Mental Health Support for Patients With Atopic Dermatitis

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Wendy Smith Begolka, MBS, chief strategy officer for research, medical, and community affairs at the National Eczema Association (NEA), sat down with The Dermatologist to discuss the NEA’s recent study evaluating mental health support by health care providers for patients with atopic dermatitis (AD). 

The Dermatologist: In your opinion, how important is it for eczema providers to address mental health issues related to AD? 

Wendy Smith Begolka: As we continue to learn more about AD, one thing is clear, it is a disease with many more impacts beyond what is visible on the skin. Other studies have pointed to the higher risk of anxiety and depression among AD patients. Our research builds on this to translate it into what is happening to patients in the real world. We found that more than 70% of survey respondents felt their mental health was negatively affected by their AD in the past year, and 26% had mental health symptoms more than 10 days per month. Importantly, these impacts were not restricted to those with more severe disease. While we saw correlation of mental health symptoms with AD severity, between 44% and 56% of patients with current clear/almost clear skin felt their mental health was still affected by their AD in the past year. That is striking and speaks to the lingering impacts of AD even when physical symptoms may be improving. Bringing mental health into the picture means more holistic care—caring for the patient, not just the AD. 

The Dermatologist: What impact do you think it would have on overall patient care if mental health was more routinely addressed when treating AD? 

Wendy Smith Begolka: Although our research did not address this specifically, we can infer a few things. The first is a stronger and more trusting patient-health care provider relationship. This can be a challenging conversation, but ultimately many patients with AD want their health care provider to have a better understanding and acknowledgement of their journey—connection before care. This could then lead to more alignment and agreement with care decisions, maybe even the choice of different therapies to better address AD signs and symptoms, and hopefully overall better care outcomes. Lastly, it would help identify patients and caregivers who need more mental health support in addition to their AD treatments. We need more research to help identify what types of resources and programs are most beneficial, but with the goal of holistic care, we can help patients get the care they need. 

The Dermatologist: Are there any barriers you have found for patients with AD seeking mental health support? 

Wendy Smith Begolka: That is the focus of our next paper from this survey, so stay tuned, but what I can share from our published research is that the first barrier to mental health support is having the conversation. Our research indicated that 42% of patients did not raise mental health concerns with their health care provider, 51% were not asked about their mental health during any visit for AD care, and 64% did not receive a referral for any form of mental health services. And, perhaps surprisingly, patients whose primary eczema provider was not a specialist were about 2.5 times more likely to be asked about mental health compared to those seeing a specialist. These data indicate that there is clearly an opportunity for both patients/caregivers and health care providers to improve the consistency of this conversation across different AD care settings. 

The Dermatologist: What has been your experience discussing mental health with patients who have AD? 

Wendy Smith Begolka: There is no doubt that this can be a difficult conversation. My personal experience has largely come from NEA’s Eczema Expo, and it is often filled with raw, unfiltered, and emotionally painful discussion. Some patients have been able to better address their mental health issues, others less so. This is juxtaposed against data from our survey suggesting that different patient groups had varying levels of desire to be asked about their mental health, and some were asked who preferred to have not been. The heterogeneity of the lived experience of AD extends to mental health as well. Regardless, our work at NEA is to draw attention to the significance of mental health impacts, and the importance of self-care and connection with a community that understands what you are going through. 

The Dermatologist: What suggestions do you have for improving the integration of mental health support in the care provided by eczema specialists? 

Wendy Smith Begolka: There is a growing awareness of the mental health impacts of AD but, as I mentioned before, understanding risk is much different from understanding how it is affecting a patient’s life. There is no shortcut to this except by asking. Evolving beyond asking, “How are you?” to asking, “How are you managing/handling all of this?” or something similar is a start. If you can use screening tools or some key questions from these tools that could be another option, and some of these can even be collected before the appointment. Next, refer your patients to NEA as we can help provide additional education and resources to support patients throughout their AD journey, including information and tools to support their mental health. And, lastly, while access to mental health providers may be challenging, if possible, work to develop relationships with those in your community who you can work with to help provide holistic care. 

Reference
Chatrath S, Loiselle AR, Johnson JK, Smith Begolka W. Evaluating mental health support by healthcare providers for patients with atopic dermatitis: a cross-sectional survey. Skin Health Dis. Published online June 15, 2024. doi:10.1002/ski2.408