An Unblemished Look: Understanding the Role of Acne in Internalizing Problems Both as a Risk Factor and a Context of Risk
Several studies have shown an association between acne vulgaris and depression and anxiety. Some evidence suggests that these associations may be influenced by moderating factors such as sex, clinical acne severity, and perceptions of acne severity. Overarching these questions are those pertaining to the developmental salience of these factors. The current investigation addressed these gaps based on an examination of literature to assess data from 40 studies including a total of x participants for depression outcome and x participants for anxiety outcome retrieved from PubMed, PsycINFO, MEDLINE, and Cochrane databases. A 2-step hierarchical meta-analytic approach was utilized in order to perform random effects model analyses to determine associations (1) between individuals with acne and without acne, and (2) among individuals with acne. Step 1 analyses across 1,028,893 participants from 33 studies found a significant association between acne vulgaris and depression, r = 0.199 (95% CI: 0.143-0.253, p < .00001). Similarly, across 21,634 participants from 22 studies sample sizes, results revealed a significant association with anxiety, r = 0.257 (95% CI: 0.187-0.323, p < .00001). It is of note that acne, which is often disregarded as a cosmetic concern, explains 4.41% and 6.66% of the variation in depression and anxiety, respectively. Sensitivity analyses underscored the robustness of these results. Subgroup analyses and comparisons showed influences on these associations such that females, adults, and those with more severe acne were at greater risk. Limitations included marked heterogeneity and inconsistencies between publications regarding acne and outcome ascertainment, data reporting, and studies with no control group. These considerations posed considerable barriers to synthesizing all available literature. Still, because of increased risk for depression and anxiety among individuals with acne, clinicians should consider screening patients with acne for psychiatric morbidity.