Hidradenitis Suppurativa Linked to Increased Risk of Depression, Anxiety

A new study shows that patients with hidradenitis suppurativa (HS) have an increased risk of new-onset depression and anxiety, with disease severity having no impact on this risk.1

HS, particularly prevalent among women, often onsets during late adolescence, though it can onset as early as after puberty.2 However, this is not always when HS is detected. Studies have reported an average diagnostic delay for HS anywhere between 7 and 10 years.3

Between HS onset and diagnosis, symptoms can worsen, potentially leading to complications of infection, scars, restricted movement, skin cancer, swelling, lifelong pain, psychological stress, and social isolation.2

Patients with HS have a greater prevalence of depression and anxiety compared to the general population.1 This increased risk of psychiatric disorders may be linked to impaired body image and sexual dysfunction associated with the disease. Additionally, individuals with HS are more likely to experience substance use disorders and unemployment, both of which are known to increase the risk of mental health issues further.

In this population-based cohort study, investigators, led by Nikolaj Holgersen, MD, from the Dermato-Venereology & Wound Healing Centre at Copenhagen University Hospital in Denmark, sought to evaluate the risk of new-onset and recurrent depression and anxiety among patients with HS and its association with disease severity.1 The study included 10,206 Danish patients with HS from a 1997 to 2022 population-based cohort, as well as 40,125 controls who were individuals without HS from the Danish national registries. The team analyzed the data from July 18, 2024, to May 20, 2025.

The primary outcome was the first diagnosis of depression or anxiety, and the secondary outcome was disease severity, defined as treatments received and hospitalizations for HS-related surgical procedures.

During the study, 55.5% received systemic nonbiologic medication, 12% received only topical, 6.5% received biologic, and 25.9% received no HS-related treatment.1

The analysis showed patients with HS had an increased risk for new-onset depression (adjusted hazard ratio [aHR], 1.69; 95% confidence interval [CI], 1.57 – 1.81; P < .001) and new-onset anxiety (aHR, 1.48; 95% CI, 1.38 – 1.56; P < .001). When stratified by treatment, the risks for either depression or anxiety were 1.62 (95% CI,1.41 – 1.85; P < .001) for topicals, 1.61 (95% CI, 1.51 – 1.72; P < .001) for systemic nonbiologics, and 1.38 (95% CI, 1.01 – 1.87; P < .05) for biologics. The risks for 0, 1, 2, or 3 or more hospitalizations for HS-related surgical procedures were 1.44 (95% CI,1.36 –1.53; P < .001),1.66 (95% CI,1.53 –2.17), 1.59 (95% CI,1.33 – 1.90; P < .001), and1.60 (95% CI,1.40 – 1.85; P < .001), respectively.1

“The risk of depression and anxiety did not differ notably between treatment or surgery groups,” the team wrote.1 “This could be due to several reasons, one being the fact that these variables are proxies for disease severity and not actual clinical measurements, which could either overestimate or underestimate actual severity.”

Investigators wrote that another reason why the risk of depression and anxiety did not differ significantly between treatment groups could be because disease severity is not a driving factor for the risk of these mental disorders in HS. The risk may be driven by other factors, such as increased mental burden, pain, the occurrence of flares, or body image impairment.

Compared with the general population, more patients with HS had a history of depression (7% vs 0.3%; P < .001) and anxiety (5.9% vs 0.5%; P < .001). Despite this, investigators did not observe a difference in the risk of recurrent depression (hazard ratio [HR], 0.90; 95% CI, 0.62 – 1.28; P = .55) or anxiety (HR, 1.22; 95% CI, 0.89 – 1.66; P = .22).1

“This finding emphasizes that depression and anxiety may occur independent of disease severity, and clinicians should be aware of mental disorders across all severity stages and approach these patients in a multidisciplinary setting,” investigators concluded.1 “Future research to identify other factors that may be associated with the risk of the development of depression and anxiety for this group of patients is highly warranted.

References

1. Holgersen N, Rosenø N, Nielsen V, et al. Risk of New-Onset and Recurrent Depression and Anxiety Among Patients with Hidradenitis Suppurativa. JAMA Dermatol. doi:10.1001/jamadermatol.2025.2298 Published online July 30, 2025.

2. Hidradenitis suppurativa. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306. Accessed July 30, 2025.

3. Murray N, Truman I, Milligan G, Modi H, Adlard N. Equity and Outcome Events in Hidradenitis Suppurativa: Exploring Effect Modifiers Associated with Diagnostic Delay in the Real World. Dermatol Ther (Heidelb). 2024 Dec;14(12):3211-3227. doi: 10.1007/s13555-024-01291-0. Epub 2024 Nov 2. PMID: 39487935; PMCID: PMC11604871.