Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: a systematic review

Alopecia areata (AA) is an immune-mediated disease resulting in non-scarring hair loss. Systematic reviews on the psychosocial and psychiatric comorbidities, health-related quality of life, and interventions targeting psychosocial well-being are limited. We conducted a systematic review of the psychosocial comorbidities, health-related quality of life, and treatment options targeting psychosocial well-being in adult and pediatric AA patients. Our systematic review was performed according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines within the PubMed database. Specific search terms included, but were not limited to, alopecia areata, psychosocial, psychiatry, and quality of life. Studies were then evaluated for their design and categorized into corresponding levels of evidence according to the guidelines adapted from the Oxford Center for Evidence Based Medicine. Seventy-three reports met inclusion criteria, involving approximately 414,319 unique participants. Alopecia areata patients were found to have psychiatric co-morbidities, particularly anxiety and depression. Health-related quality of life is reduced in AA patients, but data on pediatric AA quality of life is limited. Psychotherapy is often recommended as adjuvant treatment. We concluded that alopecia areata has substantial psychosocial impact on patients and results in reduced health-related quality of life. Addressing this should be an active part of treatment.斑秃（Alopecia areata, AA）是一种免疫介导性疾病，临床表现为非瘢痕性脱发。目前针对该病的社会心理与精神共病、健康相关生活质量以及靶向社会心理福祉的干预措施的系统综述仍较为匮乏。本研究针对成人与儿童斑秃患者的社会心理共病、健康相关生活质量及靶向社会心理福祉的治疗方案开展系统综述。本系统综述严格遵循《系统评价与元分析首选报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南，在PubMed数据库中完成检索流程。检索词包括但不限于：斑秃、社会心理、精神医学、生活质量。随后依据改编自牛津循证医学中心（Oxford Center for Evidence Based Medicine）的指南，对纳入研究的设计进行评估，并划分对应的证据等级。最终共有73篇研究报告符合纳入标准，涉及约414319名独立受试者。研究结果显示，斑秃患者常伴发精神共病，尤以焦虑与抑郁最为突出；斑秃患者的健康相关生活质量显著下降，但针对儿童斑秃患者生活质量的相关数据仍十分有限。心理治疗常被推荐作为辅助治疗手段。本研究结论表明，斑秃会对患者造成显著的社会心理负担，并导致其健康相关生活质量降低，对此的干预应成为临床治疗的重要组成部分。