A Meta-Analysis of Observational Studies on the Association of Chronic Urticaria With Symptoms of Depression and Anxiety

Background: Chronic urticaria (CU) is a frequently occurring skin condition associated with many psychological factors, but the effect size of associations varied in literature. Objectives: To perform a systematic review and meta-analysis on the associations of CU with the symptoms of depression and anxiety. Methods: According to a pre-specified protocol, we systematically searched articles published in PubMed, Web of Science, CNKI, and CQVIP databases between January 2000 and January 2019. Pooled estimates in terms of odds ratios (ORs) or standardized mean differences (SMDs) were calculated according to outcome measures. Subgroup analysis by disease subtypes and tool of measurement, and sensitivity analysis were performed. Risk of bias and quality of studies were evaluated. Results: Twelve studies were selected for the systematic review. The ORs were 3.99 [95% confidence interval (CI): 3.24-4.91, P < 0.001] for anxiety and 2.94 (95% CI: 2.42-3.58, P < 0.001) for depression. The SMDs of severity were 0.98 for anxiety (95% CI: 0.76-1.200, P < 0.001) and 0.84 for depression (95% CI: 0.59-1.10, P < 0.001). Subgroup analysis by disease subtypes and tool of measurement showed variations in effect size, where chronic spontaneous urticaria showed greater effects on anxiety (OR = 6.62, 95% CI: 3.67-11.95, P < 0.001) and depression (OR = 6.13, 95% CI: 2.31-16.31, P < 0.001). Sensitivity analysis demonstrated consistent results. Conclusion: CU is associated with higher risks of anxiety and depression.