Supplementary Material for: Hidradenitis Suppurativa and Bipolar Disorders: A Population-Based Study

Background: Psychological comorbidities have been reported in patients with hidradenitis suppurativa (HS), yet only a few studies have investigated the possible association between HS and severe psychiatric disorders. The current study aimed to assess the association between HS and bipolar disorder, a major, chronic, psychiatric disease. Methods: A nationwide, population-based study was performed utilizing data from the Clalit Health Services (CHS) database in Israel. The study included 4,191 HS patients and 20,941 age- and gender-matched controls. A multivariate binary logistic regression, adjusted for demographic and behavioral risk factors, was performed. Results: A higher proportion of bipolar disorders was found among HS patients compared to controls (0.7 vs. 0.1%, respectively). There was an increased proportion of active smokers among HS patients than among controls (53.4 vs. 13.5%, respectively). In the multivariate analysis, adjusting for age, sex, and smoking, HS was found to be independently and positively associated with bipolar disorders (OR 2.12, 95% CI 1.21–3.27, p Conclusions: Bipolar disorders are associated with HS. Future studies should explore whether cardiometabolic deficiencies might account for this association. Healthcare providers should consider this potential co-occurrence as it may impede patient compliance and require appropriate screening and treatment. Results also stress the need for a multidisciplinary approach to optimize management of the disease and its associated comorbidities.

**背景**：已有研究报道化脓性汗腺炎（hidradenitis suppurativa，HS）患者存在心理共病，但目前仅有少数研究探讨了HS与重度精神疾病之间的潜在关联。本研究旨在评估HS与双相情感障碍（bipolar disorder）——一种重型慢性精神疾病——之间的关联。
**方法**：本研究为基于人群的全国性研究，采用以色列Clalit健康服务（Clalit Health Services，CHS）数据库的数据。研究共纳入4191名HS患者与20941名年龄、性别匹配的对照个体，并实施了校正人口学与行为危险因素的多变量二元logistic回归分析。
**结果**：HS患者的双相情感障碍检出比例高于对照组（分别为0.7%与0.1%）。HS患者的当前吸烟者占比亦显著高于对照组（分别为53.4%与13.5%）。在多因素分析中，校正年龄、性别与吸烟状态后，HS与双相情感障碍呈独立正相关（优势比OR=2.12，95%置信区间CI：1.21~3.27，p）。
**结论**：双相情感障碍与HS存在关联。未来研究应探讨心脏代谢缺陷是否为该关联的潜在机制。临床医护人员需重视这一潜在共病情况，因为其可能降低患者治疗依从性，且需要针对性的筛查与干预措施。本研究结果同时强调，需采用多学科诊疗模式以优化该病及其共病的管理方案。