(1.212, 1.279)), 8% more likely to have suicidal ideation (RR=1.078, 95% CI=(1.004,1.153)), and had a lower risk of intentional self-harm (RR=0.892, 95% CI=(0.736, 1.082). This study demonstrates the substantial risk in HS patients for developing anxiety and recurrent MDD. HS-associated lifestyle factors that can explain the results include impaired quality of life leading to social withdrawal and poor self-care. In addition, shared pathobiological pathways include neuroinflammatory processes with aberrant cytokine signaling, such as IL-6, TNF-alpha, and IL-17 that also impact brain function. These findings underscore the importance of early mental health screening and interventions in HS patient care. Jack Woll¹, Ulysses Cázares¹, Milan M. Hirpara¹, Anagha Thiagarajan¹, Megan T. Nguyen¹, Makenna C. Chapman¹, Gabrielle Baker¹, Natasha Mesinkovska¹ 1. University of California Irvine Department of Dermatology, Irvine, CA, United States. Clinical Research: Epidemiology and Observational Research