Department of Economics and Business Economics

Psychiatric comorbidity in individuals with bullous pemphigoid and all bullous disorders in the Danish national registers

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  • Marianna Rania, Magna Græcia University, Mater Domini University Hospital, Karolinska Institutet
  • ,
  • Liselotte Vogdrup Petersen
  • Michael Erikson Benros, University of Copenhagen
  • ,
  • Zhi Liu, University of North Carolina
  • ,
  • Luis Diaz, University of North Carolina
  • ,
  • Cynthia M. Bulik, Karolinska Institutet, University of North Carolina

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering skin disease that takes a profound physical and mental toll on those affected. The aim of the study was to investigate the bidirectional association between BP and all bullous disorders (ABD) with a broad array of psychiatric disorders, exploring the influence of prescribed medications. METHODS: This nationwide, register-based cohort study encompassed 6,470,450 individuals born in Denmark and alive from 1994 to 2016. The hazard ratios (HRs) of a subsequent psychiatric disorder in patients with BP/ABD and the reverse exposure and outcome were evaluated. RESULTS: Several psychiatric disorders were associated with increased risk of subsequent BP (4.18-fold for intellectual disorders, 2.32-fold for substance use disorders, 2.01-fold for schizophrenia and personality disorders, 1.92-1.85-1.49-fold increased risk for organic disorders, neurotic and mood disorders), independent of psychiatric medications. The association between BP and subsequent psychiatric disorders was not significant after adjusting for BP medications, except for organic disorders (HR 1.27, CI 1.04-1.54). Similar results emerged with ABD. CONCLUSION: Psychiatric disorders increase the risk of a subsequent diagnosis of BP/ABD independent of medications, whereas medications used for the treatment of BP/ABD appear to account for the subsequent onset of psychiatric disorders. Clinically, an integrated approach attending to both dermatological and psychiatric symptoms is recommended, and dermatologists should remain vigilant for early symptoms of psychiatric disorders to decrease mental health comorbidity.

Original languageEnglish
Article number411
JournalBMC Psychiatry
Number of pages10
Publication statusPublished - 2020

    Research areas

  • Bullous disorders, Bullous pemphigoid, Comorbidity, Mental health, Psychiatric disorders

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