Georgian Scientists/ . 4 N 3, 2022 253 Georgian Scientists Vol. 4 Issue 4, 2022 https://doi.org/10.52340/gs.2022.04.04.28 Anxiety and depression in patients with chronic urticaria Z. Telia MD PhD student of the Department of Allergology and Clinical Immunology of Tbilisi State Medical University Introduction Urticaria is an allergic and dermatological disease caused by the degranulation of mast cells and clinically manifested by wheals and angioedema [1]. Acute urticaria lasts for six weeks, while chronic urticaria for more time [2]. Chronic Spontaneous Urticaria (CSU) deserves special attention from physicians and researchers as it impacts a person’s quality of life and often lasts for several years [3]. This condition is accompanied by itching and psycho-neurological problems [4], which negatively affect a person's daily activities, mood and appearance. Recent studies have shown that 35-60% of patients with chronic urticaria have sleep disorders, anxiety, depression, and other psychiatric disorders [5-8]. This study aimed to assess the association between CSU and anxiety and CSU and depression while employing a data mining approach to match CSU patients to gender and age control participants. Were used the database of the Allergology and clinical immunology department clinics of TSMU (Tbilisi State Medical University). This assessment considered demographic and clinical factors (thyroid disease, diabetes, physical urticaria, obesity and smoking). Anxiety and depression rates were assessed using the GAD-7 (Generalized Anxiety Disorder) and PHQ-9 (Patient Health Questionnaire) questionnaires [25]. Methods Study population In chronic urticaria, the urticarial rash that lasted more than six weeks and recurred over months or years was assessed. Also, if this diagnosis has been made at least four times. Controls included individuals of randomly selected age and sex (including medical students) who did not have urticaria or any other allergic manifestations. Anxiety and depression were identified through appropriate questionnaires (GAD-7 and PHQ-9) by allergists, dermatologists, and general practitioners. The study Georgian Scientists/ . 4 N 3, 2022 254 was conducted using a case-control protocol and included 690 individuals aged 18 to 70. The study and control groups had 330 people with chronic urticaria and 360 randomly selected healthy individuals. Demographic and clinical data of the subjects were obtained from the department database and included age, sex, diabetes, obesity, thyroid dysfunction, and smoking status. Statistical analysis Statistical analysis was performed using software version 25 SPSS and Review Manager 5.4.1. Odds ratios (ORs) utilised a 95% confidence interval, with a p-value lower than 0.05 considered significant. The analysis was carried out in 4 subgroups according to demographic and clinical characteristics. Results The homogeneity of the study and control groups according to demographic and clinical parameters was assessed first. This analysis confirmed that these groups did not differ in age (M = 47.4, SD = 16.7 and M = 46.2 SD=17.1) and sex (men -34% vs. 30%, OR= 0.80, 95% CI 0.58 -1.10; women - 65% vs. 70% OR = 1.25, 95% CI 0.91-1.72). The difference between the groups was observed only according to the coexisting clinical factors (74% CSU vs. 19.4% control; OR=0.26, 95% CI 0.13-0.52) such as physical urticaria ((OR = 0.09, 95% CI 0.05-0.15 95% CI), thyroid dysfunction ((OR = 0.23, 95% CI 0.12-0.43), diabetes (OR = 0.36, 95% CI 0.14-0.93), obesity (OR = 0.47, 95% CI 0.26-0.84), and tobacco use (OR = 0.42, 95% CI 0.22-0.79) (see in Table 1). Table 1. Demographic and clinical characteristics of the study groups Odds ratios for the association between CSU and anxiety, stratified by age and sex, are demonstrated in Table 2. Anxiety was almost 1.7 times more common in the CSU group than in controls (24% vs 14%, respectively; OR = 1.93, 95% CI 1.31- 2.84). More precisely in men with chronic urticaria anxiety was 1.9 times and in women 1.6 times more higher than in control groups respectively 30% Georgian Scientists/ . 4 N 3, 2022 255 vs. 16% (OR = 2.19; 95% CI 1.15-4.16) and 21% vs. 13% (OR = 1.75; 95% CI 1.07-2.84). After age stratification, a higher rate of anxiety prevalence was observed only in the 50-69 age group with CSU than in the same age control group (OR = 0.36, 95% CI 0.18-0.75). Patients with urticaria were more likely to suffer from depression than controls (36% vs 9.7%; OR = 5.45, 95% CI 3.60-8.24). However, it was more common in women with urticaria (37% vs 19%; OR = 2.46, 95% CI 1.62-3.72); It should be noted that this trend was not found in men. However, depression was particularly pronounced in patients of both sexes in the age group 30-49 years (CVD 36% vs 17%; OR = 2.73, 95% CI 1.05-7.08). Table 2. Frequency of anxiety and depression in CSU stratified by demographic variables Discussion These results (anxiety (24.5%) and depression (36.9%)) support previous studies by other authors that have found a higher prevalence of anxiety and depression in patients with CSU [10] and confirm the hypothesis of an independent effect of this emotional distress on urticaria [9]. The study also found that anxiety and depression were more common in both sexes in the active group than in the control group. At the same time, anxiety is reliably elevated in individuals aged 50-69 with chronic urticaria and depression - in the 30-49 age group. According to other authors association of CSU with anxiety was the strongest in the 18–29 and 30-49 age groups, and depression was highest in the 50-69 age group and not in the 18–29 and 30-49 age groups [10], in our study on the contrary - significant higher anxiety was in the 50–69 age group, and depression - in 30-49 age group. Our results support previous studies showing a higher prevalence of anxiety and depression in patients with CSU is often accompanied by physical urticaria, thyroid disorders, diabetes, obesity, and tobacco smoking [10]. Many studies indicate the influence of negative emotional factors on dermatological manifestations, including urticaria [11, 12], this association between chronic urticaria, on the one hand, and anxiety and depression, on the other hand, is still not well understood [13]. Some authors have Georgian Scientists/ . 4 N 3, 2022 256 suggested that urticaria predominates in autoimmune diseases, predominantly in adult women [14] and that it is often associated with anxiety and depression (mainly in the 50-69 age group [15]). This is consistent with the data of our studies on the manifestation of anxiety in patients of both sexes. Most authors link depression and anxiety to the age factor. They believe that these emotional disorders are associated with feelings of loneliness, social exclusion, and isolation (especially at a later age). However, they also agree that they are pretty standard in the healthy population, which significantly complicates the study of the links between these two phenomena in different diseases [16, 17, 18, 19]. Some authors believe that urticaria predates the onset of autoimmune diseases, especially in adult women [20], and this trend is associated with an age factor. This disease is more common with anxiety in young people and depression in the elderly. Our research could not confirm such a clear connection, probably because different additives cause anxiety and depression at different ages. So, for example, young people experience dermatological problems more painfully than the elderly. In the elderly, this condition is associated with many unknown factors (ethnic, social, religious, geographical, etc.) [21]. The results of the current study have both scientific and practical significance. Most of the studies conducted in this direction differ in methodological terms. They were first selecting the subjects involved in the research, their distribution in the groups, and the agreed results' processing. The phenomenon of "P-hacking" is observed in most studies, which increases the likelihood of false-positive type I errors [22]. Current research provides additional information on the association between chronic urticaria, anxiety and depression. This study is also essential in the context of a total deficit of replication studies, which makes it significantly more difficult to conduct systematic reviews (highest level of evidence) [23]. Research confirms that concomitant psychiatric manifestations are quite common in skin diseases and that their consideration is essential in managing these conditions [24, 25]. Of course, several methodological factors were identified during and after the study that could not be ignored for various reasons. The study protocol we use (case-control) ranks third in the hierarchy of evidence (after cohort and experimental-control studies). Thus, the case-control study does not allow establishing a causal relationship between CHF and anxiety and CHF and depression. The study was limited to the evaluation of medical history and questionnaires, and the methods used in selecting and assigning subjects to groups also had certain shortcomings. Conclusion The study showed that: in patients suffering from chronic spontaneous urticaria, anxiety and depression are pretty common; this emotional distress probably has an independent effect on this state. Anxiety and depression occur in both sexes. In this disease, urticaria is more often observed at the age of 50-69 years and depression in the group of 30-49 years. The presence of anxiety and depression in CSU is often accompanied by physical urticaria, thyroid pathologies, diabetes, obesity and tobacco Georgian Scientists/ . 4 N 3, 2022 257 smoking. The association of depression and anxiety with chronic urticaria is not well understood. Further study is required to elucidate the causal relationship between these conditions. Reference 1. Zuberbier T, Aberer W, Asero R et al. (2018) The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 73:1393–1414; 2. 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Ioannidis Ioannidis JPA (2005) / Why most published reseafindingsings are false. PLoS Med 2(8): e124; 24. Katon WJ (2011) Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci 13:7–23; 25. The prevalence of depressive symptoms, anxiety symptoms and sleep disturbance in higher education students during the COVID-19 pandemic: A systematic review and meta-analysis Jiawen Deng, Fangwen Zhou, et al. l. www.elsevier.com/locate/psychres. Georgian Scientists/ . 4 N 3, 2022 259 . – , . , 35-60% , , . (XCK - CSU) CSU , CSU . e ( M ). o T o P ( TP - GAD-7) (A - PHQ-9). 690 18 70 . 330 360 . (24.5%) (36.9%)) , CSU, . , CSU 18–29 30–49 , — 50–69 , 18–29 30–49 , , , 50-69 , - 30-49 . , CSU, , , , . , . , , . , , , . «P-hacking» , -I. , ( ). , . Georgian Scientists/ . 4 N 3, 2022 260 . , . , 35-60%- , , . ( - CSU) CSU- . - ( ) . 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